Gallbladder

Last updated 30.06.13

 

Definition

-  Sac attached to inferior surface of liver which stores & secretes bile

 

Gall Bladder Location

 

Features

-  Thin walled bluish-green pear shaped sac

-  Stem represented by cystic duct inferiorly

-  Body & fundus represent body of the pear

-  Lies along right edge of quadrate lobe of liver in gallbladder fossa

-  Covered by peritoneum on its inferior & posterior surfaces, occasionally completely invested w peritoneum

-  May be connected to liver by short mesentery

-  Lined w transitional epithelium

-  Functions

-  Stores & concentrates bile from liver

-  Storage of 30 – 60ml bile

-  Releases bile in response to hormones (cholecystokinin)

 

Clinical Significance

-  Cholecystitis

-  Choledocolithiasis

-  Ascending Cholangitis

-  Cancer of Gall Bladder

-  Neonatal Cholestasis

-  Choledocal Cysts

-  Cholecystectomy: Lap Chole

-  Imaged with

-  Abdominal US

-  ERCP

-  MRCP

-  Intraoperative cholangiogram

 

Anatomical Features

-  Fundus

-  Rounded, wide, proximal end of gallbladder

-  Projects from inferior border of liver

-  Located at approximately tip of the right 9th costal cartilage in midclavivular line where linea semilunaris of rectus abdominus muscle meets costal margin

-  Passes inferiorly, anteriorly & laterally where it comes into contact with the posterior abdominal wall & descending part of duodenum

-  Body

-  Passes superiorly, posteriorly & medial of the fundus

-  In contact with & attaches to inferior visceral surface of liver via loose connective tissue

-  In contact with right transverse colon & superior part of duodenum

-  Neck of the Gallbaldder

-  Narrow, tapered & forms an S shaped bend

-  Becomes continuous with cystic duct

-  Directed towards porta hepatis of liver (where right & left hepatic ducts join to form common hepatic duct)

-  Serves as a guide to omental foramen (epiploic foramen) which lies immediately medial to the Sprial Fold (Valve of Heister)

-  Formed of muscosa from twisting of neck of gallbladder

-  +/- Hartmans pouch: pathological

-  Cystic Duct

-  Ranges in length from 2–4cm

-  Runs between layers of lesser omentum parallel to common hepatic duct

-  Passes initially superiorolateral from gallbladder, then posteriorly then inferioirly to join common hepatic duct

-  Together w common hepatic duct from liver forms common bile duct immediately inferior to porta hepatis

-  Spiral Fold of cystic duct (Spiral Valve)

-  Continuous w spiral fold of neck of gall bladder

-  Coils along entire length of cystic duct

-  Maintains patencey of cystic duct to ensure

-   Bile can pass into gallbladder when common bile duct is closed by choledochal sphincter &/or hepatopancreatic sphincter

-   Bile can pass into duodenum when gallbladder contracts

-  Forms inferior wall of Calots Triangle

 

Gall Bladder

 

Arterial Supply

-  Cystic artery

-  Branch of right hepatic artery

-  Passes between common hepatic duct & cystic duct through Calots triangle

-  Variations are common

-  Is secured & resected in cholecystectomies (Lap Chole)

 

Venous Drainage

-  Fundus & body of gallbladder drain into anterior & posterior cystic veins (right branch of portal vein)

-  Biliary ducts & neck of gallbladder drain into the gastric, duodenal & pancreatic veins

 

Lymphatic Drainage

-  Cystic lymph nodes near the neck of gallbladder drain to hepatic lymph nodes (coeliac lymph nodes)

 

Innervation

-  Vagus nerve supplies parasympathetic fibers

-  Coeliac plexus supplies sympathetic fibers

-  Right phrenic nerve supplies sensory fibers

-  Hepatic plexus supplies part of the cystic artery

-  All these nerves pass alongside the cystic artery

 

 

 

References

 

Moores Clinically Oriented Anatomy

Pic (Gallbladder): http://www.healthhype.com/gallbladder-location-anatomy-parts-function-pictures.html