Gallbladder

Extra Hepatic Biliary Apparatus

System to collect bile from liver then store in gall

bladder and transmit it to 2nd part of Duodenum.
It includes :

• Hepatic ducts (Right and left )

• Common Hepatic duct .
• Gall Bladder
• Cystic duct
• Bile duct.
 Hepatic Duct
Originates from liver(Right from right
lobe and left from left lobe ) and
emerges from PORTA HEPATIS .

Common Hepatic Duct

Formed by union of right and left hepatic
ducts , runs down for about 3cm and join
on its right side by cystic duct to form
BILE DUCT.
 Accessory Hepatic Ducts
May present in 15 % subjects. They can originate from right lobe
of liver and terminate on gall bladder or CBD or any where in its
course or even in the upper part of bile duct .
Gallbladder

Shape:
Pear shaped.

Location:
Situated in a fossa on the inferior
surface of right lobe of liver .

Reservoir of Bile
 Dimensions and Capacity

Length: 7-10 cm

Width: 3cm

Capacity: 30-50 ml
 Parts
3 Parts
Projects beyond inferior border of liver ,
Fundus Angle between lateral border of right Rectus abdominis
and the ninth costal cartilage.

Body The body lies in the fossa of gall bladder on liver .

Neck Narrow upper end . continuous with Cystic duct.

Constriction at the junction.
 Cystic Duct
Origin
from neck of gallbladder
Insertion
end at the common hepatic duct
form acute angle to form bile duct
Spiral valve of Heister
5 to 12 crescentic folds spirally arranged
formed by the mucous membrane of cystic duct
not a true valve
Function
Aid in the passage of bile.
Regulate the degree of gallbladder distention
Functions of Gallbladder
Storage of bile, and its release into the duodenum when required.
Absorption of water and concentration of bile. Bile may be
concentrated as much as ten times.
The normal gallbladder also absorbs small amounts of a loose bile salt-
cholesterol compound.
When the gallbladder is inflamed, the concentration function becomes
abnormal and the bile salts alone are absorbed leaving cholesterol
behind.
Bile salts have a powerful solvent action on cholesterol which tends to
be precipitated. This can lead to the formation of gallstones.
It regulates pressure in biliary system by appropriate dilation or
contraction. Thus the choledoco-duodenal mechanism is maintained.
 Bile Duct
Union of cystic and common hepatic duct
Near porta hepatis
8cm length/long
 Course
The bile duct run downwards and
backwards, supraduodenal part;
Behind the first part of the duodenum
the retroduodenal part;
Near the middle of left side of the
second part of the duodenum it comes
in contact with the pancreatic duct and
accompanies it through the wall the
duodenum , the intraduodenal part.
 Intra duodenal part
Hepatopancreatic ampulla :
with in the wall of duodenum two duct (
pancreatic duct and bile duct) unite to form the
hepatopancreatic ampulla .
Major duodenal papilla :
The constricted end of the ampulla opens at the
summit of the structure called major duodenal
ampulla 8 to 10 cm distal to ampulla
 Sphincters
Sphincter choledochus :
It is a ring of smooth muscle that surround the terminal part of
the bile duct just above its junction with the pancreatic duct
Normaly closed So the bile formed in the liver keeps
accumulating in the gall bladder.
When food specially fatty meal enters the duodenum , the
sphincter opens and bile stored in the gallbladder is poured into
the duodenum .
Sphincter pancreaticus:
Less developed sphincter present around the terminal part of
the pancreatic duct.
Sphincter ampulla or sphincter of oddi :
A third sphincter surrounds the hepatopancreatic ampulla
Chief supply – cystic artery
Distribution to gall bladder, cystic duct ,heptic duct and
upper part of bile duct
Several branches from superior pancreaticoduodenal
artery supply- lower part of the bile duct
Right hepatic artery –supply middle part of bile duct
HEPATIC VEIN – Superior surface of gall bladder.
CYSTIC VEINS – Rest of gall bladder- open into right branch of
portal vein.
PORTAL VEIN – Lower part of bile duct
Cystic nodes and to the nodes of anterior border of the
epiploic foremen.
Lower hepatic and upper pancreaticosplenic nodes
 Cystic plexus
Left and right vagi
Right phrenic nerve

Parasympathetic are motor to gall bladder and bile

duct but inhibitory to the sphincters

From T7 to T9 are vaso motor and motor to the

sphincters
Pain from gal bladder may travel along vagus ,the
sympathetic nerves or along the phrenic nerves

REFFERED SITES :

VAGUS TO STOMACH OR EPIGASTRIUM

SYMPATHETIC NERVE TO INFERIOR ANGLE OF

RIGHT SCAPULA

PHRENIC NERVE TO RIGHT SHOULDER

Biliary obstruction
It arises when passage of bile into duodenum is blocked
either completely or partially.
Intrahepatic
Extrahepatic
Causes:
Gallstones which slip down in bile duct and block it.
Cancer of head of pancreas which compresses bile
duct
 Types of gallstones

o Cholecystitis-inflammation of gallbladder from

stones.
o Cholelithiasis-tiny crystals of stones in the
gallbladder.
o Choledocholithiasis-stones stuck in the bile
duct.
 CHOLECYSTITIS
Inflammation of gall bladder.
Symptoms:
Pain over the right hypochondrium, right scapula, right shoulder.
Murphy’s sign:
When a finger is placed just below the costal margin, at the tip of
9th costal cartilage, the patient feel sharp pain on inspiration. He
winces with a catch in his breath.
 CHOLETHIASIS
Stones may form in gall bladder. Occur mostly in females. Murphy’s sign is
important.
BILIARY COLIC:
The stones are responsible for time to time spasmodic pain called biliary colic.
 INFECTIONS
Gall bladder is invariably infected by typhoid fever and the
carrier state may be due to the persistence of typhoid bacilli
in this organ.
 CHOLECYSTECTOMY
The surgical removal of the gallbladder. The operation is done to
remove the gallbladder due to gallstones causing pain or
infection.
 Courvoisier’s Law
It states that in the presence of an enlarged gallbladder
which is no tender and accompanied with mild jaundice, the
cause is unlikely to be gallstones. This sign implicates
possible malignancy of the gall bladder or pancreas and the
swelling is unlikely due to gallstones
 Gallbladder Cancer
Cancer of the gallbladder is a relatively rare disease. If not
treated, however, it can spread from the inner walls of the
gallbladder, to the outer layers, and then to the other
organs and ducts.
 Can Gallbladder Disease be Prevented
According to the Medical Center at the University of Maryland, studies have found
a lower risk of gallstones in people who consume foods with
• monosaturated fats or omega 3 fatty acids (found in fish oil).
• Fruits and vegetables,
• nuts,
• alcohol, and coffee appear to be associated with a lower risk of gallstones.
Sugar consumption, however, is associated with a higher risk of gallbladder
disease