Anatomy of Gallbladder and

Pancreas
By Dr.Dilrukshi Thavin
 Learning Outcomes
On completion of this plenary, the students should be able to
1. describe the location and relations of the gallbladder.
2. discuss the blood supply and lymphatic drainage of the gallbladder.
3. explain the gross anatomy of the pancreas and its clinical
importance.
4. relate the blood supply of the pancreas and its
development.
5. discuss microscopic structures of the gallbladder and the
pancreas .
 GALLBLADDER

• a pear-shaped sac lying along

the right side of the quadrate
lobe of the liver in a shallow
fossa.
• covered by the peritoneum.

• receives, concentrates and

stores the bile formed in the
liver.
• capacity 30-50 ml.
• rounded end (fundus)
• major part (body)
• narrow part (neck).
• fundus projects beyond
the inferior margin of the
liver at the level of right
9th costal cartilage.

• body ----- contact with the

visceral surface of the
liver.
• directed upward,
backward, and to the left.
Neck of GallBladder
• mucosa is thrown into a sprial
fold (valve of Heister)
• serves a guide to the epipolic
foramen.
• continuous with the cystic duct.

Cystic Duct Neck

Cystic duct

• 3.8 cm (1.5 in.) long

• connects the neck to the
common hepatic duct to form
the bile duct.
• mucous membrane is raised to
form the spiral fold known as the
“spiral valve” which keeps the
lumen constantly open.
 Percutaneous transhepatic
cholangiogram demonstrating the bile
duct system
Endoscopic retrograde cholangiography of gallbladder
and biliary passages
 Relations

Anterior
- the anterior abdominal
wall
- the inferior surface of
the liver

Posterior
- the transverse colon
- the first and second
parts of the duodenum
Arterial supply
- the cystic artery from the

right hepatic artery

(a branch of the hepatic
artery proper).

Venous drainage
- the cystic vein drains
directly into the portal
vein. (joins the right
branch of portal vein)
Common variations of blood supply to the gallbladder
 Cystic
yst
Lymph drainage
lymph node

- Drains into a cystic

lymph node situated
near the neck of gall Hepatic Celiac nodes

bladder.
nodes

- pass to the hepatic

nodes along the
hepatic artery and
then to the celiac
nodes.
Nerve Supply

Sympathetic, visceral afferent (pain) fibres celiac plexus

Parasympathetic vagus nerve
Somatic afferent fibres right phrenic nerve

The gallbladder contracts in response to the hormone

cholecystokinin produced by the mucous membrane of the
duodenum on the arrival of fatty food from the stomach.
 Calot’s Triangle (Cysto-hepatic
triangle of Calot)

• Visceral surface of liver – Superior

• Common hepatic duct - medially
• Cystic duct - inferiorly

• The cystic artery lies within the

triangle.
 Microscopic srtuctures of the
Gallbladder

Epithelium (simple columnar)

Lamina propria

(Muscularis externa)
Smooth muscle
Applied Anatomy
1. Gall stones collect in the gallbladder causing
gallstone colic or producing acute cholecystitis.
2. Acute Cholecystitis
• Referred pain over the
shoulder because the skin in
this area is supplied by the
supraclavicular nerves (C3,4).
• Inflammation of gallbladder
may irritate the
subdiaphragmatic parietal
peritoneum which is supplied
in part by the phrenic nerve
(C3,4,5).
3. Gangrene of the gallbladder
Rarely becomes gangrenous because the small
vessels from the visceral surface of the liver also
supply the gallbladder.
4. Biliary colic
 PANCREAS
 elongated structure

 lies in the epigastrium and Pancreas

the left upper quadrant.

 Retroperitoneal structure

 both an exocrine and an

endocrine gland.
 Microscopic structure of the Pancreas
• An exocrine secretion
(pancreatic juice from the
acinar cells) enters the
duodenum through the
main and accessory
pancreatic ducts.

- Endocrine secretions from the pancreatic islets [of Langerhans]

- Alpha cells – 20%, lie at the periphery, produce glucagon
(A cells)
- Beta cells - 60-80%, smaller and more numerous than A cells
(B cells) lie at the centre of the islet, produce insulin
- Delta cells - least in number, large cells
(D cells)
 head, neck, body and tail.
 Head of pancreas ---- within the C-shaped
concavity of the duodenum.
 A part of the head, which extends to the
left behind the superior mesentric vessels,
is called the uncinate process.

 Neck the constricted portion

anterior to the superior mesentric vessels.

 The body of the pancreas runs upwards and to the left.

 The tail of the pancreas passes between the layers of
splenorenal ligament.
Relations
Anteriorly: right to left
the transverse colon, the
attachment of transverse mesocolon
the lesser sac, stomach
Posteriorly: right to left
the bile duct, the portal and splenic
veins, the inferior vena cava, aorta,
the origin of superior mesentric
artery, the left psoas muscle, the
left suprarenal gland, the left
kidney, the hilum of the spleen
 PANCREATIC DUCT
 main pancreatic duct (Wirsung)
begins in the tail and runs the length
of the gland.
 joins the bile duct forming the Main
pancreatic
duct

hepatopancreatic ampulla (ampulla Major

of Vater) in the lower part of head. duodenal

papilla

 ampulla enters the descending Hepatopancreatic

ampulla

(second) part of the duodenum at

the major duodenal papilla.

 Sometimes drains separately into the duodenum.

 Surrounding the ampulla - the sphincter of ampulla
(Sphincter of Oddi).
 accessory pancreatic duct
(Santorini) drains the upper
part of the head and opens
into the duodenum a short
distance above the main
duct on the minor duodenal
papilla.
 main and accessory
pancreatic ducts usually
communicate with each
other.
 The presence of these two
ducts reflects the
embryological origin of the
pancreas from dorsal and
ventral buds from the
foregut.
Variations in the ductal system of
the pancreas
Blood Supply
Arteries
• gastroduodenal artery from
the common hepatic artery (a

branch of celiac trunk).

(anterior superior
pancreaticoduodenal artery,
posterior superior
pancreaticoduodenal artery)

- dorsal pancreatic artery from

the inferior pancreatic artery (a

branch of the splenic artery).

• superior mesentric artery

-(anterior and posterior inferior pancreaticoduodenal artery)

Veins
Drain into the portal system.

Lymph drainage
• Pancreaticosplenic lymph nodes.
• The efferent vessels drain into the celiac and superior
mesentric lymph nodes.

Nerve Supply
Sympathetic and parasympathetic (vagal) nerve
 Duct System of the Bile
 extends from the liver
 connects with the gallbladder
 empties into the second part of the duodenum.
 Right and left hepatic ducts common hepatic duct
 Common hepatic duct and the cystic duct the bile duct (common bile duct).
 Bile duct and main pancreatic duct ampulla of Vater opens into the

duodenum
Applied Anatomy

1. Pain from the pancreas referred

to the back

2. obstructive jaundice in the case of

carcinoma of the head of the
pancreas

3. Impaction of a stone in the ampulla

of Vater Infected bile into the
pancreatic duct, producing
pancreatitis.
4. Splenectomy damage of the tail of
pancreas
(in the splenorenal ligament)

5. Annular pancreas may cause the

obstruction of the duodenum.
Vomiting may start a few hours after birth.
 Questions

Murphy’s point

Importance of the relations of the pancreas