it describes different parts of extrahepatic biliary apparatus and their clinical significance.

1. Gross anatomy and histology of
extrahepatic biliary apparatus.
Dr. Laxman Khanal
Associate Professor, Department of Human Anatomy
BPKIHS, Dharan, Nepal

2. Q. Cystic artery is the branch of:
a. Hepatic artery proper b. Right hepatic artery
c. Left hepatic artery d. common hepatic artery
Q. Gall bladder is located in:
a. Inferior surface of right lobe of liver
b. Posterior surface of right lobe of liver
c. Inferior surface of left lobe of liver
d. Posterior surface of left lobe of liver
Q. Clinically GB pain is referred to:
a. Inferior angle of Rt scapula
b. Tip of Rt shoulder
c. Stomach region
d. All of the above

3. What is extrahepatic biliary apparatus (EHBA)?
The extrahepatic biliary apparatus receives the bile from liver, stores
and concentrates it in the gallbladder, and transmits it to the second
part of the duodenum when required.
Consists of five components:
1. Right and left hepatic ducts
2. Common hepatic duct
3. Gallbladder
4. Cystic duct
5. Bile duct or common bile duct
Anatomical knowledge about it is
important to understand various disease
processes such as cholelithiasis and
cholecystitis and also to understand the
surgical process like cholecystectomy.

4. Rt lobe Rt lobe
Lt lobe Lt lobe
• Gallbladder is located in fossa for gallbladder in right lobe of liver.
• It is attached to the liver by right and left hepatic duct.
• Fundus of gallbladder is extended below the lower margin of liver.
Porta hepatis is the point of
initiation of EHBA.

5. Components of EHBA
Extends below the lower
margin of liver and lies at the
tip of Rt 9th costal cartilage of
the costal margin.

6. Hartmann’s pouch:
Prone to lodgment of stone
50 ml
Functions of GB
1. Storage of bile
2. Concentration of bile
3. Acidification of bile
Bile is an emulsifying
agent which facilitates
pancreatic lipase for
hydrolysis of lipid.
Gall bladder

7. Peritoneal covering of gallbladder
Covered by peritoneum except for the surface resting on liver.

8. Microanatomy of gall bladder
Mucous membrane
• lined by columnar epithelium (cholangiocyte)
• Forms folds (Rugae)
• Similar to villi (but no goblet cells)
• No Muscularis mucosa
Muscle layer (smooth muscle fibers)
Serous (peritoneal) layer
• Lined by mesothelium
Poorly developed submucosa layer

9. Epiploic foramen
Lesser sac

10. Supra duodenal part
Retro duodenal part
Infra duodenal part
Intra duodenal part

11. Hepatopancreatic ampulla
(ampulla of Vater)
1. Sphincter choledochus
2. Sphincter pancreaticus
3. Sphincter ampullae
(sphincter of Oddi)
Major duodenal papilla
Fore gut- midgut
transition point

12. CCK
+
_

13. Blood supply of biliary system
Common hepatic artery
Rt gastric artery
Gastroduodenal artery
Hepatic artery proper
Cystic artery
Artery: cystic artery
Vein: cystic vein
Lymph : cystic LN
Nerve: cystic plexus
Sympathetic: T7-T9
Parasympathetic: Vagus nerve

14. Blood supply of bile duct
1. Descending branch of cystic artery
2. Ascending branch of sup pancreaticoduodenal artery

15. Blood supply of GB
and Calot’s triangle
Contents of Calot’s triangle:
1. Cystic artery & vein
2. Cystic LN
Boundaries of calot’s triangle
1. Undersurface of liver (sup)
2. CHD (left side)
3. Cystic duct (right side)
Ligation of cystic artery in this triangle
is the one of the crucial steps in
surgical removal of gall bladder.
• Also called as cystohepatic triangle

16. Moynihan’s Hump
Or
Caterpillar’s turn

17. Gall stone (cholelithiasis)
• Gallstones are present in approximately 10% of people over the age
of 40 and are more common in women.
• They are predominantly a mixture of cholesterol and bile pigment.
• They may undergo calcification, which can be demonstrated on plain
radiographs.
• The gallbladder cannot empty normally and contractions of the
gallbladder wall produce severe pain.
• If pain persists a cholecystectomy (removal of the gallbladder) may be
necessary.

18. Cholesterol stone Pigment stoneMixed stone

20. Cholecystitis
• Inflammation of the gall bladder is called as cholecystitis.
• Most commonly caused by cholelithiasis which causes obstruction of
bile duct or cystic duct.
• Symptoms
Biliary colic
Jaundice
Murphy’s sign positive
Murphy’s sign
 Deep pressure at GB point at the
height of inspiration
 Patient feels stabbing pain
 Catch in breath

21. Cholecystectomy