Gallbladder refers to auxiliary unpaired organs. However, in its absence, the duodenum takes over the function of accumulating bile.
What is the gallbladder?
The gallbladder is an elongated, hollow, muscular sac that stores bile produced by the liver. Located under the liver, the gallbladder controls the flow of bile into the duodenum. Bile and bile pigments play important role in the breakdown and absorption of fats. It is not an essential organ and is often removed with surgical procedure, known as cholecystectomy in cases of gallbladder disease or when present.
Anatomy of the gallbladder
The gallbladder is a pear-shaped organ that is approximately 7 to 10 centimeters in length and 2 to 3 cm in width. It has the ability to accumulate about 50 milliliters of bile inside itself, which can be released, if necessary, through the small bile duct (gallbladder channel) into the general bile duct. From here, bile enters the lumen duodenum. Usually this process is interconnected with the digestion process. The release of bile is carried out under the control of the autonomic nervous system in response to receiving a signal about the arrival of food. Therefore, when used often fatty foods increased bile formation occurs and the person feels the movement of bile. This is just a response to a stimulus.
The wall of the gallbladder consists of several layers, including the epithelium (inner layer), mucosa, muscularis, and serosa (outer layer).
Structure of the gallbladder
The gallbladder consists of 3 parts - the fundus, the body and the neck. The fundus protrudes from under the liver and is the part visible from the front, which can be examined using ultrasound diagnostic methods. The body is the main expanded part that lies between the fundus and the cystic duct. The neck of the gallbladder is narrow part which passes into the cystic duct.
The cystic duct is about 3 to 4 centimeters in length and transports bile into the common bile duct.
Blood supply and lymphatic drainage
The arterial blood supply to the gallbladder is through the portal artery, which arises from the right hepatic artery. Venous drainage occurs through the bile vein - this mainly accounts for the drainage of venous blood from the neck and cystic duct. Venous drainage of the body and bottom of the gallbladder is carried out directly with the participation of the visceral surface of the liver and through the hepatic sinusoids. Lymphatic fluid drains into the cystic The lymph nodes, which are located next to the liver and have access to the abdominal lymph nodes.
Innervation of the gallbladder
Innervation is carried out through:
- solar plexus;
- nervus vagus;
- right-sided phrenic nerve bundle.
These nerve endings regulate contraction of the gallbladder, relaxation of the corresponding sphincters and provoke pain in diseases.
Location of the gallbladder in the human body
The gallbladder is located in the right hypochondrium, below the visceral surface of the liver. This organ is interconnected with the liver using thin connective tissue. Therefore, any inflammatory processes in it quickly spread to the liver parenchyma. The gallbladder is located in the right upper quadrant of the abdominal cavity. The bottom of this organ protrudes anterior to the lower border of the liver. It is located slightly to the right of the location of the duodenum. It has exits into the colon and duodenum.
What functions does it perform in the human body?
The main functions of the gallbladder relate to the storage and secretion of bile.
1. Accumulation and storage of bile. This organ is also capable of causing an increase in the concentration of bile coming from the liver, so that a large volume of bile can be stored in a small space (1 liter of bile can be concentrated in a volume of 50 ml).
The gallbladder, only in appearance, seems to be an inconspicuous organ. If you look at it, it plays an important role in the functioning of the entire system. gastrointestinal tract.
All this suggests that thanks to it a person feels good and does not face health problems.
To date, it has been possible to almost thoroughly study the anatomical structure of the human body.
Modern technologies make it possible to treat pathologies, even if they do not have external manifestations and bright clinical symptoms.
It is important to be attentive to the body’s signals and consult a doctor on time.
About the gallbladder
It should be noted that the gallbladder is one of the elements of the gastrointestinal tract. Its function is to accumulate bile, which comes from the liver.
The gallbladder is located in the hypochondrium area with right side. More precisely, this is the lower edge of the rib on the right side.
In fact, the structure of an organ indicates what its main functions are. Human anatomy confirms the fact that the gallbladder is very similar to a pear in appearance.
It turns out that it’s not for nothing that experts divide it into several parts. One of them was called “bottom”. The thing is that this is often the widest organ. The middle one is called the “body”, but the narrow one is called the “neck”.
Looking at the pictures showing the gallbladder, you can better understand why the departments were given such names. The gallbladder canal extends from the cervix; it is called the cystic duct. It is connected to the hepatic, and there is a small distance between them.
In accordance with the size of the organ, it should be noted that the length of the gallbladder can vary from 5 to 14 cm.
Its volumes are considerable, the indicators vary from 30 to 80 ml. This amount of secretory fluid may remain in the organ.
Functions of bile
In fact, not everyone wonders what role the gallbladder plays in the gastrointestinal tract. You need to understand that the liquid accumulated in it is very important.
It is able to launch important enzymes that improve digestion. The process takes place in the intestinal area.
Thanks to bile, it is possible to break down fats. The liver releases bile, it passes into the bladder, and from there into the area of the duodenum.
About 1.5 liters of secretory fluid can pass through the gallbladder per day. It turns out that the organ is really important, and therefore it is incredibly difficult for the gastrointestinal tract to do without it.
Knowing what the gallbladder looks like and what its real tasks are in the digestive tract, it is also important to understand what causes diseases of the organ.
