Anatomy
Abdomen
A 45 year old overweight female, with known gallstones presents to ED complaining of severe right upper quadrant pain. Imaging shows that large gallstones have eroded through the posterior wall of the fundus of the gallbladder to enter the intestine. Which of the following parts of the intestine is most likely to first contain gallstones:
Answer:
The fundus of the gallbladder lies anterior to and in contact with the transverse colon, thus gallstones eroding through the posterior wall of fundus of the gallbladder will enter the right transverse colon (and then pass naturally through the descending colon and sigmoid colon). Gallstones lodged in the body of the gallbladder may ulcerate through the posterior wall of the body to enter the duodenum (and may then become lodged at the ileocaecal junction causing intestinal obstruction).Gallbladder
Anatomy / Abdomen / Liver and Biliary Tract
Last Updated: 11th April 2019
Anatomical Position
The gallbladder is a pear-shaped sac lying on the visceral surface of the right lobe of the liver in a fossa between the right and quadrate lobes. It is an intraperitoneal structure and lies in the right hypochondrium.
Gallbladder. (Image by OpenStax College [CC BY 3.0 , via Wikimedia Commons)
Surface Marking
The gallbladder is located at the junction of the right ninth costal cartilage and the lateral border of the rectus abdominis muscle which is the site of maximal tenderness in the acute inflammation of the gallbladder.
Structure
The gallbladder has:
- a rounded end, the fundus, which may project from the inferior border of the liver
- a major part in the fossa, the body, which may lie against the transverse colon and the superior part of the duodenum
- and a narrow part, the neck, which tapers to become continuous with the cystic duct.
The neck contains a mucosal fold, known as Hartmann's pouch, which is a common site for gallstones to become lodged.
Relations
The gallbladder lies:
- posterior and inferior to the liver
- posterior to the anterior abdominal wall
- anterior to the transverse colon and the proximal duodenum
- superior to the biliary tree and the duodenum.
Innervation
Inflammation of the gallbladder may present with pain in the right upper quadrant and also in the right shoulder due to irritation of the diaphragmatic peritoneum. N.B. Pain arising from structures supplied by the phrenic nerve is often referred to other somatic regions served by spinal nerves C3 - C5.
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
