Gallbladder

Question 1

Gallbladder overview

Answer 1

• Located behind tip of 9th costal cartilage (where lateral border of rectus sheath crosses costal margin)
• Can store up to 50ml of bile
• Spiral folds (spiral valves) open cystic duct to release bile

Question 2

Vasculature

Answer 2

Arterial:
1) Cystic artery (branch of right hepatic artery)

Venous:

1) Neck of gallbladder –> Cystic vein (which empty directly into hepatic portal vein)
2) Body and fundus of gallbladder –> Hepatic sinusoids

Question 3

Gallstones (Cholelithiasis)

Answer 3

-Can be classified as either cholesterol/pigmented
-Sites of obstruction:
1) Hepatopancreatic ampulla (of Vater)
2) Cystic duct
3) Hartmann’s pouch (infundibulum) – pathological dilation above neck of gallbladder)
-Leads to Jaundice
symptoms:
1) Dark urine
2) Pale stool
3) Yellow discolouration of sclera/skin

Peptic duodenal ulcer can cause a fistula (abnormal connection), leading to gallstones entering the duodenum

Question 4

Referred Pain

Answer 4

-Gallbladder pain can be referred to the back of shoulder because inflammation of gallbladder can spread to the diaphragm (innervated by phrenic nerve (C3-C5))

Question 5

Murphy’s sign

Answer 5

• Patients asked to take in and hold a deep breath while examiner palpate the right subcostal area
• If pain occurs on inspiration, whilst inflamed gallbladder comes into contact with examiner’s hand, Murphy’s sign is positive
• Indicate acute cholecystitis