ALT and AST
03.07.2020

Atlas of human anatomy of the gallbladder. Human gallbladder anatomy. Brief anatomy of the duodenum

Most patients do not even know where the gallbladder (GB) is located. At the same time, this organ performs important functions in the body - it actively participates in the digestive process and carries out the breakdown and emulsification of lipid droplets necessary for metabolism. The gallbladder is a hollow organ with thin walls, inside which bile accumulates, coming from the liver and excreted through the duodenum. In case of any disturbances in its functioning, it is necessary to take urgent measures to reduce the severity of symptoms. Refusal of therapy can lead not only to complications, but also to the development of chronic diseases.

The gallbladder most often has a pear-shaped shape, but various diseases or pathologies of the organ can contribute to the formation of constrictions, resulting in its deformation.

The standard gallbladder parameters are as follows:

  1. length - no more than 100 mm;
  2. width - within 40 mm;
  3. capacity - about 70 ml.

The wall of the gallbladder is elastic and can stretch, which occurs with cholelithiasis. In this case, the capacity of the organ increases to 200 ml.

Anatomy of the gallbladder

The structure of the gallbladder consists of the following sections:

  • body - the largest part, covered by the liver from above and in front;
  • The neck is a continuation of the body. At the junction there is a Hartmann's pouch, which has a slight narrowing near the junction with the neck. With a funnel-shaped narrowing, this section of the bladder forms the cystic duct;
  • bottom - facing the anterior wall of the peritoneal cavity and protrudes slightly from behind the liver. If the bladder is full of bile, the bottom can be detected by palpation.

The walls of the gallbladder consist of several layers: mucous, muscular, fibrous and serous.

The mucous membrane is represented by a loose elastic layer of fibers, high epithelium of the prismatic type. There are also glands responsible for the production of mucus. The largest number of glands is located near the neck.

The upper part of the epithelium has small villi, which increase the area of ​​contact with bile secretion. The mucous surface is uneven, folded, and has a velvety appearance. Pronounced folds are noted near the neck and duct and form valves - “Geyster valves”.

The muscle layer is a loose tissue and consists of smooth muscle tissue, as well as elastic fibers that have different directions. Circular fibers near the neck are pronounced and are capable of forming a sphincter - “Lutkens sphincter”.

The fibrous membrane and muscle tissue in the body of the organ are interconnected. There are moves between them. In the upper part of the organ, the tubular passages have epithelium, which communicates with the bile ducts located inside the liver.

Location of the gallbladder

The shape and location of the gallbladder and liver are individual and depend on various characteristics of the human body. This must be taken into account when diagnosing diseases and pathologies.

Typically, the gallbladder is covered on all sides by the walls of the abdominal cavity, and one side is in contact with the liver. But there are exceptions when complete coverage by the peritoneum is diagnosed, only blood vessels, nerves and duct remain free.

On the right side of the gallbladder there is the large intestine and duodenum. On the left is the stomach.

Between the upper border of the organ and the lower part of the liver there is connective tissue that has a loose consistency. The bottom is covered with sheets of the abdominal cavity, which also affect the liver. When the organ is completely covered by the peritoneum, it becomes mobile.

Most often, a person experiences immersion of most of the bladder into the liver, which creates certain difficulties when removing the organ.

It is also worth considering that between the internal ducts of the liver and the bladder there is a thin layer - parenchyma. In rare cases, it is located inside the liver. In this case, the neck of the bladder still remains outside this organ.

As for the neck of the bladder and the hepatic duct, they are connected to each other to form the cystic duct, the length of which normally should not exceed 40 mm. The bile duct in the human body is considered the longest and can reach a length of 80 mm. It includes such departments as:

  1. supraduodenal;
  2. retroduodenal;
  3. pancreatic;
  4. interstitial.

In most cases, this duct in humans connects with the pancreatic duct and opens into the area of ​​the duodenal papilla.

If a patient is diagnosed with an inflammatory process in the liver, stomach, or intestines, then inflammation is also observed in neighboring areas that are associated with the bladder.

