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The hepatobiliary system develops during the second half of the eight week embryonic stage of development, known as the organogenetic period [ 1 ]. Many of the anatomic variations of the system are the consequences of occurrences during this period [ 2 ]. At the beginning of gestational week 4, early development of only the nervous and cardiovascular systems has occurred. The full length of the flat, three-layered embryonic disc lies in contact with the yolk sac, and the developing heart lies at the rostral end (fig. 1.1A_2). Rapid growth of the dorsally-placed central nervous system in the long axis of the embryo results in simultaneous folding at the cranial and caudal ends and sides of the embryo. Concurrently, there is relative constriction at the junction of the embryo and yolk sac, so that the full length contact is diminished to a connecting yolk stalk (fig. 1.1C_2). In this process, the neural folds have thickened disproportionately to the rest of the neural place, forming the primordium of the brain. The thickest, most rostral part, destined to become the forebrain, overhangs the developing heart, contained within a transverse mesodermal fold, the transverse septum (fig. 1.1B_2)

The exterior morphology of the liver and the intrahepatic ramifications of its vasculature has been a subject for study throughout the ages. From historical data, which Stieda refers to, images of the liver come into light during the Babylonian era, i.e., 4–5000 B.C. [ 1 ]

A good working knowledge of the incidence and types of anomaly or variation is key to a safe cholecystectomy, as 50% of patients presenting with gallbladder stones or common bile duct stones show a significant variation from what is generally considered as the expected normal pattern. Ignorance of these anomalies may well be responsible for catastrophic injuries of the bile duct during laparoscopy. The onus is therefore on the surgeon to be versed in the possible anatomical variations that he might encounter during surgery and to ensure that this knowledge is passed on to surgical trainees

This chapter drew and wrote by the authors intended to evoke the interest of surgeons about ultrasonography on liver and biliary tree. The value of this indispensable tool is that it can be also applied with high sensitivity and specificity intraoperatively and in endoscopic and laparoscopic diagnostic and interventional procedures

One of the most important functions of the liver is the secretion of bile which normally varies between 0,6 and 1,2 lit/day. Composition of bile is given in table 5.1

The plain abdominal X-ray is the simplest and oldest imaging modality, however it is not very useful in the detection of biliary tract pathology. Findings that relate to biliary tract disease are seen quite by chance in an abdomen X-ray done for other reasons (e.g., detection of free intra or extraperitoneal gas), as the plain X-ray is no longer requested for its detection

Endoscopic retrograde cholangiopancreatography (ERCP) has proven to be a very useful method in the diagnosis of most diseases of the biliary tract. In particular it displays a great accuracy in diagnosing extrahepatic biliary disease, making it the gold standard compares to other diagnostic studies in this field. It further plays a major and most important role in the differentiation between benign and malignant extrahepatic biliary disorders. Despite its preponderance in extrahepatic biliary tract conditions, endoscopic selective biliary cannulation has also offered important improvements in the diagnosis of gallbladder and intrahepatic duct system diseases. It is however worth noting that the diagnostic accuracy of ERCP very much relies on the endosco-pist’s experience

Endoscopic ultrasound (EUS) has recently emerged as a very reliable imaging modality for the pancreaticobiliary system. Apart from other applications, EUS is a minimally invasive imaging technique which is widely used all over the world for identifying biliary abnormalities. Lesions as small as 2 to 3 mm in diameter, can be visualized by EUS. In France, 48.039 EUS procedures were performed during 1999, 58% of which related to pancreaticobiliary diseases [ 1 ]. In a recent series in a center where EUS is currently available, the rate of diagnostic endoscopic retrograde cholangiopancreatographies (ERCP_S) was only 9.5% in a total of 1,159 ERCP procedures [ 2 ]. Recent years have seen new technical developments recorded in the field of EUS

The term hepatobiliary disease refers to acute or chronic disorders of the hepatic cells and/or the biliary tract. In this chapter are firstly described the clinical forms of the hepatobiliary disease and, secondly, the pathophysiologic mechanisms that are responsible for hepatic cell damage. Since surgery in patients with pre-existing severe hepatobilary disease is associated with significant morbidity and mortality rates, the anaesthesiologist should be able to diagnose and evaluate hepatic dysfunction during the perioperative period. Even with careful attention to history and symptoms, some cases of liver disease can be misdiagnosed. However, in most cases the cause of misdiagnosis results from failure to ask simple questions or to look for obvious findings on physical examination. Laboratory investigation of the hepatobiliary disease lacks in specificity in defining a certain liver disease. Instead of this, laboratory testing of liver function helps to differentiate the diagnosis among hepatocellular injury, impaired hepatocellular synthetic function and cholestasis

Biliary atresia is a disorder in which there is obliteration or discontinuity of the extrahepatic biliary tree. If untreated it leads to cirrhosis, liver failure and death in less than 2 years after birth. The disorder of the biliary tree is the end result of a panductal sclerosing process appearing before birth with gradual loss of patency of the biliary system which is completed around birth. The biliary structures disappear and fibrous tissue remains at 4 months. The histology of the liver is characterized by a non-specific giant cell transformation and portal expansion by fibrous tissue with ductural proliferation followed by ductopenia, fibrosis and cirrhosis [ 1 ]