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(S-W5-Sun-Gen.S) (By Dr. Emad) Gall Bladder 1
(S-W5-Sun-Gen.S) (By Dr. Emad) Gall Bladder 1
Ducts Surgery
1
Emad Geddoa
FICS, MD, MRCS
Laparoscopic General & GIT Surgeon
October 2018
Learning Objectives
• At the junction of the neck of the gallbladder and the cystic duct,
there is an out-pouching of the gallbladder wall forming a
mucosal fold known as Hartmann's pouch, where gallstones
commonly get stuck.
• The muscle fiberes in the wall of the gall bladder are arranged in
a criss-cross manner, being particularly well developed in its
neck.
• Occasionally, the cystic duct may join the right hepatic duct .
• The common hepatic duct is usually less than 2.5 cm long and is
formed by the union of the right and left hepatic ducts.
• Bile is produced by the liver and stored in the gall bladder from
which it is released into the duodenum.
1. Reservoir for bile. During fasting, resistance to flow through the sphincter
of Oddi is high, and bile excreted by the liver is diverted to the gall bladder.
After feeding, the resistance to flow through the sphincter is reduced, the gall
bladder contracts and the bile enters the duodenum.
These motor responses of the biliary tract are in part effected by the hormone
cholecystokinin.
2. Concentration of bile by active absorption of water,
sodium chloride and bicarbonate by the mucous
membrane of the gall bladder.
The hepatic bile which enters the gall bladder becomes
concentrated 5–10 times, with a corresponding
increase in the proportion of bile salts, bile
pigments, cholesterol and calcium.
3. Secretion of mucus – approximately 20-30 ml is
produced per day.
With complete obstruction of the cystic duct in an
otherwise healthy gall bladder, a mucocoele may
develop as a result of ongoing mucus secretion by
the gall bladder mucosa.
Compositions of bile
• Plain x-rays
• The skillfully taken plain x-ray of the gall bladder will show
radiopaque gallstones in 10 per cent of patients.
• Rarely, the centre of a stone may contain radiolucent gas in a
triradiate or biradiate fissure and this gives rise to
characteristic dark shapes on a radiograph – the ‘Mercedes–
Benz’ or ‘seagull’ sign.
• A plain x-ray may also show the rare cases of calcification of the gall bladder, a so-called ‘porcelain’ gall bladder.The importance of
this appearance is that it is associated with carcinoma in up to 25 per cent of cases and is an indication for cholecystectomy
• Gas in the gall bladder and gall bladder wall (Clostridium perfringens). Emergency surgery is
indicated.
HIDA Scan
EUS
Peroperative cholangiography
Peroperative cholangiography. (a) Normal common bile duct: gentle infusion of
contrast which passes without hindrance into the duodenum. (b) The common bile
duct is dilated with multiple stones. Contrast is seen to reflux into the pancreatic
duct. A sphincterotomy was performed