Pathologies of the gallbladder and tract
Today, deviations in the gallbladder area are quite common in people.
Sad statistics also confirm the fact that not all people understand what is really happening to them.
It cannot be otherwise, because some people don’t even know where the organ is located, what are the signs of its deviation from the normal state. If only for this reason, it is worth reading this article to the end.
If there are disruptions in the functions of the gallbladder, a person may develop an allergy.
No exception is eczema, pancreatitis and diabetes. These pathologies can be caused by an irregular shape of the gallbladder.
When a person turns to a doctor for help, he will prescribe him to undergo ultrasonography. There is no need to worry, the procedure is completely painless.
The ultrasound specialist will examine the organ, establishing how the gallbladder works, its location in accordance with other organs, and will understand whether there is any pathology.
Preparing for an ultrasound
To undergo an ultrasound examination of the gallbladder, the patient needs to know some stages of preparation, so that in the future there will be no problems with diagnosing the condition of the organ and false results research.
The preparation methods are very simple, and therefore there will be no problems with this. Before the procedure, it is better not to eat anything for 12 hours.
The doctor, on the contrary, may ask the patient to bring a number of foods for examination, which, if eaten, will cause contraction of the organ. As a rule, this is high-fat sour cream.
Determination of pathologies on ultrasound
Cholecystitis has become the most frequently diagnosed disease on ultrasound when examining the gallbladder.
The body begins to get serious inflammatory process, which triggers an increase in the thickness of the gallbladder walls.
Ultrasound allows you to determine this deviation from the norm. If this is an acute phase of the disease, its symptoms will manifest itself in the form of fever, attacks of vomiting and nausea, and weakness.
Inflammation can be characterized by pain in the area of the right hypochondrium, which manifests itself after eating fatty foods.
Often enough this pathology develops into a more serious one, becoming chronic. This brings a person enough problems in the future.
It is for this reason that you should pay attention to all signals about problems in the body, and not neglect them, hoping that they will pass on their own.
An equally common occurrence is gallstone pathology. The phenomenon is indeed quite common. It can be detected through an ultrasound examination.
Those stones that are inside the gallbladder disrupt the functioning of the gastrointestinal tract when they block the organ channel.
Thanks to modern methods diagnostics, the doctor will be able to understand what stones are in the human body and how many there actually are.
Another advantage of hardware ultrasound examination is that pathology can be determined on early stage of its development.
It just needs to be noted that a specialist should decipher the study. Only in this case can one expect that the treatment course will be chosen correctly, and therefore the pathology will soon be eliminated.
You cannot self-medicate; the outcome can be extremely unpleasant.
Anatomy of the liver and gallbladder
The location of the liver and gallbladder indicates that the organs are closely interconnected. The liver is located under the diaphragm.
Doctors consider the lobule, which consists of hepatocytes, to be the main unit of organ structure. All passages emerging from it are bile ducts.
They drain secretory fluid into the left and right bile ducts. As a result, both parts form a single duct. Thus, a system of interaction between the biliary tract and the liver is formed.
Treatment course
Having dealt with the issue of the structure of the gallbladder, the organs adjacent to it, as well as the symptoms of pathologies, it is necessary to note what the treatment will be.
IN in this case doctors adhere to general recommendations. They relate to debugging proper nutrition.
You need to follow a diet called “Table 5”. It is really strict, especially for those people who are used to eating fast food, fried and fatty foods.
You need to switch your attention to river fish, lean meat and poultry. It is recommended to eat more vegetables and fruits, dairy products.
It is best to use a double boiler or multicooker for cooking. Doctors consider stewing or boiling to be the optimal methods.
It is not forbidden to eat egg white omelettes, vegetable soups, cereals, and dried bread. But it is better to avoid sour vegetables and generally products with similar properties.
The thing is that acid irritates the mucous membrane of the organ, negatively affecting its condition. This contributes to increased pain in humans.
If you follow a dietary diet, the patient will feel relief. You need to make sure that the food you eat is not very cold or hot.
The same applies to drinks. The mode must be debugged. The fractional principle of nutrition will help with this, when a person eats in small portions 5-6 times a day. Getting used to this method of consumption is not so difficult.
Official medicine
There are other methods of therapeutic treatment. They promote recovery functional features organ, allowing you to eliminate signs of pathologies and eliminate inflammation.
Chinese healing methods
Here it would be appropriate to note the fact that not all patients like treatment using the methods of official medicine.
There are also those representatives who prefer to be treated in unconventional ways. A similar solution is often found in eastern countries.
Ways are being cultivated alternative medicine for the treatment of gallbladder in China. They are based on the teachings of meridians.
In accordance with the existing theory, a meridian should be understood as a channel that allows vital energy to make its way through to the human body. This energy is called “Qi”.
In such situations, representatives of this movement select special treatment methods. One must admit that one must find good specialist It's not easy in our country. This requires a lot of time and a lot of financial resources.
Folk recipes
But there are other directions therapeutic therapies, which may include folk recipes. They are also known for their effectiveness and have more than once helped to alleviate the situation of a sick person faced with gallbladder pathology.
To eliminate gallstone pathology, you can eat fresh strawberries. Servings should be 3 glasses per day. The course of therapy is 21 days.