Blood flow, lymph flow and innervation

The gallbladder is supplied with blood from the cystic artery, which arises from the right hepatic artery. The gallbladder artery is located on the outside of the cervix and is divided into two branches going to the lower and upper walls of the organ. In the anterior section, the artery is located under the lymph node of Mascagni’s gland.

However, the artery can take its origins from other arteries, which are localized in the area of ​​the stomach, liver or duodenum.

The outflow of blood from the gallbladder occurs through veins that form venous trunks.

The outflow of lymph is carried out into the lymphatic system of the liver or into extrahepatic vessels.

The organ is innervated from the solar plexus, from the accumulation of the phrenic and vagus nerves.

Operation

The gallbladder collects and concentrates bile within itself. When the appropriate signal is received from the gastrointestinal tract, it releases bile, which helps process food.

Bile is produced by the liver parenchyma. Its amount depends on the patient's diet. Products such as animal fats, seasonings, spices, alcoholic beverages, and tobacco smoking can trigger increased bile production. Intense flow of bile stretches the walls of the gallbladder and leads to a pathological condition.

Gallbladder diseases lead to disruption of the normal functioning of the organ. The formation of stones indicates the progression of the inflammatory process in the body.

The performance of the gallbladder is regulated by cholecystokinin, a hormonal substance that provokes contraction of the muscle tissue of the organ wall. Its production occurs in the cells of the duodenum. In order for cholecystokinin to leave the organ, simultaneous contraction of the bladder wall and relaxation of the exit sphincter of Oddi must occur. If the process is disrupted, the patient will suffer from contractions in the right hypochondrium half an hour after eating.

Currently, doctors have proven that a person can live without a gallbladder. Its removal is carried out in case of gallstone disease, tumor and other lesions.

Atlas: human anatomy and physiology. Complete practical guide Elena Yuryevna Zigalova

Gallbladder

Gallbladder

Gallbladder is a reservoir for storing bile. It is an elongated bag 8–12 cm long, 4–5 cm wide, with an expanded bottom resembling a pear in shape, with a capacity of about 40 cm 3 ; its wide end forms bottom, narrowed – neck, turning into cystic duct, through which bile enters and is released from the bladder. Between the bottom and the neck is located bubble body. The folded mucous membrane is lined with a single-layer columnar epithelium with a striated border of microvilli, which intensively absorbs water, so the gallbladder bile thickens 3-5 times compared to bile from the common hepatic duct.

The cystic duct, connecting with the common hepatic duct, forms common bile duct, which is directed downward, pierces the descending part of the duodenum, merging with the pancreatic duct and opening at the apex of the major duodenal papilla. At the confluence of the two ducts there is an expansion of the hepatopancreatic ampulla. Bundles of muscle fibers surround the end of the common bile duct in the thickness of the intestinal wall, forming a poorly developed sphincter ampulla(soda), which prevents the contents of the duodenum from flowing into the bile and pancreatic ducts. Above the sphincter, above the junction of the pancreatic duct with the common bile duct, there is another powerful sphincter of the common bile duct, which, in fact, regulates the flow of bile into the duodenum.

Hepatic bile is concentrated in the gallbladder; gallbladder bile contains less water, more bile acids, bilirubin, and cholesterol. Bile performs many important functions. It neutralizes hydrochloric acid, inactivates pepsin, enhances the activity of pancreatic enzymes, facilitates the breakdown of fats, accelerates the absorption of fatty acids, and prevents putrefaction in the colon.

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The right and left hepatic ducts emerge from the liver, merging at the hilum into the common hepatic duct. As a result of its fusion with the cystic duct, the common bile duct is formed.

The common bile duct passes between the layers of the lesser omentum anterior to the portal vein and to the right of the hepatic artery. Located posterior to the first section of the duodenum in a groove on the posterior surface of the head of the pancreas, it enters the second section of the duodenum. The duct crosses the posteromedial wall of the intestine obliquely and usually joins the main pancreatic duct to form the hepatopancreatic ampulla (ampulla of Vater). The ampoule forms a protrusion of the mucous membrane directed into the intestinal lumen - the major duodenal papilla (papilla of Vater). In approximately 12-15% of those examined, the common bile duct and the pancreatic duct open into the lumen of the duodenum separately.

