16.Gallbladder

• Gall bladder


  Pear-shaped sac lying on the inferior surface of the liver
• Gall bladder


  • Capacity of 30 – 50 ml
  • Receives, stores & concentrates bile by absorbing water and salts
  • Located at the junction of the 9th costal cartilage and lateral border of the Rectus abdominis
  • Contracts to expel bile upon release of cholecystokinin from duodenum
• Gall bladder


  • Anterior relations: anterior abdominal wall and inferior surface of liver
  • Posterior relations: transverse colon and 1st – 2nd parts of duodenum
• Parts of the gall bladder

  • Fundus – rounded blind end
  • Body – major part
  • Neck – narrow part and gives rise to the CYSTIC DUCT with Spiral valves (HEISTER's)
  • Narrow part directed toward the porta hepatis which gives rise to cystic duct
  • Hartmann pouch – infundibulum of the GB , junction between neck and cystic duct
• Cystohepatic triangle


  Also known as the triangle of Calot
• Cystohepatic triangle


  • Boundaries:
  • Liver - superior
  • Cystic duct - inferior
  • Common hepatic duct - medial
• Triangle of Calot


  Clinically important area that is carefully dissected during cholecystectomy
• Cholecystectomy


  1. Identify the biliary ducts

  2. Identify the cystic artery

  3. Identify the hepatic artery
• The right hepatic artery in the Triangle of Calot is usually in danger during surgery and must be located before ligating the cystic artery
• Cystic artery


  From R hepatic artery
• Hepatopancreatic ampulla


  Common site of an impacted gallstone
• Gallstone impacting the hepatopancreatic ampulla

  Patients exhibit referred pain in the epigastric region
• Gallstone blocking the cystic duct


  Causes enlargement of the gallbladder
• Biliary colic


  Severe colicky pain that begins in the epigastric region but moves to a point where the 9th costal cartilage intersects the lateral border of the rectus sheath
• Referred pain


  Stimulation of visceral pain fibers that innervate a GIT structure results in a dull, aching, poorly localized pain that is referred over the T5 through L1 dermatomes