If you can’t buy strawberries, you can help the patient by taking beetroot decoction. The recipe is not complicated. You need to take the vegetable tubers, wash them and, unpeeled, put them on the stove to cook.
They must be on fire for 6 hours. The liquid will thicken. This will be a healing panacea.
You need to drink 1/5 of a glass a day before meals. The reception is designed for every day for 15 days.
But it is important to consult with a specialist; beets have the ability to lower blood pressure, which in turn can lead to trouble.
Manifestation of gallbladder pain
In fact, one of the most serious signs of malfunction of the gallbladder should be called painful sensations in the organ.
This symptom should be a reason to visit a doctor. You should contact a gastroenterologist or a therapist who will write a referral to see a specialist.
Many people wonder what pain in the gallbladder area is like. First, you need to note that it is important to know where the organ is located.
These are the right costal arches, the area where the liver is located. These organs, as mentioned above, have a tight relationship.
Those. The gallbladder is located in the lower part of the liver on the right side. If pain occurs in this area, this may indicate biliary colic.
In accordance with practical experience, it was found that pain can be felt not only in this area, but also in the area between the shoulder blades or in the area of the right shoulder.
Clarifying the nature of pain during colic, it should be noted that it manifests itself in the form of attacks. It starts suddenly, maybe even late at night.
It is provoked by eating heavy food or alcohol. Over the course of an hour, pain may intensify, and sometimes even reach its maximum peak.
As a rule, the duration can reach up to 6 hours. Subsequently, it is difficult for a person to understand exactly where it hurts, because the discomfort moves to the navel and other areas, gradually spreading more and more.
There is no need to endure the sensations; you should immediately seek help from a doctor. Pathology can develop into serious consequences. One of them is gallbladder cancer.
Even if the phenomenon is rare, it is still better to pass full examination see a doctor to eliminate the risk of disease.
Useful video
Most patients do not even know where the gallbladder (GB) is located. Wherein this body performs in the body important functions- actively participates in the digestive process and carries out the breakdown and emulsification of lipid droplets necessary for metabolism. The gallbladder is a hollow organ with thin walls, inside which bile accumulates, coming from the liver and excreted through the duodenum. In case of any disturbances in its functioning, it is necessary to take urgent measures to reduce the severity of symptoms. Refusal of therapy can lead not only to complications, but also to the development of chronic diseases.
The gallbladder is most often pear-shaped, but various diseases or organ pathologies can contribute to the formation of constrictions, resulting in its deformation.
The standard parameters of the gallbladder are as follows:
- length - no more than 100 mm;
- width - within 40 mm;
- capacity - about 70 ml.
The wall of the gallbladder is elastic and can stretch, which occurs when cholelithiasis. In this case, the capacity of the organ increases to 200 ml.
Anatomy of the gallbladder
The structure of the gallbladder consists of the following sections:
- body - the largest part, covered by the liver from above and in front;
- The neck is a continuation of the body. At the junction there is a Hartmann's pouch, which has a slight narrowing near the junction with the neck. With a funnel-shaped narrowing, this section of the bladder forms the cystic duct;
- bottom - facing the anterior wall of the peritoneal cavity and protrudes slightly from behind the liver. If the bladder is full of bile, the bottom can be detected by palpation.
The walls of the gallbladder consist of several layers: mucous, muscular, fibrous and serous.
The mucous membrane is represented by a loose elastic layer of fibers, high epithelium of the prismatic type. There are also glands responsible for the production of mucus. The largest number of glands is located near the neck.
The upper part of the epithelium has small villi, which increase the area of contact with bile secretion. The mucous surface is uneven, folded, and has a velvety appearance. Pronounced folds are noted near the neck and duct and form valves - “Geyster valves”.
The muscle layer is a loose tissue and consists of smooth muscle tissue, as well as elastic fibers that have different directions. Circular fibers near the neck are pronounced and are capable of forming a sphincter - “Lutkens sphincter”.
The fibrous membrane and muscle tissue in the body of the organ are interconnected. There are moves between them. In the upper part of the organ, the tubular passages have epithelium, which communicates with the bile ducts located inside the liver.
Location of the gallbladder
The shape and location of the gallbladder and liver are individual and depend on different features human body. This must be taken into account when diagnosing diseases and pathologies.
Typically, the gallbladder is covered on all sides by the walls of the abdominal cavity, and one side is in contact with the liver. But there are exceptions, when complete coverage by the peritoneum is diagnosed, only the blood vessels, nerves and duct.
On the right side of the gallbladder there is the large intestine and duodenum. On the left is the stomach.
Between upper limit organ and bottom The liver contains connective tissue that has a loose consistency. The bottom is covered with sheets of the abdominal cavity, which also affect the liver. When the organ is completely covered by the peritoneum, it becomes mobile.
Most often, a person experiences immersion of most of the bladder into the liver, which creates certain difficulties when removing the organ.
It is also worth considering that between the internal ducts of the liver and the bladder there is a thin layer - parenchyma. In rare cases, it is located inside the liver. In this case, the neck of the bladder still remains outside this organ.
As for the neck of the bladder and the hepatic duct, they are connected to each other to form the cystic duct, the length of which normally should not exceed 40 mm. The bile duct in the human body is considered the longest and can reach a length of 80 mm. It includes such departments as:
- supraduodenal;
- retroduodenal;
- pancreatic;
- interstitial.
