TBL18 - Gallbladder

Question 1

What does the cystic artery branch from and what does it supply? Where does lymph drainage from the gallbladder go to?

Answer 1

1) The cystic artery branches from the right hepatic artery to supply the gallbladder
2) Lymph drainage from the gallbladder, like that of the liver, goes to the hepatic and celiac lymph nodes

Question 2

Where does the fundus of the gallbladder project from? What is the gallbladder in close proximity to?

Answer 2

1) The fundus of the gallbladder projects from the inferior border of the liver at the edge of the 9th costal cartilage on the right midclavicular line
2) The gallbladder is in close proximity to the duodenum and transverse colon

Question 3

What causes biliary colic and how could it lead to cholecystitis? How is pain perceived after blockage of the cystic duct?

Answer 3

1) A gallstone lodged in the cystic duct causes biliary colic (intense, spasmodic pain)
2) If the stone blocks the cystic duct, cholecystitis (inflammation of the gallbladder) occurs because of bile accumulation, causing enlargement of the gallbladder
3) Inflammation of the gallbladder may cause pain in the posterior thoracic wall, or right shoulder owing to irritation of the diaphragm

Question 4

Why does a cholecystoenteric fistula involve the 1st part of the duodenum or transverse colon and what is the diagnostic radiographic sign of the fistula?

Answer 4

1) Continued inflammation of the gallbladder may break down (ulcerate) the tissue boundaries between the gallbladder and a part of the gastrointestinal tract adherent to it, resulting in a cholecystoenteric fistula
2) Because of their proximity to the gallbladder, the superior part of the duodenum and the transverse colon are most likely to develop a fistula of this type. The fistula would enable a large gallstone, incapable of passing though the cystic duct, to enter the gastrointestinal tract
3) A cholecysto-enteric fistula also permits gas from the gastrointestinal tract to enter the gallbladder, providing a diagnostic radiographic sign

Question 5

What is the most common treatment for gallstones?

Answer 5

The most common gallstone treatment method is laparoscopic surgery

Question 6

When do mucosal folds of the gallbladder disappear? How does the simple columnar epithelium of the gallbladder function in luminal storage?

Answer 6

1) The mucosal folds of the gallbladder disappear when the lumen is distended with bile
2) The simple columnar epithelium absorbs water to concentrate bile for luminal storage (up to a 50 ml)

Question 7

What is the muscularis externa of the gallbladder made up of? Define the contractile stimulus of the muscle after dietary fat intake.

Answer 7

1) The muscularis externa of the gallbladder contains longitudinally and diagonally organized bundles of smooth muscle
2) The gallbladder stores bile, which is released by reflex contraction of smooth muscle in its wall in response to the hormone cholecystokinin. Concomitantly, sphincters associated with the common bile duct and the ampulla relax to permit bile to enter the duodenum

Question 8

Branches of which nerves are conveyed to foregut-derived viscera by periarterial plexuses on branches of the celiac trunk?

Answer 8

Branches of the vagus nerves, postsynaptic sympathetic fibers from the celiac ganglion, and visceral sensory fibers from DRG at T5-T9 are conveyed to foregut-derived viscera by periarterial plexuses on branches of the celiac trunk

Question 9

What regulates blood flow to the gallbladder and liver? Do parasympathetic fibers affect the liver? Contraction of the gallbladder is mainly controlled by what?

Answer 9

1) Sympathetic-mediated vasoconstriction regulates blood flow to the gallbladder and liver
2) Parasympathetic fibers do not affect the liver
3) Contraction of the gallbladder is mainly under hormonal control