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Gallbladder Pathology Online

Normal Anatomy of the Gallbladder

Dr Sampurna Roy MD  

 

The gall-bladder is pear shaped, 7.5 to 12.5 cm long, with a capacity of about 50 ml, but capable of fifty-fold distension.    

The anatomical subdivisions are, a fundus, a body, and a neck which terminates in the narrow infundibulum.

The angulated distal part of the neck forms a pouch, called Hartmann’s pouch, a common site for a solitary gall-stone  to lodge.

The muscle fibers in the wall of the gall-bladder are arranged in a criss-cross manner, being particularly well developed in the neck.

The mucous membrane contains indentations of the mucosa that sink into the muscle coat - these are the crypts of Luschka.

The cystic duct is about 2.5 cm in length. Internal projections of circular muscle fibers account for the spiral valve of Heister, which makes the passage of calculi difficult.

The common hepatic duct is usually less than 2.5 cm long, and is formed by the union of the right and left hepatic ducts.

The common bile duct, about 7.5 cm long, is formed by the junction of the cystic and the common hepatic ducts.

 It is divided into four parts:

- The supraduodenal portion, about 2.5 cm long, runs in the free edge of the lesser omentum.

- The retroduodenal portion.

- The infraduodenal portion lying in a groove, but at times in a tunnel in the posterior surface of the pancreas.

- The intraduodenal portion passes obliquely through the wall of the second part of the duodenum and is surrounded by the sphincter of Oddi and then forms an ampulla (Vater) before terminating with an opening on the summit of the duodenal papilla.

Microscopic features of normal gallbladder:

 

The wall of the gallbladder is composed of three layers: mucosa ; muscularis and serosa. There is no muscularis mucosae or submucosa.

There are different sized branching folds lined by single layer of columnar cells with a pale cytoplasm and basally located nuclei.

The lamina propria is composed of loose connective tissue, blood vessels, nerves and some plasma cells.

The muscle layer is composed of haphazardly distributed bundles of smooth muscle fibers.

                                                                                            

Calot's triangle was first described by Jean-François Calot as an "isosceles" triangle in 1891. It is an anatomical landmark of special importance in cholecystectomy.

Boundaries of Calot's triangle: The cystic duct, which is often tortuous and has a beaded appearance, passes downward and to the left to join the common duct,  the cystic artery arises from the hepatic artery and passes under the common hepatic duct to the gallbladder. These three structures— On the right cystic duct, on the left common hepatic duct and superiorly cystic artery— form the Calot's triangle.

Boundaries of Hepatocystic Triangle - On the right proximal part of gallbladder and cystic duct, on the left common hepatic duct and superiorly the margin of the right lobe of the liver.

 

 

 

 

 

 

          

 

 

 

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