WELCOME

Dewan Institute Of Rehabilitation Sciences

Shaheed Benazir Bhutto

Dewan University

2

GALL BLADDER:

o It is a small sac-shaped organ beneath the liver, in which

bile is stored after secretion by the liver and before release into

the intestine.

o The gallbladder squeezes stored bile into the small intestine

through a series of tubes called ducts.

POSITION:

o It lies just beneath the right lobe of the liver. 

o In adults, the gallbladder measures approximately 8 centimetres (3.1 in) in length and 4 centimetres (1.6 in) in diameter when fully distended. 

o The gallbladder has a capacity of about 100 mL.

Fig. Gallbladder Position.

STRUCTURE :

o The gall bladder is a hollow organ.

o Its shaped is like a tapered sac, with the open end opening into the biliary tree and the cystic duct.

PARTS OF GALL BLADDER : Anatomically, the gallbladder is divided into three sections:

Fundus

Body

Neck

Fig. Parts of Gall bladder.

1. Fundus:The fundus is a rounded end that faces the front

of the body.

2. Body:The body is in contact with the liver, lying in the

gallbladder fossa, a depression at the bottom of the

liver.

3. Neck:The neck tapers and is continuous with the cystic duct,

part of the biliary tree. The cystic duct unites with the

common hepatic duct to become the common bile duct.

At the junction of the neck of the gallbladder and the

cystic duct.

LAYER OF GALL BLADDER:The inner most layer is epithelium.

The submucosa is a thin layer of loose connective tissue

with smaller blood vessels.

The muscular layer, formed by smooth muscular tissue.

The serosa is a thick layer that covers the outer surface

of the gallbladder, and is continuous with the peritoneum.

Fig. Layers of Gall bladder.

FUNCTION OF GALL BLADDER:

The main purpose of the gall bladder is to

store bile, also called gall. The gall bladder is

part of the biliary system and serves as a reservoir for bile, which is produced by the liver.

The liver produces the bile and then it flows through

the hepatic ducts into the gallbladder.

The bile that is secreted by the liver and stored in the

gallbladder is not the same as the bile that is secreted by the gallbladder. During gallbladder storage of bile,

it is concentrated by removal of some water and

electrolytes.

Lymphatic drainage of GB:

1. Terminate @ celiac nodes

2. Cystic node at neck of GBa. Actually a hepatic node

b. Lies at junction of cystic

& common hepatic ducts

3. Other lymph vessels also drain into

hepatic nodes.

•

Arterial Supply to the Gallbladder

Cystic artery

Right hepatic artery Proper hepatic artery

Common hepatic artery

Common Hepatic Artery

Proper Hepatic Artery

Gastroduodenal Artery

Blood Supply:

- Cystic artery branch of Rt. Hepatic artery

- Cystic vein end in portal vein

- Small branches ( arteries and veins run between liver and gall bladder

Nerve supply

Sympathetic and parasympathetic from celiac plexus

Parasympathetic ---- vagous nerve Hormone cholecystokini duodenum

Extra hepatic biliary system

Rt. hepatic duct+Lt hepatic duct↓Common hepatic duct+Cystic duct↓Common bile duct

- 4cm- Descend in free edge of lesser omentum- Supra duodenal part Retro duodenal part Retro pancreatic part

Common bile duct

Bile duct……. parts and relations

-1st part-Located in right free margin of

lesser omentum in front of the

opening into the lesser sac (Epiploic

opening) Rt to hepatic artery and

portal vein

-

-2nd part-Behind the 1st part of the duodenum

-Rt to the gastroduodenal artery.-3 rd part-Posterior surface of the head of the

pancreas

-Contact with main pancreatic duct

-Related with IVC, gastroduodenal artery,

portal vein

-End in the half second part of duodenum at

ampulla of Vater

Fig. Layers of Gall bladder.

Ampulla of Vater with CBD and Pancreatic Duct

Ampulla of Vater

Hepaticopancreatic ampulla(Ampulla of Vater)

The ampulla of Vater, also known as the

hepatopancreatic ampulla,or as

hepatopancreatic duct, is formed by the union of

the pancreatic duct and the common bile duct.

Blood supply of CBD

Small arteries supplying CBD

a. Arise from cystic artery b. Posterior branch of superior

pancreaticoduodenal artery

CLINICAL DISORDERS:• GALL STONE: (cholelithiasis)For unclear reasons, substances in bile

can crystallize in the gallbladder, forming gallstones. Common and usually harmless, gallstones can sometimes cause pain, nausea, or inflammation.

• Cholecystitis: Inflammation of the gallbladder, often due to a

gallstone in the gallbladder. Cholecystitis causes severe pain and fever, and can require surgery when inflammation continues or recurs.

