Gallbladder

Dr Dan J Bell and A.Prof Frank Gaillard et al.

The gallbladder is a pear-shaped musculomembranous sac, lodged in a fossa on the undersurface of the right lobe of the liver, and extending from near the right extremity of the porta hepatis to the anterior border of the liver. 

It typically measures from 7 to 10 cm in length and 2.5 cm in breadth at its widest point. It holds from 30 to 35 mL of bile when distended, although if obstructed it can distend to accomodate up to 300 mL 2. It is divided into a fundus, body, and neck. 

The fundus, or broad extremity, is directed downward, forward, and to the right, and projects beyond the anterior border of the liver; the body and neck are directed upward and backward to the left. The upper surface of the gallbladder is attached to the liver by connective tissue and vessels. The undersurface is covered by peritoneum, which is reflected on to it from the surface of the liver. 

The gallbladder consists of four layers: 

  • serosa
  • muscularis externa
  • lamina propria
  • mucosa

Note the gallbladder does not have a submucosa or muscularis mucosae 4.

The serosa, derived from the peritoneum, completely invests the fundus, but covers the body and neck only on their undersurfaces (the superior surface being apposed to the undersurface of the liver).

The muscular layer, is a thin but strong layer forming the framework of the gallbladder, and consists of dense fibrous tissue, which interlaces in all directions, admixed with muscular fibres, disposed chiefly in a longitudinal direction, a few running transversely.

The mucosa is loosely connected with the fibrous layer. It is generally of a yellowish-brown colour, and is elevated into minute rugae. Opposite the neck of the gallbladder the mucous membrane projects inward in the form of oblique ridges or folds, forming a sort of spiral valve.

The mucous membrane is continuous through the hepatic duct with the mucous membrane lining the ducts of the liver, and through the common bile duct with the mucous membrane of the duodenum. It is covered with columnar epithelium, and secretes mucin. Occasionally the mucosa has small outpouchings that penetrate into muscular wall. These are known as Rokitansky-Aschoff sinuses, and are more commonly seen in patients with chronic cholecystitis and adenomyomatosis.

  • superiorly: liver
  • inferiorly: transverse colon, D2 segment of the duodenum (or pylorus of the stomach)
  • anteriorly: transverse colon, 9th costal cartilage

The gallbladder receives the vast majority of its arterial blood from the cystic artery. There is no single cystic vein, but rather the gallbladder drains directly into the venous system of the liver through the gallbladder fossa and by a number of veins into the right branch of the portal vein 2.

Lymphatics of the gallbladder drain toward the porta hepatis and to portal nodes. 

The gallbladder receives both sympathetic and vagal supply:

The gallbladder has a number of variations in its anatomy based on:

  • morphology
    • Phrygian cap: the fundus is sometimes folded back upon itself 
    • Hartmann pouch (infundibulum)
      • in some instances the neck is focally dilated (adjacent to the body) 2,3
      • probably pathological, related to cholelithiasis 3
    • occasionally the whole gallbladder is invested by the serous membrane, and is then connected to the liver by a kind of mesentery, rendering the organ prone to torsion
    • internal septation
  • number
  • location: ectopic gallbladder has been reported in many different abdominal sites and can result in increased complexity when undertaking cholecystectomy
    • intrahepatic
    • retrohepatic
    • transverse
    • retroperitoneal
    • left-sided: extremely rare (<0.20%) 5
Abdominal and pelvic anatomy
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Article information

rID: 12413
Section: Anatomy
Synonyms or Alternate Spellings:
  • Gall bladder
  • Gall-bladder

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