2846 GALLBLADDER

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GALLBLADDER
A Madden, London Metropolitan University, London,
UK
Copyright 2003, Elsevier Science Ltd. All Rights Reserved.
Introduction
0001 The gallbladder is located under the right lobe of the
liver. It is a pear-shaped sac, usually measuring about
9 cm in length, but varying between 4 and 14 cm.
Its average volume in health is 50 ml but this may
treble in disease conditions. The thin and easily dis-
tended walls consist of undifferentiated muscle layers
covered by a partial or complete covering of periton-
eum. The mucosa is deeply folded and these indenta-
tions penetrate the muscle layer.
body of the gallbladder joins the cystic duct at the
neck, where there is an indentation – Hartmann’s
pouch. The cystic duct, with its spiral mucosal folds,
joins with the common hepatic duct to form the
common bile duct, which is 5–10 mm in diameter.
This passes behind the duodenum, where it is joined
by the pancreatic duct before reaching the ampulla of
Vater. Around the duct, as it passes through the
duodenal wall and ampulla, is a ring of circular muscle
fibers called the sphincter of Oddi, which is respon-
sible for controlling bile flow into the duodenum.
The cystic artery, a branch of the hepatic artery, 0004
supplies the gallbladder with blood which returns to
the portal venous system via the cystic vein. The
gallbladder is well innervated by both the sympa-
thetic and parasympathetic nervous systems.

Structure
Function
0002 The anatomy of the gallbladder and biliary tract,
shown in Figure 1, may vary between individuals. The role of the gallbladder is to concentrate and store 0005

These variations have little clinical significance bile produced by the liver. When the gallbladder con-
except during surgery or radiological investigations. tracts, bile passes into the duodenum. Contraction of
0003 The fundus, which is the wide end of the gallblad- the muscles in the gallbladder is under both humoral
der, may be palpable on physical examination. The and neurological control. The presence of food, espe-
cially fat, in the duodenum and jejunum causes local
secretion of cholecystokinin (CCK) by the mucosa;
Cystic duct CCK is carried via the blood to the gallbladder, where
it stimulates muscle contraction. This contraction may
Spiral valve also be brought about by vagal stimulation, which
causes a simultaneous relaxation of the muscle in the
Neck sphincter of Oddi. In the duodenum and small intes-
Hepatic ducts
tine, bile is essential for the emulsification of dietary fat.
Hartmann's Common hepatic
pouch duct

Common bile duct

Gallstones (Cholelithiasis)
Body

Pancreatic duct
The most common disorder affecting the gallbladder 0006

Fundus is the formation of stones. This occurs predominantly

Sphincter of Oddi
in populations consuming a western-style diet, with
Duodenum an incidence of 12–20%.
Ampulla of Vater Gallstones are composed most commonly of a mix- 0007

ture of cholesterol, various calcium salts, phospho-

fig0001 Figure 1 The gallbladder and connecting biliary ducts. Repro-
duced from Gall Bladder. Encyclopaedia of Food Science, Food
Technology and Nutrition, Macrae R, Robinson RK and Sadler MJ
(eds), 1993, Academic Press.
lipids, and bile pigments. Cholesterol-rich (up to 98%
in some cases) stones are the most common, but
occasionally stones may be composed almost entirely