The dimensions of the common bile duct, when determined by different methods, are not the same. The diameter of the duct measured during operations ranges from 0.5 to 1.5 cm. With endoscopic cholangiography, the diameter of the duct is usually less than 11 mm, and a diameter of more than 18 mm is considered pathological. With ultrasound examination (ultrasound), it is normally even smaller and amounts to 2-7 mm; with a larger diameter, the common bile duct is considered dilated.

The part of the common bile duct passing in the wall of the duodenum is surrounded by a shaft of longitudinal and circular muscle fibers, which is called the sphincter of Oddi.

The gallbladder is a pear-shaped sac 9 cm long, capable of holding about 50 ml of fluid. It is always located above the transverse colon, adjacent to the duodenal bulb, projected onto the shadow of the right kidney, but located significantly in front of it.

Any decrease in the concentration function of the gallbladder is accompanied by a decrease in its elasticity. Its widest section is the bottom, which is located in front; it is this that can be palpated when examining the abdomen. The body of the gallbladder passes into a narrow neck, which continues into the cystic duct. The spiral folds of the mucous membrane of the cystic duct and the neck of the gallbladder are called the valve of Heister. The saccular expansion of the neck of the gallbladder, in which gallstones often form, is called Hartmann's pouch.

The wall of the gallbladder consists of a network of muscle and elastic fibers with poorly defined layers. The muscle fibers of the neck and bottom of the gallbladder are especially well developed. The mucous membrane forms numerous delicate folds; There are no glands in it, but there are depressions that penetrate into the muscle layer, called Luschka's crypts. The mucous membrane does not have a submucosal layer or its own muscle fibers.

Rokitansky-Aschoff sinuses are branched invaginations of the mucous membrane that penetrate the entire thickness of the muscular layer of the gallbladder. They play an important role in the development of acute cholecystitis and gangrene of the bladder wall.

Blood supply. The gallbladder is supplied with blood from the cystic artery. This is a large, tortuous branch of the hepatic artery, which can have a different anatomical location. Smaller blood vessels enter from the liver through the fossa of the gallbladder. Blood from the gallbladder flows through the cystic vein into the portal vein system.

The blood supply to the supraduodenal part of the bile duct is carried out mainly by the two accompanying arteries. The blood in them comes from the gastroduodenal (bottom) and right hepatic (top) arteries, although their connection with other arteries is possible. Strictures of the bile ducts after vascular damage can be explained by the peculiarities of the blood supply to the bile ducts.

Lymphatic system. There are numerous lymphatic vessels in the mucous membrane of the gallbladder and under the peritoneum. They pass through the node at the neck of the gallbladder to the nodes located along the common bile duct, where they connect with the lymphatic vessels that drain lymph from the head of the pancreas.

Innervation. The gallbladder and bile ducts are richly innervated by parasympathetic and sympathetic fibers.

Development of the liver and bile ducts

The liver is formed in the form of a hollow protrusion of the endoderm of the anterior (duodenal) intestine in the 3rd week of intrauterine development. The protrusion is divided into two parts - hepatic and biliary. The hepatic part consists of bipotent progenitor cells, which then differentiate into hepatocytes and ductal cells, forming the early primitive bile ducts - the ductal plates. As cells differentiate, the type of cytokeratin changes. When the c-jun gene, which is part of the API gene activation complex, was experimentally deleted, liver development stopped. Normally, fast-growing cells of the hepatic part of the protrusion of the endoderm perforate the adjacent mesodermal tissue (transverse septum) and meet with capillary plexuses growing in its direction, emanating from the vitelline and umbilical veins. From these plexuses, sinusoids are subsequently formed. The biliary part of the endoderm protrusion, connecting with the proliferating cells of the hepatic part and with the foregut, forms the gallbladder and extrahepatic bile ducts. Bile begins to be released around the 12th week. From the mesodermal transverse septum, hematopoietic cells, Kupffer cells and connective tissue cells are formed. In the fetus, the liver performs mainly the function of hematopoiesis, which fades in the last 2 months of intrauterine life, and by the time of birth only a small number of hematopoietic cells remain in the liver.


