The gall bladder and biliary tree (Dave's notes)

Question 1

Describe the shape, volume and components of the gall bladder

Answer 1

• Globular pear shaped viscus of 50mL approx
• consisting of fundus, body and neck

Question 2

What are the relations of the gall bladder?

Answer 2

• anterior and superiorly: inferior border of liver and anterior abdominal wall
• posterior: transverse colon and proximal duodenum
• inferiorly: biliary tree and remaining parts of duodenum

Question 3

Describe the cystic duct with length and distance to significant structures

Answer 3

• Connects neck of gallbladder to the common hepatic duct. Draining bile to and from the biliary tree.
• approx 2-3cm long and 2-3 in diameter.
• travels towards the porta hepatis to join CHD 1cm above the duodenum

Question 4

What is the blood supply of the gall bladder?

Answer 4

• Cystic artery which is a branch of the right hepatic.
• Found in Calot’s triangle. - The cystic artery is an end artery but the gall bladder can be sustained by supply from the bed.

Question 5

What constitutes the borders of Calot’s triangle?

Answer 5

• inferior surface of liver
• common hepatic duct
• cystic duct

Question 6

Describe the venous drainage of the gall bladder

Answer 6

neck: cystic vein -> PV

fundus and body : hepatic sinusoids.

Question 7

Describe the lymphatic drainage of the gall bladder

Answer 7

cystic LN (at the gb neck) -> hepatic LN -> coeliac nodes

Question 8

What and where is mucous secreted in the gall bladder?

Answer 8

Mucous is secreted by columnar epithelium (not goblet cells) in the neck

Question 9

Describe the confluence of the common hepatic duct

Answer 9

R and left hepatic ducts emerge from the porta hepatis uniting on the right side in a Y shaped manner.

Question 10

What are the dimensions of the common hepatic duct?

Answer 10

4cm long and 4mm in diameter

Question 11

Where does the cystic duct meet the common hepatic duct?

Answer 11

The cystic duct usually meets the common hepatic duct on the right side about 1cm above the duodenum but there is significant variation

Question 12

Describe the dimensions of the common bile duct

Answer 12

8cm long and 7mm diameter.

Question 13

What is the blood supply of the common bile duct?

Answer 13

Network of arteries from several sources:

• above: right hepatic artery & cystic artery
• below: posterior superior pancreaticoduodenal artery, retroduodenal artery and retroportal artery

Question 14

What are the three divisions of the common bile duct?

Answer 14

*Upper (supraduodenal), *middle (retroduodenal)
*lower (paraduodenal).

Question 15

What are the relations of the upper/supraduodenal segment of the common bile duct?

Answer 15

The supraduodenal segment of the common bile duct lies in the free edge of the lesser omentum
- Anterior to the portal vein
- Right of the hepatic artery

Question 16

What are the relations of the middle/retroduodenal segment of the common bile duct?

Answer 16

The retroduodenal segment of the common bile duct runs behind D1 and slopes down to the right away from the portal vein

Question 17

What are the relations of the lower/paraduodenal segment of the common bile duct?

Answer 17

The paraduodenal segment slopes further to teh right behind the head of the pancreas and D2, joinging the pancreatic duct

Question 18

What is the nerve supply of the gall bladder?

Answer 18

Sympathetic and parasympathetic.

Question 19

What is the origin and action of the parasympathetic supply to the gall bladder?

Answer 19

The parasympathetic supply to the gall bladder is via the hepatic branch, and stimulates contraction

Question 20

What is the origin and action of the sympathetic supply to the gall bladder?

Answer 20

?? Origin, inhibits contraction

Question 21

What provides the majority of control over the gall bladder?

Answer 21

Hormonal control

Question 22

Where is biliary pain felt?

Answer 22

Usually in the right hypochondrium and epigastrium, but may radiate to the back and infrascapular region