Gallbladder Flashcards
Pear-shaped sac lying on the inferior surface of the liver
Receives, stores and concentrates bile by absorbing water and salts
Contracts to expel bile upon release of cholecystokinin from duodenum
Capacity of 30-50ml
Gallbladder
Cystohepatic triangle
Triangle of Calot
Boundaries of Triangle of Calot
Liver - SUPERIOR
Cystic duct - INFERIOR
Common hepatic duct - MEDIAL
Parts of GB
Fundus - rounded blind end
Body - major part
Neck - narrow part directed toward the portahepatis which gives rise to cystic duct
Hartmann’s pouch - infundibulum of the GB, junction between neck and cystic duct
The cystic artery usually originates from the ____ artery:
Right hepatic
Blood supply
CYSTIC ARTERY from R HEPATIC ARTERY
Celiac artery
Left gastric
Splenic
Hepatic - common hepatic - R/L hepatic - gastroduodenal
Valve of Houston is associated with what organ?
Rectum
Common site of an impacted gallstone; patients exhibit referred pain in the epigastric region
Hepatopancreatic ampulla
May cause enlargement of the GB; patients exhibit 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
A STONE BLOCKING THE CYSTIC DUCT
Stimulation of visceral pain fibers that innervated a GIT structure results in a DULL, poorly localized pain that is referred over the T5 through L1 dermatome a
Referred pain
Has a fundus (anterior portion), body & neck (posterior portion)
Hartmann pouch may extend from neck
- common site for gallstones to lodge
Gallbladder
Occurs when the mucosa of the gallbladder penetrates deep into the muscularis externa
Early indicator of pathologic changes
Rokitansky-Aschoff sinuses
Venous drainage
Cystic veins –> portal vein or directly to liver sinusoids
Lymphatic drainage
Hepatic & pancreaticoduodenal lymph nodes
Sensory fibers
Great thoracic splanchnic nerves to spinal level T7-10
Parasympathetic
Action:
- GB contract
- sphincter of Oddi relax (bile release)
Vagus nerve (pre & postganglionic)
Sympathetic
Action:
- GB relax
- sphincter of Oddi contract
Greater thoracic splanchnic nerve (Preganglionic)
Celiac plexus (postganglionic)
Hormone secreted by I cells of small intestine
Mimics parasympathetic functions of vagus nerve on GB & sphincter of Oddi
Cholecystokinin (CKK)
Functions of GB
Bile storage & concentration (10 fold)
Bile calcification, addition of mucus (“white bile”)
R & L hepatic ducts –> common hepatic duct
Common hepatic duct + cystic duct –> CBD
- mucosa of cystic duct is arranged in a spiral fold with a core of smooth muscle called SPIRAL VALVE OF HELSTER
CBD passes posterior to pancreas –> ends at hepatoduodenal ampulla (ampulla of Vater) where it joins the pancreatic duct
Extrahepatic biliary ducts
Surrounds CBD as it transverses the ampulla
Sphincter of Oddi
Produced by hepatocytes
Average rate: 600 ml/day
Composition:
- water
- electrolytes
- bilirubin glucoronide (bile pigment)
- Cholic acid
- chenodeoxycholic acid conjugated to glycine or taurine (bile salts)
- cholesterol
- lecithin (lipids) calcium
- secretory IgA
Function: emulsify fats
Lactated Ringer solution: good replacement fluid for bile loss
Bile
Large & smooth
Obesity, chronic disease, cystic fibrosis, clofibrate, estrogen, rapid weight loss
Cholesterol stones
Smooth, green/black
Hemolysis (sickle cell, spherocytosis)
Cirrhosis, biliary infection
More common in Asia
Pigment (bilirubin) stones
Infection or inflammation of biliary
Calcium bilirubinate
GALLSTONE OBSTRUCTION
within the cystic duct
Biliary colic, pain shifts to R hypochondriac region
Causes acute cholecystitis
Bile precipitates in the GB –> “milk of calcium” bile
No jaundice because bile flow from liver, remains open
Large gallstone impacted in cystic duct extrinsically obstruct the common hepatic duct
Mirizzi syndrome
GALLSTONE OBSTRUCTION
within the CBD
Obstructs bile flow GB & the liver
Jaundice (1st observed under the tongue)
- moderate, fluctuates because a stone rarely causes complete obstruction
GALLSTONE OBSTRUCTION
at hepatoduodenal ampulla
Obstruct bile flow from both the GB & the liver
Pancreatic duct may be blocked
Jaundice & pancreatitis are common
Relations:
ANTERIOR - anterior abdominal wall, inferior surface of liver
POSTERIOR - transverse colon, 1st-2nd parts of duodenum
Gallbladder
