Anatomy Of Gallbladder

The gallbladder is a pear-shaped sac, about 7 to 10

cm long, with an average capacity of 30 to 50 mL
The gallbladder is located in a fossa on the inferior
surface of the liver
A line from this fossa to the inferior vena cava
divides the liver into right and left liver lobes.
The gallbladder is divided into four anatomic areas:
o fundus,
o the corpus (body),
o the infundibulum, and
o the neck

The gallbladder is divided into four

anatomic areas:
fundus,
the corpus (body),
the infundibulum, and
the neck

 The fundus is the rounded, blind end that normally extends 1

to 2 cm beyond the liver's margin.
It contains most of the smooth muscles of the organ, in
contrast to the body, which is the main storage area and
contains most of the elastic tissue.
The body extends from the fundus and tapers into the neck,
a funnel-shaped area that connects with the cystic duct.
The neck usually follows a gentle curve, the convexity of
which may be enlarged to form the infundibulum or
Hartmann's pouch
The neck lies in the deepest part of the gallbladder fossa and
extends into the free portion of the hepatoduodenal ligament

 The cystic artery that supplies the gallbladder is

usually a branch of the right hepatic artery
(>90% of the time).
The course of the cystic artery may vary, but it
nearly always is found within the hepatocystic
triangle, the area bound by the cystic
duct, common hepatic duct, and the liver
margin (triangle of Calot). When the cystic
artery reaches the neck of the
gallbladder, it divides into anterior and posterior
divisions.

 Venous return is carried either through small veins

that enter directly into the liver or, rarely, to a large
cystic vein that carries blood back to the portal vein.
Gallbladder lymphatics drain into nodes at the neck
of the gallbladder.
The nerves of the gallbladder arise from the vagus
and from sympathetic branches that pass through
the celiac plexus.
The hepatic branch of the vagus nerve supplies
cholinergic fibers to the gallbladder, bile ducts, and
the liver

 Gallstones form as a result of solids settling out of solution.

The major organic solutes in bile are bilirubin, bile salts,
phospholipids, and cholesterol.
Gallstones are classified by their cholesterol content as
either cholesterol stones or pigment stones.
Pigment stones can be further classified as either black or
brown.
In Western countries, about 80% of gallstones are cholesterol
stones and about 15 to 20% are black pigment stones.
Brown pigment stones account for only a small percentage.
Both types of pigment stones are more common in Asia.

 The formation of gallstones is often preceded by

the presence of biliary sludge, a viscous mixture of
glycoproteins, calcium deposits, and cholesterol
crystals in the gallbladder or biliary ducts
most gallstones consist largely of bile
supersaturated with cholesterol
This hypersaturation, which results from the
cholesterol concentration being greater than its
solubility percentage, is caused primarily by
hypersecretion of cholesterol due to altered
hepatic cholesterol metabolism

 A distorted balance between pronucleating

(crystallization-promoting) and antinucleating
(crystallization-inhibiting) proteins in the bile
also can accelerate crystallization of cholesterol
in the bile
Mucin, a glycoprotein mixture secreted by
biliary epithelial cells, has been documented as
a pronucleating protein.
It is the decreased degradation of mucin by
lysosomal enzymes that is believed to promote
the formation of cholesterol crystals

 Loss of gallbladder muscular-wall motility and

excessive sphincteric contraction also are involved
in gallstone formation
This hypomotility leads to prolonged bile stasis
(delayed gallbladder emptying), along with
decreased reservoir function
The lack of bile flow causes an accumulation of bile
and an increased predisposition for stone formation.
Ineffective filling and a higher proportion of hepatic
bile diverted from the gallbladder to the small bile
duct can occur as a result of hypomotility

 Occasionally, gallstones are composed of

bilirubin, a chemical that is produced as a
result of the standard breakdown of RBCs
Infection of the biliary tract and increased
enterohepatic cycling of bilirubin are the
suggested causes of bilirubin stone formation
Bilirubin stones, often referred to aspigment
stones, are seen primarily in patients with
infections of the biliary tract or chronic
hemolytic diseases (or damaged RBCs)

cholesterol stones
Supersaturation

Crystal
formation
Vesical maturation
Nucleation
Crystal growth

Microscopic
stone formation
Crystal retention

Pigment stones
Black pigment stones
Black stones form primarily in the gallbladder in
sterile bile and are associated with advanced age,
chronic hemolysis, alcoholism, cirrhosis,
pancreatitis, and total parenteral nutrition.
Brown pigment stones
Brown stones form not only within the gallbladder
but also within the intrahepatic and extrahepatic
ducts; they are uniformly infected with enteric
bacteria and are usually associated with
ascending cholangitis.

Pigment stone
Decreased
secretion of
biliary acids
Increased
secretion of
unconjugated
bilirubin in the
bile
Infection of the
biliary tract

Clinical manifestation
Right upper quadrant pain radiating
to the back or right shoulder
Nausea
Vomiting
Jaundice
Scleral Icterus
bile duct
obstruction
fever