Gallbladder

Where is the gallbladder located?

The organ is located on the visceral surface of the liver in the gallbladder fossa (fossa vesicae biliaris). This fossa separates the anterior part of the right lobe of the liver from the quadrate lobe.

The surface of the gallbladder facing the liver lacks peritoneum and is connected to the fibrous capsule of the liver. The free surface facing the abdominal cavity is covered by visceral peritoneum. Variations of intraperitoneal position of the organ and the presence of a mesentery are possible.

Organ structure

The gallbladder has a dark green color, a relatively thin wall, and an elongated pear-shaped form. Its width gradually decreases from the fundus to the neck. Anatomically, it has three parts:

• Fundus (fundus vesicae biliaris / felleae) is the widest and most distal part. It is directed forward and toward the inferior border of the liver, and may sometimes project below it.
• Body (corpus vesicae biliaris / felleae).
• Neck (collum vesicae biliaris / felleae) is the proximal narrow part. At the junction of the body and the neck, there is often a bend, causing the neck to lie at an angle to the body. It is oriented toward the porta hepatis.

The neck transitions into the cystic duct (ductus cysticus). The neck and cystic duct lie within the hepatoduodenal ligament (lig. hepatoduodenale). By joining the common hepatic duct, the cystic duct forms the common bile duct (ductus choledochus).

Innervation and motility

The process of bile excretion and the motility of the biliary tract are referred to as cholekinesis. The function of the organ is regulated by the autonomic nervous system:

• Parasympathetic nervous system (visceromotor fibers of the vagus nerve, n. vagus): causes contraction of the gallbladder and bile excretion.
• Sympathetic nervous system (via $\beta_2$-receptors): causes relaxation of the organ.

Clinical significance and diagnostics

• Duodenal intubation: a method of obtaining bile using a tube with a metal olive tip. It allows for the collection of 5 fractions and separately retrieving bile from the common bile duct, gallbladder, and intrahepatic ducts. The method is contraindicated in suspected cholelithiasis, as stimulation of bile secretion can provoke stone movement and colic.
• Radiopaque methods: transhepatic percutaneous cholangiography (introduction of contrast via a needle through the skin and liver tissue directly into the ducts or gallbladder) and ERCP (retrograde introduction of contrast through the opening of the common bile duct during endoscopy) are used to visualize anatomy.
• Infections and parasitoses: in cholera, the gallbladder becomes sharply distended and filled with colorless watery bile; vibrios enter it via an ascending route from the intestine. In opisthorchiasis, parasites migrate into the bile ducts and gallbladder due to positive chemotaxis toward bile.

Surgical procedures (cholecystectomy)

Gallbladder removal can be performed using two main approaches:

• Retrograde cholecystectomy (from the neck): the cystic artery (a. cystica) is isolated and ligated. Then the cystic duct is isolated and ligated, 0.5 cm away from its junction with the common bile duct. Leaving too long a stump threatens dilation and stone formation, while ligation flush with the duct narrows the lumen of the common duct. Intraoperative cholangiography is performed.
• Antegrade cholecystectomy (from the fundus): the peritoneum is incised from the fundus to the neck, the gallbladder is grasped with a clamp and dissected from its bed. It is extremely critical to avoid opening the lumen of the gallbladder to prevent infecting the abdominal cavity. After removal, the liver bed is peritonealized (serosal edges are sutured together).

Class and exam questions

What else to study on this topic

• Liver (hepar) and its visceral surface
• Common bile duct (ductus choledochus)
• Hepatoduodenal ligament (lig. hepatoduodenale)
• Vagus nerve (nervus vagus)

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.