In most cases, this duct in humans connects with the pancreatic duct and opens into the area of the duodenal papilla.
If a patient is diagnosed with an inflammatory process in the liver, stomach, or intestines, then inflammation is also observed in neighboring areas that are associated with the bladder.
Blood flow, lymph flow and innervation
The gallbladder is supplied with blood from the cystic artery, which arises from the right hepatic artery. The gallbladder artery is located on the outside of the cervix and is divided into two branches going to the lower and upper walls of the organ. In the anterior section, the artery is located under the lymph node of Mascagni’s gland.
However, the artery can take its origins from other arteries, which are localized in the area of the stomach, liver or duodenum.
The outflow of blood from the gallbladder occurs through veins that form venous trunks.
The outflow of lymph is carried out into the lymphatic system of the liver or into extrahepatic vessels.
The organ is innervated from the solar plexus, from the accumulation of the phrenic and vagus nerves.
Operation
The gallbladder collects and concentrates bile within itself. When the appropriate signal is received from the gastrointestinal tract, it releases bile, which helps process food.
Bile is produced by the liver parenchyma. Its amount depends on the patient’s diet. Products such as animal fats, seasonings, spices, alcoholic beverages, and tobacco smoking can trigger increased bile production. Intense flow of bile stretches the walls of the gallbladder and leads to a pathological condition.
Gallbladder diseases lead to disruption of the normal functioning of the organ. The formation of stones indicates the progression of the inflammatory process in the body.
The performance of the gallbladder is regulated by cholecystokinin - hormonal substance, provoking contraction of the muscle tissue of the organ wall. Its production occurs in the cells of the duodenum. In order for cholecystokinin to leave the organ, simultaneous contraction of the bladder wall and relaxation of the exit sphincter of Oddi must occur. If the process is disrupted, the patient will suffer from contractions in the right hypochondrium half an hour after eating.
Currently, doctors have proven that a person can live without a gallbladder. Its removal is carried out in case of gallstone disease, tumor and other lesions.
The biliary tract is complex system biliary excretion, including intrahepatic and extrahepatic bile ducts and gallbladder.
Intrahepatic bile ducts- intercellular bile canaliculi, intralobular and interlobular bile ducts (Fig. 1.7, 1.8). Bile excretion begins with intercellular bile canaliculi(sometimes called bile capillaries). Intercellular bile canaliculi do not have their own wall; it is replaced by indentations on the cytoplasmic membranes of hepatocytes. The lumen of the bile canaliculi is formed outer surface the apical (capalicular) part of the cytoplasmic membrane of adjacent hepatocytes and dense contact complexes located at the points of contact of hepatocytes. Each liver cell participates in the formation of several bile canaliculi. Tight junctions between hepatocytes separate the lumen of the bile canaliculi from circulatory system liver. Violation of the integrity of tight junctions is accompanied by regurgitation of canalicular bile into the sinusoids. Intralobular bile ducts (cholangioles) are formed from intercellular bile canaliculi. After passing through the border plate, the cholangioles in the periportal zone merge into the periportal bile ducts. At the periphery of the hepatic lobules, they merge into the bile ducts themselves, from which interlobular ducts of the first order are subsequently formed, then of the second order, and large intrahepatic ducts are formed that leave the liver. When leaving the lobule, the ducts expand and form an ampulla, or intermediate duct of Hering. In this area, the bile ducts are in close contact with blood and lymphatic vessels, and therefore the so-called hepatogenic intrahepatic cholangiolitis can develop.
Intrahepatic ducts from the left, quadrate and caudate lobes of the liver form the left hepatic duct. Intrahepatic ducts right lobe, merging with each other, form the right hepatic duct.
Extrahepatic bile ducts consist of a system of ducts and a reservoir for bile - the gallbladder (Fig. 1.9). The right and left hepatic ducts form the common hepatic duct, into which the cystic duct flows. The length of the common hepatic duct is 2-6 cm, diameter 3-7 mm.
The topography of the extrahepatic bile ducts is variable. There are many options for connecting the cystic duct to the common bile duct, as well as additional hepatic ducts and options for their flow into the gallbladder or common bile duct, which must be taken into account when diagnostic studies and during operations on the biliary tract (Fig. 1.10).
The confluence of the common hepatic and cystic ducts is considered the upper limit common bile duct(its extramural part), which enters the duodenum (its intramural part) and ends with a large duodenal papilla on the mucous membrane. In the common bile duct, it is customary to distinguish the supraduodenal part, located above the duodenum; retroduodenal, passing behind the upper part of the intestine; retropancreatic, located behind the head of the pancreas; intrapancreatic, passing through the pancreas; intramural, where the duct enters obliquely through back wall descending department duodenum (see Fig. 1.9 and Fig. 1.11). The length of the common bile duct is about 6-8 cm, diameter is 3-6 mm.
In the deep layers of the wall and submucosa of the terminal part of the common bile duct there are glands (see Fig. 1.9) that produce mucus, which can cause adenomas and polyps.
