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Anatomy of Gall Bladder ;
Physiology of Gall Bladder.
Arterial
supply of the Gall-bladder
The cystic
artery, a branch of the right hepatic artery is usually given off
behind the common hepatic duct.
Thus it
makes the base of Calot’s triangle, the other sides being the right
hepatic artery above, and the cystic duct below.
Occasionally
an accessory cystic artery arises from the gastro-duodenal artery.
In 15% of
cases the right hepatic artery and/or the cystic artery cross in front
of the common bile duct and the cystic duct.
The most
dangerous anomaly of all is when the hepatic artery takes a tortuous
course in front of the origin of the cystic duct or the right
hepatic artery is tortuous, and the cystic artery is short.
The tortuosity is known as the ‘caterpillar turn’ or Moynihan’s hump.
There is a
possibility of liver infartion in accidental ligation of the common
hepatic artery, but chances of recovery in this and right
hepatic ligation are improved by giving neomycin or ampicillin by
mouth, and ensuring a high intake of glucose.
Hyperbaric
oxygen would be useful, if available.
Infarction
in a jaundiced patient is probably lethal.
Lymphatic
supply of the Gall Bladder
The lymph
vessels of the gall-bladder (subserosal and submucous), drain into the
cystic lymph nodes of Lund (the sentinel lymph node), which lies in
the fork created by the junction of the cystic and common bile ducts.
Efferent
vessels from this lymph node go to the hilum of the liver, and to the
celiac lymph nodes.
The
subserosal lymphatic vessels of the gall-bladder also connect with the
subcapsular lymph channels of the liver, and this accounts for the
frequent spread of carcinoma of the gall-bladder to the right lobe of
the liver.
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