Gallbladder

View of gallbladder along with stomach duodenum and pancreas and opening of hepatopancreaticduct into duodenum through major duodenum papilla in the 2nd part of duodenum

In vertebrates, the Gallbladder, also known as the cholecyst, is a small hollow organ where bile is stored and concentrated before it is released into the small intestine. In humans, the pear-shaped gallbladder lies beneath the Liver, although the structure and position of the gallbladder can vary significantly among animal species. It receives bile, produced by the liver, via the common hepatic duct, and stores it. The bile is then released via the common bile duct into the duodenum, where the bile helps in the digestion of fats.

The gallbladder can be affected by gallstones, formed by material that cannot be dissolved – usually cholesterol or bilirubin, a product of hemoglobin breakdown. These may cause significant pain, particularly in the upper-right corner of the abdomen, and are often treated with removal of the gallbladder (called a cholecystectomy). Cholecystitis, inflammation of the gallbladder, has a wide range of causes, including result from the impaction of gallstones, infection, and autoimmune disease.

Structure

The human gallbladder is a hollow grey-blue organ that sits in a shallow depression below the right lobe of the liver. In adults, the gallbladder measures approximately 7 to 10 centimetres (2.8 to 3.9 inches) in length and 4 centimetres (1.6 in) in diameter when fully distended. The gallbladder has a capacity of about 50 millilitres (1.8 imperial fluid ounces).

The gallbladder is shaped like a pear, with its tip opening into the cystic duct. The gallbladder is divided into three sections: the fundus, body, and neck. The fundus is the rounded base, angled so that it faces the abdominal wall. The body lies in a depression in the surface of the lower liver. The neck tapers and is continuous with the cystic duct, part of the biliary tree. The gallbladder fossa, against which the fundus and body of the gallbladder lie, is found beneath the junction of hepatic segments IVB and V. The cystic duct unites with the common hepatic duct to become the common bile duct. At the junction of the neck of the gallbladder and the cystic duct, there is an out-pouching of the gallbladder wall forming a mucosal fold known as "Hartmann's pouch".

Lymphatic drainage of the gallbladder follows the cystic node, which is located between the cystic duct and the common hepatic duct. Lymphatics from the lower part of the organ drain into lower hepatic lymph nodes. All the lymph finally drains into celiac lymph nodes.

Function

The main functions of the gallbladder are to store and concentrate bile, also called gall, needed for the digestion of fats in food. Produced by the liver, bile flows through small vessels into the larger hepatic ducts and ultimately through the cystic duct (parts of the biliary tree) into the gallbladder, where it is stored. At any one time, 30 to 60 millilitres (1.0 to 2.0 US fl oz) of bile is stored within the gallbladder. A function of the gallbladder appears to be protection against carcinogenesis as indicated by observations that removal of the gallbladder (cholecystectomy) increases subsequent cancer risk.

History

Depictions of the gallbladder and biliary tree are found in Babylonian models found from 2000 BCE, and in ancient Etruscan model from 200 BCE, with models associated with divine worship.

Diseases of the gallbladder are known to have existed in humans since antiquity, with gallstones found in the mummy of Princess Amenen of Thebes dating to 1500 BCE. Some historians believe the death of Alexander the Great may have been associated with an acute episode of cholecystitis. The existence of the gallbladder has been noted since the 5th century, but it is only relatively recently that the function and the diseases of the gallbladder has been documented, particularly in the last two centuries.

The first descriptions of gallstones appear to have been in the Renaissance, perhaps because of the low incidence of gallstones in earlier times owing to a diet with more cereals and vegetables and less meat. Anthonius Benevinius in 1506 was the first to draw a connection between symptoms and the presence of gallstones. Ludwig Georg Courvoisier, after examining a number of cases in 1890 that gave rise to the eponymous Courvoisier's law, stated that in an enlarged, nontender gallbladder, the cause of jaundice is unlikely to be gallstones.

The first surgical removal of a gallstone (cholecystolithotomy) was in 1676 by physician Joenisius, who removed the stones from a spontaneously occurring biliary fistula. Stough Hobbs in 1867 performed the first recorded cholecystotomy, although such an operation was in fact described earlier by French surgeon Jean Louis Petit in the mid eighteenth century. German surgeon Carl Langenbuch performed the first cholecystectomy in 1882 for a sufferer of cholelithiasis. Before this, surgery had focused on creating a fistula for drainage of gallstones. Langenbuch reasoned that given several other species of mammal have no gallbladder, humans could survive without one.

The debate whether surgical removal of the gallbladder or simply gallstones was preferred was settled in the 1920s, with the consensus that removal of the gallbladder was preferred. It was only in the mid and late parts of the twentieth century that medical imaging techniques such as use of contrast medium and CT scans were used to view the gallbladder. The first laparoscopic cholecystectomy performed by Erich Mühe of Germany in 1985, although French surgeons Phillipe Mouret and Francois Dubois are often credited for their operations in 1987 and 1988 respectively.

Society and culture

To have "gall" is associated with bold, belligerent behaviour, whereas to have "bile" is associated with sourness.

In the Chinese medicine, the gallbladder (膽) is associated with the Wuxing element of wood, in excess its emotion is belligerence and in deficiency cowardice and judgement, in the Chinese language it is related to a myriad of idioms, including using terms such as "a body completely [of] gall" (渾身是膽) to describe a forward person, and "single, alone gallbladder hero" (孤膽英雄) to describe a lone hero, or "they have a lot of gall to talk like that".

In the Zangfu theory of Chinese medicine it is an extraordinary Fu or yang organ, as it holds bile. The gallbladder not only has a digestive role, but is seen as the seat of decision-making and judgement.