الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The biliary system and liver originate from the embryonic foregut. The development of the liver involves interplay between an endodermal envagination of the foregut and the mesenchymal cells from the septum transversum. The liver diverticulum initially separates into a caudal and cranial portion. The caudal portion gives rise to the cystic duct and gallbladder and the cranial portion gives rise to the intrahepatic and hilar bile ducts.
The gallbladder is located on the visceral surface of the liver in a shallow fossa at the plane dividing the right lobe from the medial segment of the left lobe. The extrahepatic bile ducts consist of the right and left hepatic ducts, the common hepatic duct, the cystic duct, and the common bile duct or choledochus .The common bile duct enters the second portion of the duodenum through a muscular structure, the sphincter of Oddi. The hepatocystic triangle is formed by the proximal part of the gallbladder and cystic duct to the right, the common hepatic duct to the left, and the margin of the right lobe of the liver superiorly. Bile is formed in hepatic lobules and is isotonic to plasma. It is then secreted into a complex network of canaliculi, small bile ductules, and larger bile ducts. Bile acids flow from the liver through these ducts to the gallbladder, where they are stored for future use. The total solute concentration of bile from the liver is 3 to 4 g/dL and the total daily basal secretion is 500 to 600 mL.
Cholecystitis in its varied forms is the most prevalent surgical entity afflicting populations of industrialized countries. The most common cause of cholecystitis and biliary colic is cholelithiasis.. Some 1% to 2% of people who have cholelithiasis develop symptoms or complications per year. These complications include biliary colic, acute or chronic cholecystitis, choledocholithiasis, cholangitis, pancreatitis, and gallbladder carcinoma As the gall bladder stones is an important pathology which may be associated with many complications that leads to significant morbidity and mortality , many investigations used to detect them and their complications . either radiological investigations ( ultrasonography , MRCP, CT cholangiography, HIDA scan) or Interventional radiological investigations which have a therapeutic role beside diagnosis ( ERCP , PTC ) hematological investigations (CBC , Bilirubin level , Alkaline Phosphatase , Gamma GT) American Society for Gastrointestinal Endoscopy published a review for screening methods used to detect common bile duct stones. It proposed a scoring system to categorize common bile duct stones risk into high, intermediate and low and also advised a diagnostic and therapeutic algorithm for its management. There is a general consensus regarding the therapeutic algorithm of 1st and 3rd ones. The 1st group would require preoperative ERCP followed by laparoscopic cholecystectomy, and the 3rd only laparoscopic cholecystectomy. However, intermediate-risk patients have a great variety of endoscopic/surgical therapeutic options (laparoscopic cholecystectomy with cleaning of the bile duct in a single stage, or with the assistance of intraoperative ERCP, or two-stage management with preoperative ERCP followed by laparoscopic cholecystectomy, or laparoscopic cholecystectomy and postoperative ERCP).