Gallbladder
Tributary
A 30-50 mL reservoir lying in the fossa between the right and quadrate lobes (segments IV and V) that stores hepatic bile and concentrates it up to ten-fold by absorbing sodium and water. Cholecystokinin, released from the duodenum by fat and amino acids, contracts its wall and relaxes the sphincter of Oddi so that concentrated bile is delivered through the cystic duct. Its fundus lies at the tip of the ninth costal cartilage, where the lateral border of rectus abdominis meets the costal margin in the transpyloric plane.
Detail
- Capacity
- 30-50 mL; concentrates bile 5-10 times
- Artery
- Cystic artery, from the right hepatic artery, in Calot's triangle
- Venous drainage
- Cystic veins to the right branch of the portal vein, and directly into the liver from the hepatic surface
- Surface marking
- Tip of the 9th costal cartilage, transpyloric plane (L1)
- Sensory
- Sympathetic T7-T9 via the greater splanchnic nerve (epigastrium, right hypochondrium); diaphragmatic irritation via phrenic C3-C5 to the right shoulder tip
When it goes wrong
Stone impacted in the neck (Hartmann's pouch) with acute cholecystitis
Constant right upper quadrant pain, fever, positive Murphy's sign and right shoulder-tip pain; jaundice is absent unless the bile duct is also involved
Chronic cholecystitis eroding a cholecystoduodenal fistula (gallstone ileus)
Small-bowel obstruction from a large stone impacted at the terminal ileum, with air in the biliary tree on imaging
Palpable, non-tender gallbladder in a jaundiced patient
Courvoisier's law: the obstruction is unlikely to be a stone (a stone-bearing gallbladder is fibrosed and cannot distend) and is more likely carcinoma of the pancreatic head or ampulla
Practise this structure
3 questions in the bank tagged Surface Anatomy.
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