The structure of the terminal section of the common bile duct is very variable. In most cases (55-90%), the mouths of the common bile and pancreatic ducts merge into the common duct, forming an ampulla (V-shaped version), where bile and pancreatic juice are mixed (Fig. 1.12). In 4-30% of cases, there is a separate flow of ducts into the duodenum with the formation of independent papillae. In 6-8% of cases they merge high (Fig. 1.13), which creates conditions for biliary-pancreatic and pancreatobiliary reflux. In 33% of cases, the fusion of both ducts in the area of the major duodenal papilla occurs without the formation of a common ampulla.
The common bile duct, merging with the pancreatic duct, pierces the posterior wall of the duodenum and opens into its lumen at the end of the longitudinal fold of the mucous membrane, the so-called major duodenal papilla, called the papilla of Vater. In approximately 20% of cases, 3-4 cm proximal to the papilla of Vater on the mucous membrane of the duodenum, you can see the accessory duct of the pancreas - the minor duodenal papilla (papilla duodeni minor, s. Santorini) (Fig. 1.14). It is smaller and not always functioning. According to T. Kamisawa et al., the patency of the accessory pancreatic duct at 411 ERCPs was 43%. Clinical significance accessory pancreatic duct is that when its patency is preserved, pancreatitis develops less frequently (in patients with acute pancreatitis the duct functions only in 17% of cases). With a high pancreatobiliary junction, conditions are created for the reflux of pancreatic juice into the biliary tree, which contributes to the development of the inflammatory process, malignant tumors and so-called enzymatic cholecystitis. With a functioning accessory pancreatic duct, the incidence of carcinogenesis is lower, since reflux of pancreatic juice from the bile ducts can be reduced due to its entry into the duodenum through the accessory duct.
The formation of biliary pathology can be influenced by peripapillary diverticula, the frequency of which is about 10-12%, they are risk factors for the formation of gallstones, bile ducts, create certain difficulties in performing ERCP, papillosphincterotomy, and are often complicated by bleeding during endoscopic manipulations in this zone.
Gallbladder- a small hollow organ, the main functions of which are the accumulation and concentration of liver bile and its evacuation during the digestion process. The gallbladder is located in a depression on the visceral surface of the liver between the quadrate and right lobes. The size and shape of the gallbladder are highly variable. Usually it has a pear-shaped, less often conical shape. The projection of the gallbladder onto the surface of the body is shown in Fig. 1.15.
The upper wall of the gallbladder is adjacent to the surface of the liver and is separated from it by loose connective tissue, the lower wall faces the free abdominal cavity and is adjacent to the pyloric part of the stomach, duodenum and transverse colon(see Fig. 1.11), which causes the formation of various anastomoses with adjacent organs, for example, with a pressure sore of the gallbladder wall that developed from the pressure of a large immovable stone. Sometimes gallbladder located intrahepatically or is completely outside the liver. In the latter case, the gallbladder is covered on all sides by visceral peritoneum, has its own mesentery, and is easily movable. A mobile gallbladder is more prone to torsion and stones easily form in it.
The length of the gallbladder is 5-10 cm or more, and the width is 2-4 cm. The gallbladder has 3 sections: the bottom, the body and the neck (see Fig. 1.9). The widest part of it is the bottom; it is this part of the gallbladder that can be palpated during obstruction of the common bile duct (Courvoisier's symptom). The body of the gallbladder passes into the neck - its narrowest part. In humans, the neck of the gallbladder ends in a blind sac (Hartmann's pouch). The cervix has a spiral-shaped fold of Keister, which can complicate the evacuation of biliary sludge and small gallstones, as well as their fragments after lithotripsy.
Typically, the cystic duct arises from the superolateral surface of the cervix and flows into the common bile duct 2-6 cm beyond the confluence of the right and left hepatic ducts. Exist various options its confluence with the common bile duct (Fig. 1.16). In 20% of cases, the cystic duct does not immediately connect to the common bile duct, but is located parallel to it in the common connective tissue membrane. In some cases, the cystic duct wraps around the common bile duct in front or behind. One of the features of their connection is the high or low confluence of the cystic duct into the common bile duct. Variants of the connection of the gallbladder and bile ducts on cholangiograms are about 10%, which must be taken into account during cholecystectomy, since incomplete removal of the gallbladder leads to the formation of the so-called long stump syndrome.
The thickness of the gallbladder wall is 2-3 mm, the volume is 30-70 ml; if there is an obstacle to the outflow of bile along the common bile duct, the volume in the absence of adhesions in the bladder can reach 100 and even 200 ml.
The bile ducts are equipped with a complex sphincter apparatus that operates in a clearly coordinated manner. There are 3 groups of sphincters. At the confluence of the cystic and common bile ducts there are bundles of longitudinal and circular muscles that form the Mirizzi sphincter. When it contracts, the flow of bile through the duct stops, and at the same time the sphincter prevents the retrograde flow of bile when the gallbladder contracts. However, not all researchers recognize the presence of this sphincter. In the area of the transition between the neck of the gallbladder and the cystic duct, the spiral-shaped sphincter of Lutkens is located. In the terminal section, the common bile duct is covered by three layers of muscles that form the sphincter of Oddu, named after Ruggero Oddi (1864-1937). The sphincter of Oddi is a heterogeneous formation. It distinguishes between clusters of muscle fibers surrounding the extra- and intramural part of the duct. The fibers of the intramural region partially pass onto the ampulla. Another muscle sphincter at the end of the common bile duct surrounds the large duodenal papilla (papilla sphincter). The muscles of the duodenum approach it, bending around it. An independent sphincter is a muscular formation surrounding the terminal part of the pancreatic duct.
