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Gall bladder lecture
- 2. Gallbladder Disease By:Mohammad Mujib Munirzai Amiri Medical Complex Date:12/Nov/2016
- 3. Anatomy of Gallbladder • Location: – between • Junction of the right ninth costal cartilage • Lateral border of the rectus abdominis . • It is a pear shaped sac – lying on the inferior surface of the liver – in a fossa between – Right and quadrate lobes – Capacity of about 30 to 50 mL.
- 4. Surface Anatomy • Direct contact – superior part of the duodenum – transverse colon. • Parts: – Neck – Body – Fundus
- 5. Blood Supply of the Gall Bladder • The cystic artery, supplying the gallbladder and cystic duct commonly arises from the right hepatic artery.
- 7. Variations to the Cystic Artery
- 8. CONGENITAL ANOMALIES OF GALLBLADDER
- 9. Venous Drainage of the Gallbladder • The cystic veins, – draining the neck of the gallbladder and cystic duct, – enter the liver directly or drain through the portal vein to the liver, – The veins from the fundus and body of the gallbladder pass directly into the visceral surface of the liver and drain into the hepatic sinusoids.
- 11. Nerve Supply • Celiac nerve plexus (sympathetic and visceral afferent [pain] fibers) • The vagus nerve (parasympathetic) • The right phrenic nerve (actually somatic afferent fibers).
- 12. Functions • Gall bladder – It stores Bile – It concentrates bile – Ejects bile into lumen • Bile – Emulsify dietary lipids – Formation of micelles with products of lipid digestion.
- 13. BILE • Bile is produced at a rate of 500–1500 mL/d by the hepatocytes and the cells of the ducts • Composition of bile: • Bilirubin (by-product of haem degradation) • Cholesterol (kept soluble by bile salts and lecithin) • Bile salts/acids (cholic acid/chenodeoxycholic acid): mostly reabsorbed in terminal ileum(entero-hepatic circulation). • Lecithin (increases solubility of cholesterol) • Inorganic salts (sodium bicarbonate to keep bile alkaline to neutralise gastric acid in duodenum) • Water (makes up 97% of bile)
- 14. Secretion and enterohepatic circulation of bile salts
- 15. CHOLELITHIASIS • Presence of one or more calculi (gallstones) in the gallbladder.
- 16. Types of gallstone • 20% are Cholesterol Stones. • 5% are Pigment Stones. • 75% are Mixed… … … • In Asia 80% Pigment Stones. • In Europe 80% Cholesterol Stones.
- 17. Pigment stone
- 18. Cholesterol Imbalance between bile salts/lecithin and cholesterol allows cholesterol to precipitate out of solution and form stones Pigment Occur due to excess of circulating bile pigment (e.g. Heamolytic anaemia) Mixed Same pathophysiology as cholesterol stones Other Factors Stasis (e.g. Pregnancy) Ileal dysfunction (prevents re-absorption of bile salts) Obesity and hypercholesterolaemia Pathogenesis
- 20. Risk Factors • BIG 4..? 1. Female. 2. Forty. 3. Fertile. 4. Fatty.
- 21. Risk Factors • Pregnancy. • OCP. • Hemolytic Anemia. • Cirrhosis. • Infection. • IBD/Terminal Ileal Resection. • TPN. • Hyperlipidemia.
- 22. Pathological Effects 1. Silent Gallstones. 2. Obstruction of the Cystic Duct. 3. Movement of Stone into CBD. 4. Ulceration of Stone through Gallbladder Wall.
- 24. Clinical Presentation 1. Biliary Colic. 2. Acute Cholecystitis. 3. Chronic Cholecystitis. 4. Gallstone Pancreatitis. 5. Obstructive Jaundice. 6. Acute Cholangitis. 7. Gallstone Ileus. 8. Mucocele / Empyema of the Gallbladder.
- 25. Definitions • Biliary colic – postprandial epigastric/RUQ pain due to transient cystic duct obstruction by stone – No fever, No leukocytosis, Normal LFT
- 26. • Differential Diagnosis: – Renal Colic. – Intestinal Obstruction. – Angina. • Pain Episode may Resolve when Stone is Passed into CBD / Falls Back into the Gallbladder.
- 27. Gall bladder ultrasound • Shows gallstones → → ►
- 28. THANK YOU
Editor's Notes
- I will say more on the head body and fundus on a side note also hartmanns pouch
- Referred pain to the shoulder: indicates involvement of the phrenic nerve (or diaphragm). The supraclavicular nerve (C3-C4), which supplies sensory fibers over the shoulder, has the same origin as the phrenic nerve (c3-C5), which supplies the diaphragm.
- I have side notes to expand on here
- The critical property of bile salts is that they are amphipathic meaning the molecules have both hydrophilic (water- soluble) and hydrophobic (lipid-soluble) portions. The function of bile salts, which depends on their amphipathic properties, is to solubilize dietary lipids.
- Side notes to expand