gall bladder lecture
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Gallbladder DiseaseBy:Mohammad Mujib MunirzaiAmiri Medical ComplexDate:12/Nov/2016
Anatomy of GallbladderLocation:betweenJunction of the right ninth costal cartilageLateral border of the rectus abdominis . It is a pear shaped sac lying on the inferior surface of the liver in a fossa betweenRight and quadrate lobesCapacity of about 30 to 50 mL.
Surface AnatomyDirect contact superior part of the duodenum transverse colon.Parts:Neck BodyFundus
I will say more on the head body and fundus on a side note also hartmanns pouch*
Blood Supply of the Gall BladderThe cystic artery, supplying the gallbladder and cystic duct commonly arises from the right hepatic artery.
CYSTOHEPATIC TRIANGLE OF CALOT
Variations to the Cystic Artery
CONGENITAL ANOMALIES OF GALLBLADDER
Venous Drainage of the GallbladderThe 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.
Lymphatic Drainage of Gallbladder
Nerve SupplyCeliac nerve plexus (sympathetic and visceral afferent [pain] fibers)The vagus nerve (parasympathetic)The right phrenic nerve (actually somatic afferent fibers).
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.*
FunctionsGall bladderIt stores BileIt concentrates bileEjects bile into lumenBileEmulsify dietary lipidsFormation of micelles with products of lipid digestion.
I have side notes to expand on here*
BILEBile is produced at a rate of 5001500 mL/d by the hepatocytes and the cells of the ductsComposition 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)
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.*
Secretion and enterohepatic circulation of bile salts
Side notes to expand*
CHOLELITHIASISPresence of one or more calculi (gallstones) in the gallbladder.
Types of gallstone20% are Cholesterol Stones.5% are Pigment Stones.75% are Mixed
In Asia 80% Pigment Stones. In Europe 80% Cholesterol Stones.
Cholesterol Imbalance between bile salts/lecithin and cholesterol allows cholesterol to precipitate out of solution and form stonesPigmentOccur due to excess of circulating bile pigment (e.g. Heamolytic anaemia)MixedSame pathophysiology as cholesterol stones
Other FactorsStasis (e.g. Pregnancy)Ileal dysfunction (prevents re-absorption of bile salts)Obesity and hypercholesterolaemiaPathogenesis
Risk FactorsBIG 4..?
Risk FactorsPregnancy.OCP.Hemolytic Anemia.Cirrhosis.Infection.IBD/Terminal Ileal Resection.TPN.Hyperlipidemia.
Pathological EffectsSilent Gallstones.Obstruction of the Cystic Duct.Movement of Stone into CBD.Ulceration of Stone through Gallbladder Wall.
Clinical PresentationBiliary Colic.Acute Cholecystitis.Chronic Cholecystitis.Gallstone Pancreatitis.Obstructive Jaundice.Acute Cholangitis.Gallstone Ileus.Mucocele / Empyema of the Gallbladder.
DefinitionsBiliary colicpostprandial epigastric/RUQ pain due to transient cystic duct obstruction by stoneNo fever, No leukocytosis, Normal LFT
Differential Diagnosis:Renal Colic.Intestinal Obstruction.Angina.Pain Episode may Resolve when Stone is Passed into CBD / Falls Back into the Gallbladder.
Gall bladder ultrasoundShows gallstones
*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*