Thus, if the common bile and pancreatic ducts merge together, then the sphincter of Oddi consists of three muscle formations: the sphincter of the common bile duct, which regulates the flow of bile into the ampulla of the duct; the sphincter of the papilla, which regulates the flow of bile and pancreatic juice into the duodenum, protecting the ducts from reflux from the intestine, and, finally, the sphincter of the pancreatic duct, which controls the exit of pancreatic juice (Fig. 1.17).
In the mucous membrane of the duodenum, this anatomical formation is defined as a hemispherical, cone-shaped or flattened elevation (Fig. 1.18, A, B) and is designated as the major duodenal papilla, the major duodenal papilla, the papilla of Vater: lat. papilla duodeni major. Named after the German anatomist Abraham Vater (1684-1751). The size of the papilla of Vater at the base is up to 1 cm, height - from 2 mm to 1.5 cm, located at the end of the longitudinal fold of the mucous membrane in the middle of the descending part of the duodenum, approximately 12-14 cm distal to the pylorus.
When the sphincter apparatus is dysfunctional, the outflow of bile is disrupted, and in the presence of other factors (vomiting, duodenal dyskinesia), pancreatic juice and intestinal contents can enter the common bile duct with the subsequent development of inflammation in the ductal system.
The length of the intramural part of the common bile duct is about 15 mm. In this regard, to reduce the number of complications after endoscopic papillotomy, it is necessary to make a 13-15 mm incision in the upper sector of the major duodenal papilla.
Histological structure. The wall of the gallbladder consists of mucous, muscular and connective tissue (fibromuscular) membranes, bottom wall covered with a serous membrane (Fig. 1.19), and the upper one does not have it, it is adjacent to the liver (Fig. 1.20).
The main structural and functional element of the gallbladder wall is the mucous membrane. On macroscopic examination of an opened bladder, the inner surface of the mucous membrane has a fine-mesh appearance. The average diameter of irregularly shaped cells is 4-6 mm. Their boundaries are formed by gentle low folds 0.5-1 mm high, which flatten and disappear when the bladder fills, i.e. are not stationary anatomical education(Fig. 1.21). The mucous membrane forms numerous folds, due to which the bladder can significantly increase its volume. There is no submucosa or muscularis propria in the mucous membrane.
The thin fibromuscular membrane is represented by irregularly located smooth muscle bundles mixed with a certain amount of collagen and elastic fibers (see Fig. 1.19, Fig. 1.20). The bundles of smooth muscle cells of the bottom and body of the bladder are located in two thin layers at an angle to each other, and in the neck area circularly. Transverse sections of the gallbladder wall show that 30-50% of the area occupied by smooth muscle fibers is represented by loose connective tissue. This structure is functionally justified, since when the bladder is filled with bile, connective tissue layers with a large number of elastic fibers are stretched, which protects the muscle fibers from overstretching and damage.
In the depressions between the folds of the mucous membrane there are crypts or Rokitansky-Aschoff sinuses, which are branched invaginates of the mucous membrane, penetrating through muscle layer walls of the gallbladder (Fig. 1.22). This feature of the anatomical structure of the mucous membrane contributes to the development acute cholecystitis or gangrene of the gallbladder wall, stagnation of bile or the formation of microliths or stones in them (Fig. 1.23). Despite the fact that the first description of these structural elements of the gallbladder wall was made by K. Rokitansky in 1842 and supplemented in 1905 by L. Aschoff, physiological significance these formations are assessed only in Lately. In particular, they are one of the pathognomonic acoustic symptoms of adenomyomatosis of the gallbladder. The wall of the gallbladder contains Lushka's moves- blind pockets, often branched, sometimes reaching the serous membrane. Microbes can accumulate in them and cause inflammation. When the mouth of Luschka's passages narrows, intramural abscesses can form. When removing the gallbladder, these passages in some cases can be the cause of bile leakage in the early postoperative period.
The surface of the mucous membrane of the gallbladder is covered with high prismatic epithelium. On the apical surface of epithelial cells there are numerous microvilli that form an absorptive border. In the cervical area there are alveolar tubular glands that produce mucus. IN epithelial cells enzymes found: β-glucuronidase and esterase. Using a histochemical study, it was established that the mucous membrane of the gallbladder produces carbohydrate-containing protein, and the cytoplasm of epithelial cells contains mucoproteins.
Bile duct wall consists of mucous, muscular (fibromuscular) and serous membranes. Their severity and thickness increase in the distal direction. The mucous membrane of the extrahepatic bile ducts is covered with a single-layer high prismatic epithelium. It has many mucous glands. In this regard, the ductal epithelium can perform both secretion and resorption and synthesize immunoglobulins. The surface of the bile ducts is smooth over a large extent; in the distal part of the common duct it forms pocket-like folds, which in some cases make it difficult to probe the duct from the duodenum.
The presence of muscle and elastic fibers in the wall of the ducts ensures their significant expansion during biliary hypertension, compensates for bile outflow even with a mechanical obstruction, for example, with choledocholithiasis or the presence of putty-like bile in it, without clinical symptoms of obstructive jaundice.