CLINICAL DISORDERS:

• Gallbladder cancer:

Although rare, cancer can affect the gallbladder. It is difficult to diagnose and usually found at late stages when symptoms appear. Symptoms may resemble those of gallstones.

• Gallstone pancreatitis: An impacted gallstone blocks the ducts that drain the

pancreas. Inflammation of the pancreas results, a serious condition.

REMOVAL OF GALL BLADDER:

• A cholecystectomy is a procedure in which the gallbladder is removed. It may be removed because of recurrent gallstones, and is considered an elective procedure. A cholecystectomy may be an open procedure, or one conducted by laparoscopy. In the surgery, the gallbladder is removed from the neck to the fundus.

Definition:

The pancreas is a long, flat gland that lies in the

abdomen behind the stomach. It produces

enzymes that are released into the small intestine to

help with digestion.

POSITION:The pancreas

is locat

ed deep in the abdome

n.

The head of the pancreas is on the right side

of the abdomen.

It is connected

to the upper end

of the small intesti

ne.

The narrow end of

the pancreas, calle

d the tail, extends to

the left side of

the body

.

STRUCTURE:

o The pancreas is a secretory structure with

an internal hormonal role (endocrine) and

an external digestive role (exocrine).

o It has two main ducts, the main pancreatic

duct, and the accessory pancreatic duct.

o These drain enzymes through the ampulla

of Vater into the duodenum.

PARTS OF PANCREAS:

There are four parts of Pancreas. They are:

1. Head.

2. Neck.

3. Body.

4. Tail.

Fig. Parts of Pancreas.

1. Head:-It is disc shaped - lies within the concavity of the duodenum - A part of the head extends to the left behind the superior mesenteric vessels and is called the Uncinate process.

2. Neck:- It is the constricted portion of the pancreas- connects the head to the body.- It lies in front of the

beginning of the portal vein.

Fig. Parts of Pancreas.

3. Body:-Runs upward and to the left across the midline- It is somewhat triangular in cross section.-Three surfaces:

a. Anterior

b. Posterior

c. inferior.

a. Anterior Surface:1- Covered by peritoneum of post. Wall of lesser sac2- Tuber omental  :

where the ant. surface of pancreas join the neck.

b. Posterior Surface:- devoid of peritoneum - in contact with 1- the aorta

2- the splenic vein

3- the left kidney and its vessels

4- the left suprarenal gland

5- the origin of the superior mesenteric artery 

c. Inferior Surface:

- Narrow on the right but broader on the left

-Covered by peritoneum of greater omentum

- lies upon the duodenojejunal flexure

- Some coils of the jejunum

- its left extremity rests on the left colic flexure .

4. Tail:- Anatomically left with the hilum of the spleen.

Fig. Parts of Pancreas.

Fig. Parts of Pancreas.

Pancreatic Ducts:The Main Duct:

-Begins in the tail and runs the length of the gland

-Receiving numerous tributaries on the way .

- It opens into the second part of the duodenum at about its middle

with the bile duct on the major duodenal papilla

Fig. Pancreatic Ducts.

Pancreatic Ducts:The Accessory Duct:

- When present, drains the upper part of the head

-Then opens into the duodenum a short distance above the main

duct on the minor duodenal papilla .

- The accessory duct frequently communicates with the main

duct

Fig. Pancreatic Ducts.

Blood Supply Of Pancreas:

ArteriesThe splenic artery.

The superior pancreaticoduodenal artery.

Inferior pancreaticoduodenal arteries artery.

VeinsThe corresponding veins drain into the portal system.

Fig. Pancreatic Blood Supply.

Lymphatic Drainage• Lymph nodes are

situated along the arteries that supply the gland.

• The efferent vessels ultimately drain into the celiac and superior mesenteric lymph nodes.

Nerve supply• Sympathetic and parasympathetic chain• Parasympathetic = vagus nerve

Congenital defects of pancreas

• Annular Pancreas.• Ectopic Pancreas.

• Annular Pancreas:Pancreas encircle Duodenum.It is a rare type.

• Ectopic Pancreas.Outside the Gastrointestinal Tract.It is the most common type.

Acute Pancreatitis:• Common acute abdomen• Local inflammatory change in pancreas• Life-threatening inflammatory disorder of the

pancreas• Variable severity and duration

Acute Pancreatitis:laboratory test

• Amylase level in serum and in urine• Liver function, PaCO2 ,serum calcium.• Diagnostic paracentesis

Acute Pancreatitis:Image findings

• BUS• CT • ERCP• MRCP• Abdomen plain film

Severe Acute Pancreatitis

• Severe Acute pancreatitis (SAP)– Complicated with MODS(Multiple organ disorder

syndrome.

– Necrosis, abscess, pseudocyst

– Or both

Q?U?E?S?T?I?O?N?S?