 Figure 1 to the right of the text shows structure of the gallbladder. The gallbladder (GB) is a pear-shaped muscular-epithelial sac with a volume of about 30-80 cm3. It is attached by the visceral peritoneum, i.e., the serous membrane (SO), to the lower surface of the liver, therefore the upper and anterior surfaces of the body (T) of the gallbladder, with which it contacts the liver, do not have a serous membrane. These surfaces are clearly demarcated by the loose connective tissue of the tunica adventitia (AT). Only the bottom (D) and neck (W) are located intraperitoneally, i.e., completely covered by the peritoneum. Gallbladder in Fig. 2 is opened to show its internal structures.

Mucous membrane the empty gallbladder is dotted with numerous folds (C). When the organ is full, they become short and flattened; the distance between them increases. The body (T) of the gallbladder continues into the neck (W), which narrows into the cystic duct (CD). The latter connects with the common hepatic duct (CHD), forming the common bile duct (CBD).


The second figure on the right shows only the fibromuscular layer (MF) of the bladder and the probable organization of its smooth muscle bundles.


Fibromuscular membrane is divided into an outer layer (OL) of spirally oriented muscle bundles, which intersect to form a fine-mesh structure. Some of the bundles of these fibers are separated from the spiral outer layer, forming the inner layer (BC), the fibers of which converge at the bottom (D) of the gallbladder. Here the bundles change direction and then travel longitudinally towards the neck, where they join the outer spiral layer (only half of the outer and inner bundles are shown for clarity).


The spiral smooth muscle bundles of the gallbladder neck continue into the walls of the cystic duct (CD), where they form the musculature of the spiral Heister valve (CHV).


Functions of the gallbladder- is the storage and concentration of bile by absorption of water.


 Organ wall(the picture to the left of the text) has the following layers:


consists of a single-layer prismatic epithelium (E) without goblet cells and lamina propria (LP). The latter is formed from well-innervated and blood-supplied loose connective tissue with mucous glands only in the neck of the gallbladder. The mucous membrane is dotted with numerous elongated spiral superficial primary folds (PS), which intersect with each other, and slightly deeper located secondary folds (SF) of very diverse shapes. Read more about the mucous membrane in the article “Mucous membrane of the gallbladder”.


Deep epithelial invaginations penetrating into the muscle layer are called diverticula (D), or glands of Rokitansky-Aschoff;


represented by a layer of irregularly oriented internal and external smooth muscle cells mixed with a significant amount of collagen and elastic fibers;


Cholecystokinin is a tissue hormone secreted by one of the types of enteroendocrine cells of the small intestine that stimulates contraction of the fibromuscular membrane of the gallbladder.


- a layer of loose connective tissue of varying thickness with many blood (BC) and lymphatic (L) vessels and nerve fibers (HB);


- epithelium of the peritoneum, surrounding almost the entire organ. In the area not covered by the serosa, the subserosal base becomes the tunica adventitia (AT) with its loose connective tissue connecting the gallbladder to the liver.

The gallbladder (cholecystis) refers to the human biliary system, responsible for the production and release of bile into the duodenum. His disease is always accompanied by characteristic pain, but few know where the gallbladder is located, on which side it is located, and how to distinguish its disease from cardiac neuralgia or liver disease. Few people know about the structure of this organ, so this article offers a brief anatomy of the gallbladder and biliary tract. This is necessary in order to understand that some pathologies of the gallbladder are caused by a change in its shape - the presence of constrictions that are uncharacteristic of the healthy state of the folds.

Still, where is the gallbladder located in humans? In short, in the right hypochondrium. In medical language, cholecystis is located on the visceral (or lower) surface of the liver, where there is a special notch (longitudinal groove) for the gallbladder. The gallbladder is connected to the fibrous surface of the liver. Its outer surface, which is not located in the liver fossa and protrudes beyond its limits, is covered with dense peritoneum.