A feature of the smooth muscles of the sphincter of Oddi is that in its myocytes, compared to muscle cells gallbladder contains more γ-actin than α-actin. Moreover, the actin of the sphincter of Oddi muscles is more similar to the actin of the longitudinal muscular layer of the intestine than, for example, to the actin of the muscles of the lower esophageal sphincter.
The outer shell of the ducts is formed by loose connective tissue in which blood vessels and nerves are located.
The gallbladder is supplied with blood by the cystic artery. This is a large tortuous branch of the hepatic artery, which has a different anatomical location. In 85-90% of cases it arises from the right branch of the own hepatic artery. Less commonly, the cystic artery originates from the common hepatic artery. The cystic artery usually crosses the hepatic duct posteriorly. The characteristic arrangement of the cystic artery, cystic and hepatic ducts forms the so-called Calot triangle.
As a rule, the cystic artery has a single trunk, less often it splits into two arteries. Considering the fact that this artery is terminal and can undergo atherosclerotic changes with age, in elderly people in the presence of an inflammatory process in the gallbladder wall, the risk of necrosis and perforation increases significantly. Smaller blood vessels penetrate the wall of the gallbladder from the liver through its bed.
Veins of the gallbladder are formed from intramural venous plexuses, forming the cystic vein, which flows into portal vein.
Lymphatic system. There are three networks of lymphatic capillaries in the gallbladder: in the mucous membrane under the epithelium, in the muscular and serous membranes. The lymphatic vessels formed from them form the subserosal lymphatic plexus, which anastomoses with the lymphatic vessels of the liver. The outflow of lymph is carried out into the lymph nodes located around the neck of the gallbladder, and then into the lymph nodes located at the porta hepatis and along the common bile duct. Subsequently, they connect with lymphatic vessels that drain lymph from the head of the pancreas. Enlarged lymph nodes when they are inflamed ( pericholedocheal lymphadenitis) can cause obstructive jaundice.
Innervation of the gallbladder carried out from the hepatic nerve plexus, formed by branches of the celiac plexus, anterior vagus trunk, phrenic nerves and gastric nerve plexus. Sensitive innervation is carried out by nerve fibers V-XII of the thoracic and I-II lumbar segments spinal cord. In the wall of the gallbladder, three first plexuses are distinguished: submucosal, intermuscular and subserosal. With chronic inflammatory processes in the gallbladder, degeneration of the nervous system occurs, which underlies chronic pain syndrome and dysfunction of the gallbladder. The innervation of the biliary tract, pancreas and duodenum has a common origin, which determines their close functional relationship and explains the similarity of clinical symptoms. The gallbladder, cystic and common bile ducts contain nerve plexuses and ganglia similar to those in the duodenum.
Blood supply biliary tract carried out by numerous small arteries originating from the proper hepatic artery and its branches. The outflow of blood from the wall of the ducts goes into the portal vein.
Lymphatic drainage occurs through lymphatic vessels located along the ducts. The close connection between the lymphatic ducts of the bile ducts, gallbladder, liver and pancreas plays a role in metastasis in malignant lesions of these organs.
Innervation carried out by branches of the hepatic nerve plexus and interorgan communication like local reflex arcs between the extrahepatic bile ducts and other digestive organs.
The gallbladder (GB) is located on the visceral (lower) surface of the liver. The line that separates the right and left lobes of the latter is located in the bed of the gallbladder.
The gallbladder is a reservoir for receiving and concentrating bile. Normally its dimensions are:
- length - 9 cm, but can range from 8 to 14;
- width - 3 cm, can reach 5 cm;
- volume - from 30 to 80 ml;
- wall thickness - 2-3 mm.
As it fills, it can stretch and hold up to 200 ml of bile. Depending on the filling, the organ takes a cylindrical, pear-shaped or oval shape. A healthy organ has a bluish-greenish tint and translucent walls. As its condition worsens and becomes inflamed, it darkens and the walls become opaque and thicken.
The gallbladder has three segments that are not anatomically demarcated: the fundus, the body and the neck. The cystic duct departs from the neck, which then connects with the common hepatic duct. As a result of their fusion, a common bile duct is formed, through which bile passes into the duodenum.
Normally, a healthy organ is not palpable. The bottom of the gallbladder is covered with peritoneum and can be palpated if there are any diseases in it. The body is not completely covered with peritoneum, it top part is in contact with the liver, from which it is separated by connective tissue.
The tissue contains blood and lymphatic vessels, nerve fibers, and sometimes accessory hepatic ducts. If it is necessary to remove the gallbladder, the surgeon is faced with the task of separating the loose connective tissue to prevent blood loss. During inflammation, the tissue between the liver and gallbladder undergoes obliteration. Then the task becomes more complicated, since cholecystectomy may affect the liver parenchyma.
The neck may have a protrusion, the so-called Hartmann's pouch. But normally the cervix does not have a pocket; most often it acquires this shape during inflammatory processes.
The cystic duct extends from the neck of the bladder; at its exit there is the Lutkens sphincter, with the help of which the excretion of bile is controlled. The length of the cystic duct is 4–6 cm, sometimes it can reach 8–11 cm. The diameter is usually 2-3 mm.
