Gross anatomy and histology of

extrahepatic biliary apparatus.

Q. Cystic artery is the branch of:
a. Hepatic artery proper b. Right hepatic artery
c. Left hepatic artery d. common hepatic artery

Q. Clinically GB pain is referred to:

a. Inferior angle of Rt scapula
b. Tip of Rt shoulder
c. Stomach region
d. All of the above
Q. Gall bladder is located in:
a. Inferior surface of right lobe of liver
b. Posterior surface of right lobe of liver
c. Inferior surface of left lobe of liver
d. Posterior surface of left lobe of liver
What is extrahepatic biliary apparatus (EHBA)?
The extrahepatic biliary apparatus receives the bile from liver, stores
and concentrates it in the gallbladder, and transmits it to the second
part of the duodenum when required.
 Consists of five components:
Anatomical knowledge about it is
1. Right and left hepatic ducts important to understand various disease
2. Common hepatic duct processes such as cholelithiasis and
3. Gallbladder cholecystitis and also to understand the
4. Cystic duct surgical process like cholecystectomy.
5. Bile duct or common bile duct
 Lt lobe Lt lobe
Rt lobe Rt lobe

Porta hepatis is the point of

initiation of EHBA.

• Gallbladder is located in fossa for gallbladder in right lobe of liver.

• It is attached to the liver by right and left hepatic duct.
• Fundus of gallbladder is extended below the lower margin of liver.
Components of EHBA

Extends below the lower

margin of liver and lies at the
tip of Rt 9th costal cartilage of
the costal margin.
Functions of GB
1. Storage of bile
2. Concentration of bile
3. Acidification of bile

Bile is an emulsifying
agent which facilitates 50 ml
pancreatic lipase for
hydrolysis of lipid.

Hartmann’s pouch:
Gall bladder Prone to lodgment of stone
Peritoneal covering of gallbladder
Covered by peritoneum except for the surface resting on liver.
 Mucous membrane
• lined by columnar epithelium (cholangiocyte)
• Forms folds (Rugae)
• Similar to villi (but no goblet cells)
• No Muscularis mucosa

Poorly developed submucosa layer

Muscle layer (smooth muscle fibers)

Serous (peritoneal) layer

• Lined by mesothelium

Microanatomy of gall bladder

Epiploic foramen
Lesser sac
Supra duodenal part
Retro duodenal part
Infra duodenal part

Intra duodenal part

Major duodenal papilla
Fore gut- midgut
transition point

Hepatopancreatic ampulla
(ampulla of Vater)
1. Sphincter choledochus
2. Sphincter pancreaticus
3. Sphincter ampullae
(sphincter of Oddi)
+

CCK

_
 Common hepatic artery
Cystic artery

Artery: cystic artery

Vein: cystic vein
Lymph : cystic LN
Hepatic artery proper
Nerve: cystic plexus
Sympathetic: T7-T9
Gastroduodenal artery
Parasympathetic: Vagus nerve
Rt gastric artery

Blood supply of biliary system

 Blood supply of bile duct

1. Descending branch of cystic artery

2. Ascending branch of sup pancreaticoduodenal artery
Ligation of cystic artery in this triangle
is the one of the crucial steps in
surgical removal of gall bladder.
• Also called as cystohepatic triangle
Boundaries of calot’s triangle
1. Undersurface of liver (sup)
2. CHD (left side)
3. Cystic duct (right side)
Contents of Calot’s triangle:
1. Cystic artery & vein
2. Cystic LN
Blood supply of GB
and Calot’s triangle
Moynihan’s Hump
Or
Caterpillar’s turn
 Gall stone (cholelithiasis)
• Gallstones are present in approximately 10% of people over the age
of 40 and are more common in women.
• They are predominantly a mixture of cholesterol and bile pigment.
• They may undergo calcification, which can be demonstrated on plain
radiographs.
• The gallbladder cannot empty normally and contractions of the
gallbladder wall produce severe pain.
•If pain persists a cholecystectomy (removal of the gallbladder) may be
necessary.
Cholesterol stone Mixed stone Pigment stone
 Cholecystitis
• Inflammation of the gall bladder is called as cholecystitis.
• Most commonly caused by cholelithiasis which causes obstruction of
bile duct or cystic duct.
• Symptoms Murphy’s sign
 Biliary colic  Deep pressure at GB point at the
height of inspiration
 Jaundice
 Patient feels stabbing pain
 Murphy’s sign positive  Catch in breath
Cholecystectomy