Prepared By: A pear ar-sha haped ped sac c lying ing on the e - PowerPoint PPT Presentation

University of THi-Qar College of Nursing Prepared By:

 A pear ar-sha haped ped sac c lying ing on the e under dersu surfa rface ce of the liver er.  It has s a capacity acity of 30 30 to to 50 50 ml and d stores tores bile, e, which ich it concen ncentr trates ates by absor orbi bing ng water. er.  The e gall llbla bladder der is divided vided into to the fundus ndus, , body, dy, and d neck ck. . • The fundus is rounded and projects below the inferior margin of the liver, where it comes in contact with the anterior abdominal wall at the level of the tip of the ninth right costal cartilage. • The body lies in contact with the visceral surface of the liver and is directed upward, backward, and to the left. • The neck becomes continuous with the cystic duct, which turns into the lesser omentum, joins the common hepatic duct, to form the bile duct 2

 The e perit ritoneum oneum completel ompletely y surrounds rrounds th the e fundus ndus of of th the gallb llbladd ladder er and binds inds th the body y and d neck ck to to th the viscer ceral al surface rface of th the liver ver . Relations Anteriorly Anteri orly: The he an anter terio ior abd abdom omina inal • wall an wall and the he inf inferi rior or su surf rface ace of of the the liver er Poste Posteri riorly orly: Th The tran transver sverse se col olon on an and • the the fi first st an and seco second nd part parts of of the he duoden uodenum um Functio nction of of the Gallbl lbladd adder er When di When dige gesti stion is is not ot ta takin king place, place, the the sph phincter incter of of Odd ddi rema remains ns cl close osed an and bil bile • accumul accu mulate ates in in the the gall gallbl bladde dder. The The gal gallb lbla ladder dder co conc ncen entrate trates bile bile; sto stores res bile bile; sele selectively ctively abs absorbs orbs bil bile sal salts, keeps keeps the the bil bile acid acid; excrete xcretes chole cholester sterol ol; and nd secrete ecretes mucu mucus. To To aid aid in in the these se functi unction ons, s, the the muco ucous us me membra mbrane ne is is th throw rown int nto per permane manent nt folds lds that at unite ite with th each ch other her, givin ing the surfa rface ce a honeyco oneycombed mbed appeara pearance nce . 3

Blo lood Sup uppl ply  The he cystic stic arte tery ry is is a branch nch of of the the right ht he hepati atic artery tery.  The cyst stic ic vein drains ins directly ectly into to the the portal tal vein.  Se Several eral ve very ry small mall arteries arteries and and ve veins ins also also run un bet betwee ween the the liver liver and and gallbladd lbladder er . Nerve Supply Lymph Drainage • Sympath Sympathetic etic and and parasy parasympath pathetic etic • The he lymph lymph drains drains int into a vaga vagal fibe fibers form form the the ce celiac liac cystic cys tic lymph lymph no node de sit situat uated ed plexu plexus. Th The gallbladd gallbladder er contr contracts acts near near the the neck neck of of the the in respon in response to to the the ho hormo mone ne gallbladder gallbladd er. Fr From om here, here, the the cholec cholecystoki ystokinin in, whi which ch is is lymph vess lymph vessels els pass pass to to the the produce produced by by the the mu mucous cous hepatic hepati nodes nod es along along the the membrane membrane of of the the du duodenum denum on on course course of of the he hepati hepatic artery artery the the arri arrival val of of fatt atty foo food from from the the and th then to to the the celiac iac nodes es . sto tomach mach. 4

 The he cys cystic tic duct uct is is abo about ut 1.5 in in. (3.8 cm) cm) lon long and and connects connects the the neck neck of of the the gallbladd gallbladder er to to the the comm common hepat hepatic ic du duct ct to to form form the the bile duct.  It It usu usually ally is is somewhat somewhat S-shaped shaped and and desc descend nds for for a variable variable distance in distance in the the right right fre free mar margi gin of of the the lesseromentum sseromentum.  The he mu mucous cous membr membrane ane of of the the cys cystic tic duct uct is is rais raised ed to to form form a spir spiral al fold th fold that at is is cont continu nuou ous with with a si similar milar fold fold in in the the neck neck of of the the gallbladder gallbladd er. The he fold fold is is com common monly ly known nown as as the the “ spir spiral al valve valve. ” The he functi function on of of the the spir spiral al valve valve is is to to kee keep the the lum umen en constan constantly tly open. 5

