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BIOL226Lec06 - Gall Bladder
BIOL226Lec06 - Gall Bladder
I. Introduction/General Information A. Location: 1. Epigastric region 2. Right hypochondriac region 3. On inferior surface of liver 4. Between quadrate and right lobes
Location of Gallbladder
Gallbladder
Fundus
Introduction, continued
F. Normal measurements: 7-10 cm long ~ 6 cm diameter 30 35 cc volume G. Body and neck directed toward porta hepatis
Introduction, continued
H. Neck is continuous with cystic duct I. Cystic duct: 1. joins common hepatic duct 2. superior and posterior to pylorus of stomach
Introduction, continued
CBD, continued
Introduction, continued
Ampulla of Vater
A. Fundus of GB: 1. may be palpated 2. in angle between lateral border of right rectus abdominis and costal margin 3. At level of elbow 4. Most anterior visceral structure
B. Body of Gallbladder 1. Visceral surface of liver 2. Deep to transverse colon or hepatic flexure of colon 3. Descending portion of duodenum is medial
E. Neck of gallbladder
1. continuous with cystic duct
GB Anatomy
Spiral Valve (of Heister) in Cystic Duct
F. Hartmanns Pouch
1. Infundibulum of gallbladder 2. Lies between body and neck of gallbladder 3. A normal variation 4. May obscure cystic duct 5. If very large, may see cystic duct arising from pouch
Hartmanns Pouch
G. Cystic Duct
1. 3-4 cm long 2. Extends from neck of gallbladder to common hepatic duct 3. Joins with common hepatic duct inferior to porta hepatis 4. Spiral valve may extend into neck of gallbladder
Cystic Duct
H. Epiploic Foramen (of Winslow): 1. an opening deep to lesser omentum 2. leads to lesser peritoneal cavity 3. separates Right portal vein and IVC 4. important clinically
Epiploic Foramen
Epiploic foramen
Lesser peritoneal cavity
5. Surgically, foramen can be used to palpate CBD to check for stones 6. Clinically significant because abscesses may spread via this foramen into lesser peritoneal cavity
I. CBD has: 1. hepatic artery on left and portal vein posterior 2. descends in free margin of lesser omentum
J. Retroduodenal (2nd) portion of CBD 1. runs parallel to gastroduodenal artery 2. GDA lies to left of CBD
2. in tube or sulcus closely related to: a. IVC b. Portal Vein c. Gastroduodenal artery
3. On Transverse scans: a. CBD appears as rounded, fluid-filled structure b. anterior and lateral to portal vein
4. On Longitudinal Scans: 1. the common hepatic duct crosses anterior to right portal vein 2. the CBD courses inferior to head of pancreas
Cystic artery
c. Superficial branch, to peritoneal surface of GB d. Deep branch, to hepatic surface of GB e. May be doubled or tripled
Right Hepatic Artery Cystic Artery, Superficial Branch Cystic Artery, Deep Branch
2.
1. Anatomical variation
2. Fund is is folded back on itself
3. not pathological
1. Cholecystitis = inflammation of GB
2. Cholelithisis = Stone(s) in GB
Cholelithiasis
B. Failure to delineate GB
C. Intraluminal defects
1. GB Carcinoma
a. US useful in diagnosis
2. Polyps of GB
a. Intraluminal echogenic projections b. do not change position with patient c. Must be differentiated from septations, mucosal folds
1. septations extend across lumen 2. folds change configuration upon inspiration