cholecyst, sometimes gall bladder)
is a pear-shaped organ that stores
about 50 mL of bile (or "gall")
until the body needs it for digestion.
is about 7-10 cm long in humans and appears
dark green because of its contents (bile),
rather than its tissue. It is connected
to the liver and the duodenum by the biliary
tract. The cystic duct leads from the
gallbladder and joins with the common
hepatic duct to form the common bile duct.
The common bile duct then joins with the
pancreatic duct, and enters the duodenum
through the hepatopancreatic ampulla at
the major duodenal papilla
The layers of the gallbladder are as follows:
- The gallbladder
has a simple columnar epithelial lining
characterized by recesses called Aschoff's
recesses, which are pouches inside the
- Under the epithelium
there is a layer of connective tissue.
- Beneath the connective
tissue is a wall of smooth muscle that
contracts in response to cholecystokinin,
a peptide hormone secreted by the duodenum.
- There is essentially
no submucosa separating the connective
tissue from serosa and adventitia.
The gallbladder stores about 50 mL of bile
(1.7 US fluid ounces / 1.8 Imperial fluid
ounces), which is released when food containing
fat enters the digestive tract, stimulating
the secretion of cholecystokinin (CCK).
The bile emulsifies fats and neutralizes
acids in partly digested food.
being stored in the gallbladder, the bile
becomes more concentrated than when it left
the liver, increasing its potency and intensifying
its effect on fats. Most digestion occurs
in the duodenum.
Cholestasis is the blockage in the supply
of bile into the digestive tract. It
can be "intrahepatic" (the
obstruction is in the liver) or "extrahepatic"
(outside the liver). It can lead to
jaundice, and is identified by the presence
of elevated bilirubin level that is
Biliary colic is when a gallstone blocks
either the common bile duct or the duct
leading into it from the gallbladder.
Up to 25% of all people have gallstones
(cholelithiasis), composed of lecithin
and bile acids. These can cause abdominal
pain, usually in relation with the meal,
as the gallbladder contracts and gallstones
pass through the bile duct.
Acute or chronic inflammation of the
gall bladder (cholecystitis) causes
abdominal pain. 90% of cases of acute
cholecystitis are caused by the presence
of gallstones. The actual inflammation
is due to secondary infection with bacteria
of an obstructed gallbladder, with the
obstruction caused by the gallstone.
gallstones obstruct the common bile
duct (choledocholithiasis), the patient
develops jaundice and liver cell damage.
It is a medical emergency, requiring
endoscopic or surgical treatment such
as a cholecystectomy.
rare clinical entity is ileus (bowel)
obstruction by a large gallstone, or
gallstone ileus. This condition develops
in patients with longstanding gallstone
disease, in which the gallbladder forms
a fistula with the digestive tract.
Large stones pass into the bowel, and
generally block the gut at the level
of Treitz' ligament or the ileocecal
valve, two narrow points in the digestive
tract. The treatment is surgical.
Cancer of the gallbladder is a rare
but highly fatal disease. It has been
associated with gallstone disease, estrogens,
cigarette smoking, alcohol consumption
and obesity. Despite aggressive modern
surgical approaches, advanced imaging
techniques, and endoscopy, nearly 90%
of patients die from advanced stages
of the disease and experience pain,
jaundice, weight loss, and ascites.
Polyps (growths) are sometimes detected
during diagnostic tests for gallbladder
disease. Small gallbladder polyps (up
to 10 mm) pose little or no risk, but
large ones (greater than 15 mm) pose
some risk for cancer, so the gallbladder
should be removed. Patients with polyps
10 mm to 15 mm have a lower risk but
they should still discuss removal of
their gallbladder with their physician.
Of special note is a condition called
primary sclerosing cholangitis, which
causes inflammation and scarring in
the bile duct. It is associated with
a lifetime risk of 7% to 12% for gallbladder
cancer. The cause is unknown, although
primary sclerosing cholangitis tends
to strike younger men who have ulcerative
colitis. Polyps are often detected in
this condition and have a very high
likelihood of malignancy.
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