What is it?  By definition, cholecystitis is an inflammation of the gallbladder wall and nearby abdominal lining. Abdominal wall Gallbladder

 Can be caused by an obstruction, gallstone or a tumor .  90% of all cases caused by gallstones.  The exact cause of gallstone formation is unknown .  When there is an obstruction, gallstone or tumor it prevents bile from leaving the gallbladder .  Bile gets trapped and acts as an irritant which causes cellular infiltration within 3 – 4 days.

 This infiltration causes an inflammatory process – the gallbladder becomes enlarged and edematous.  Eventually this occlusion along with bile stasis causes the mucosal lining of the gallbladder to become necrotic.  Bacterial growth Necrotic Gallbladder occurs due to ischemia.

 Rupture of the gallbladder becomes a danger, along with spread of infection of the hepatic duct and liver.  If the disease is severe and interferes with the blood supply it can cause the gallbladder to become gangrenous. Gangrenous gallbladder Gallstones

Gallstones Gallstones . .  Th The presence nce of gallsto stones nes in the gallbla bladd dder er is ca called d c holel elithi ithiasis asis.

Path athogenes ogenesis is  Co Composi ositio tion n of bil f bile:  Bilirubin (by-product of haem degradation)  Cholesterol (kept soluble by bile salts and lecithin)  Bile salts/acids (cholic acid/chenodeoxycholic acid): mostly reabsorbed in terminal ileum(entero-hepatic circulation).  Lecithin (increases solubility of cholesterol)  Inorganic salts (sodium bicarbonate to keep bile alkaline to neutralise gastric acid in duodenum)  Water (makes up 97% of bile)

 Types of gallstone  Cho holesterol lesterol sto tones nes (20 20%) %)  Pigment ment sto tones nes (5%) %)  Mixed ed (75 75%) %)

Epi pidemiology demiology  Approx roxim imately ately 12 12% % of men and d 24 24% % of women n of all ages hav ave e gal allstones tones  80 80% % are asympto ptomatic matic  2-3% % of patients ents progress ress per year to sympto tomatic matic di disease  1% of % of pat atients ents with gal allston stones es de develop elop ac acute te co complica cation tions  Approx roxim imately ately 12 12% % of patients ents unde dergo rgoing ing ch cholecys cystectomy tectomy found d to have e CBD stone nes

Path athogenes ogenesis is  Cholestero sterol l  Imbalance between bile salts/lecithin and cholesterol allows cholesterol to precipitate out of solution and form stones  Pigment ment  Occur due to excess of circulating bile pigment (e.g. Heamolytic anaemia)  Mi Mixe xed  Same pathophysiology as cholesterol stones

Risk Ri sk fa factor ctors s fo for gal alls lstone tone fo forma mation tion  Ag Age  Risk isk is is x4 between between the the ages ages of of 40 40-69 69 co compa mpared red with with younger ger subjects jects  Due to to incr creased eased ch cholestero sterol co content ent in in bile  Sex  Hig Highe her prevalance revalance in in wo women men, up up to to x3 between between age ages of of 30 30-39 39  Pregn egnanci ancies es / ho hormones nes  Re Related ated to to fre requ quen ency cy an and number er of of pre regna gnancies ncies  New biliary ary sludg dge may form in in up up to to 30 30% of of women  Oest Oestrogens rogens prom romote ote ch cholestero olesterol hype hypersecreti secretion on in in bi bile le and re an redu duce ce bile ac acid syn ynthes thesis is

Risk Ri sk fa factor ctors s fo for gal alls lstone tone fo forma mation tion  Proges gesteron terones es promote te stasis and impair co contracti actility ity  Oral al cont ntraceptives raceptives an and H HRT  As As above ve  Al Also so found ound to to apply apply to to men men rec receiving iving oestrog oestrogen en the therapy rapy for prostate fo rostate ca cancer ncer, compa compared red to to thos those who who elec lecte ted for or orch chiectomy ectomy (s (small study) dy)  Obesi sity ty  Enhanced anced ch cholestero esterol l syn ynthe thesis sis an and se d secr cretion etion