The size of cholecystis varies depending on a number of factors, including: age, body structure. Usually the organ reaches sizes from 8 to 14 centimeters in length and 4-5 cm in width, like a chicken egg. The volume of the gallbladder is approximately 40 milliliters. These indicators are the norm for a person; otherwise, they indicate the occurrence of pathology. The shape of the organ in humans resembles an elongated pear; other names are cone-shaped, baggy, oval. The color of cholecystis is dark green, which is associated with the color of the bile itself (it is not for nothing that the tongue becomes yellowish-green during various diseases associated with its stagnation).

Internal structure

The structure of the gallbladder consists of three main anatomical elements: the fundus, the body and the neck. The fundus is located slightly outside the liver, being the largest section of the gallbladder in width. The body is the area in the middle, which then smoothly passes into the neck with access to the cystic duct. The shape of a person’s bladder can change due to pathological processes occurring inside it.

The bladder tissue is quite soft and thin. The weakest point is the junction of the cervix and the body of cholecystitis - if the pressure inside the organ exceeds the required values, it is there that tissue rupture occurs, followed by the release of contents into the abdominal cavity.

The surface of the organ is three-layered, consisting of three membranes:

  • serous;
  • muscular;
  • mucous membrane;
  • under the peritoneum there is a special lining of connective tissue with a loose structure (the so-called subserosal tissue).

The muscle tissue on the surface of cholecystis is responsible for the motility of the gallbladder and ensures the movement of bile. It consists of circular and longitudinal smooth muscle fibers, the number of which increases towards the neck - it is there that the motility of the bladder is of paramount importance. The cystic ducts are also covered with a muscular layer, which is connected to that of cholecystis.

The mucous tissue covers the cholecystis with a thin layer, similar to a mesh due to numerous folds. These folds have anatomical differences depending on their location. Thus, they become stronger towards the neck and form a series of spiral folds. The glands of the submucosa are also located closer to the neck.

The activity of the gallbladder is regulated by a special hormone - cholecystokinin. This hormone is secreted by the cells of the duodenum itself and controls the feeling of hunger and appetite, regulates the functioning of the muscular gate - the sphincter of Oddi - and also participates in the process of bile secretion, stimulating the liver.

Connection to other organ systems

Cholecystis is connected to other digestive organs by bile ducts. The biliary tract, coming from cholecystis, merges with the hepatic tract into the common bile duct, which in medicine is called the common bile duct. Its diameter does not exceed 4 millimeters and is connected to the duodenum, where bile is supplied for further enzymatic processing of food. The liver produces a large amount of bile every day, but the digestion process does not occur around the clock, and not all the bile produced by the liver is immediately consumed. Excess bile is stored in the gallbladder, which, upon a signal, is removed through the ducts into the intestine due to increased tone of the organ.

Four parts of the common bile duct:

  1. The area above the intestine.
  2. Posterior to the apex of the duodenum.
  3. The distance between the head of the pancreas and the downward wall of the duodenum.
  4. Close to the head of the pancreas, where the duct is attached to the intestine.

Fusion with the common bile duct occurs due to the sphincter of Oddi in the papilla of Vater. This is a special anatomical formation that plays the role of a muscular gate that regulates the flow of bile and pancreatic product into the duodenum.

The common bile duct is covered with denser muscles, consisting of longitudinal and circular layers. The thickening of the muscular surface forms the common bile duct sphincter. The mucous surface does not have folds, like the gallbladder, and the shape of the tissues is smooth.

The circulatory system supplies the organs with blood through the gallbladder artery. The hepatic artery, which is similar in function, is also located there. The organs are supplied by the portal vein, which circulates blood through the intraorgan veins and back to the portal vein.

Conclusion

The gallbladder is an important organ of the digestive system, involved in the accumulation of bile for its further removal to the duodenum. Not a single process of food digestion can occur without it, so it is extremely important to know where it is located in order to notice its diseases in time. If you feel pain in the right hypochondrium, contact a gastroenterologist - such a symptom may indicate pathologies of the organ.

Remember also that pain can radiate from one organ to another, so you should not self-medicate. Even if you know exactly where your gallbladder is, have a qualified professional examine you. He will prescribe an instrumental examination of this area and clarify the diagnosis.
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