The blood supply to the gallbladder passes through the cystic artery, which arises in one or two trunks from the hepatic artery or its branch located on the right.
The wall of the organ (in the mucous and serous membranes) contains a network lymphatic vessels. The submucosa also contains a plexus of lymphatic capillaries.
The location of the gallbladder depends on age and body type. Relative to the spine, it is located at the height of 1 and/or 2 lumbar vertebrae.
Read also:
Gallbladder – signs and symptoms.
Read more about hepatitis A.
Bile is produced in the liver constantly and is consumed as food is consumed. Since we do not eat 24 hours a day, bile reserves enter the gallbladder.
During the day, the liver produces up to one liter of bile. It can, bypassing the bladder, immediately enter the common bile duct. But normally, most of it accumulates in the bladder. There are cystic bile and hepatic bile.
In the bladder, bile is concentrated tenfold. 50 ml of gallbladder bile is equivalent to 500 ml of liver bile.
When food enters the duodenum, hormones (cholecystokinin, secretin, endorphins) are released, which cause the gallbladder to contract and the sphincter of Oddi to open - bile is released from the bladder.
When the contents of the intestines become alkaline under the influence of bile, the secretion of hormones stops and the flow of bile stops.
Despite their simple functions, the gallbladder is susceptible to diseases and can cause trouble for its owner.
Deformations
The anatomy of the gallbladder begins to interest us if there are any problems with the organ. Diseases of the gallbladder and biliary tract are not very common, but they are very common. According to some data, up to 30 percent of women and 10 percent of men after 40 years of age suffer from them. The most common diseases are:
- biliary dyskinesia;
- cholelithiasis;
- cholecystitis (most often the disease is a consequence of the presence of stones).
Polyps and tumors are much less common.
Acquired diseases are prevalent mainly in developed countries, where there are no food shortages and the majority of the population has access to meat products rich in cholesterol. Diseases are also associated with overeating, obesity, and lifestyle. In the USA and Europe, up to 10–15% of the population is affected, in African countries - no more than 2%.
In Russia, in some regions, gastrointestinal tract diseases are detected in 40–50 percent of ultrasound scans.
As a result of diseases, anatomical deformations of the organ develop. The following acquired deformities are distinguished:
- kinks of the gallbladder;
- enlargement (decrease) of an organ;
- diverticulum - protrusion of the wall of the bladder;
- wall deformation.
Gallbladder kinks are a common pathology in adults. The deformity usually occurs at the junction of the cervix with the body, but can also occur in other areas, which impairs the flow of bile. It stagnates and stones gradually begin to grow.
Bladder bending is one of the causes of cholelithiasis. And the causes of excesses in adults can be:
- physiological inflection - anatomical prolapse of organs in old age;
- enlarged gallbladder or liver;
- obesity;
- fasting or overeating;
- functional inflection that occurs due to overload and heavy lifting.
Diverticulum - a protrusion of the wall of the gallbladder - is very rare, more often as an acquired form. May not show itself long years. And it can cause stagnation of bile with the formation of stones.
Deformation of the walls - their thickening - occurs as a result of chronic cholecystitis. There are calculous cholecystitis (with the presence of stones in the bladder) and acalculous cholecystitis. The walls are more than 4 mm thick; the organ cannot be palpated during palpation, since it most often decreases in size due to sclerosis and scarring of the tissue.
At chronic cholecystitis, if treatment does not help, doctors recommend cholecystectomy, otherwise the gallbladder ceases to perform its functions.
"Disabled" organ
The term “disabled” gallbladder was coined by radiologists. When the contrast agent did not enter the organ, they said that it was turned off, that is, it did not function, did not accumulate bile and did not release it. The reasons may be:
- Blockage of the bile duct by a stone or scar.
- The entrance to the residential complex is closed due to a bend.
- Filling with stones.
- Organ sclerosis. Due to inflammation, the muscles have atrophied and the bladder is filled with scar tissue.
- The deposition of calcium salts on the walls leads to a condition where the walls become hard, “porcelain-like.”
A disabled gallbladder in most cases requires surgery - cholecystectomy.
Is a gallbladder necessary at all?
The structure of the gallbladder and biliary tract is not the most perfect structure in the human body. Their inflammation can lead to diseases of the duodenum and pancreas.
Many people suffer from gallbladder diseases and eventually decide to undergo cholecystectomy. In Russia, up to 600 thousand such operations are performed per year, in the USA - more than a million.
And many people have a question: is this organ needed at all? After all, bile can flow freely into the intestines without a reservoir. There are two polar opposite opinions.
Surgeons are convinced that we needed it when a person ate irregularly, and the gallbladder helped digest food when it was possible to eat enough. In modern conditions, the gallbladder is not particularly required, nor are fat reserves.
Naturopaths assure that it is impossible to do without it, and it must be protected like the apple of your eye. After cholecystectomy, bile will allegedly continuously flow into the intestines and irritate it.
We really need a healthy bladder; without it, digestion will not be as comfortable. But if the gallbladder has ceased to perform its functions, there is an inflammatory process in it, it causes suffering, then such an organ is absolutely not needed by the body. In addition, it becomes dangerous for the organs and tissues surrounding it.
The bile ducts can store bile and take over its function.
