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World J Gastroenterol. Mar 7, 2007; 13(9): 1384-1392
Published online Mar 7, 2007. doi: 10.3748/wjg.v13.i9.1384
On the mechanical behavior of the human biliary system
Xiaoyu Luo, Wenguang Li, Nigel Bird, Swee Boon Chin, NA Hill, Alan G Johnson
Xiaoyu Luo, NA Hill, Department of Mathematics, University of Glasgow, Glasgow, G12 8QW, United Kingdom
Wenguang Li, Swee Boon Chin, Department of Mechanical Engineering, University of Sheffield, Sheffield, S1 3JD, United Kingdom
Nigel Bird, Alan G Johnson, Academic Surgical Unit, Royal Hallamshire Hospital, Sheffield, S10 2JF, United Kingdom
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Xiaoyu Luo, Department of Mathematics, University of Glasgow, Glasgow, G12 8QW, United Kingdom. x.y.luo@maths.gla.ac.uk
Telephone: +44-141-3304746 Fax: +44-141-3304111
Received: December 11, 2006
Revised: December 29, 2006
Accepted: February 6, 2007
Published online: March 7, 2007
Abstract

This paper reviews the progress made in understanding the mechanical behaviour of the biliary system. Gallstones and diseases of the biliary tract affect more than 10% of the adult population. The complications of gallstones, i.e. acute pancreatitis and obstructive jandice, can be lethal, and patients with acalculous gallbladder pain often pose diagnostic difficulties and undergo repeated ultrasound scans and oral cholecystograms. Moreover, surgery to remove the gallbladder in these patients, in an attempt to relieve the symptoms, gives variable results. Extensive research has been carried out to understand the physiological and pathological functions of the biliary system, but the mechanism of the pathogenesis of gallstones and pain production still remain poorly understood. It is believed that the mechanical factors play an essential role in the mechanisms of the gallstone formation and biliary diseases. However, despite the extensive literature in clinical studies, only limited work has been carried out to study the biliary system from the mechanical point of view. In this paper, we discuss the state of art knowledge of the fluid dynamics of bile flow in the biliary tract, the solid mechanics of the gallbladder and bile ducts, recent mathematical and numerical modelling of the system, and finally the future challenges in the area.

Keywords: Fluid dynamics; Gallstone; Bile flow; Cystic duct; Gallbladder; Soft tissue mechanics; Acalculous biliary pain; Stress; Mechanical factors