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Gallbladder and bile

Last updated: January 8, 2021

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The gallbladder is an intraperitoneal organ derived from the endoderm that is located inferior to the liver. It is divided into a fundus, a body, and a neck. The gallbladder is perfused by the cystic artery, a branch of the right hepatic artery that drains into the cystic vein and the hepatic sinusoids. It receives sympathetic innervation via the celiac plexus, parasympathetic innervation via the vagus nerve, and sensory innervation via the branches of the phrenic nerve. The main function of the gallbladder is bile storage. Bile is secreted by the liver and facilitates digestion, neutralization of gastric acid, fat absorption, and excretion of bilirubin and cholesterol. The biliary tract, which is divided into intrahepatic and extrahepatic bile ducts, transports bile to the intestine. The ductules are intrahepatic bile ducts that unite to form the left and right hepatic ducts, which drain bile from the liver. The extrahepatic bile ducts include the cystic duct and the common hepatic duct, which unite to form the common bile duct. The common bile duct unites with the pancreatic duct and drains into the hepatopancreatic ampulla in the duodenum. Excessive saturation of bile with cholesterol or bilirubin leads to gallstone formation. Diseases of the biliary tract include cholecystitis, primary sclerosing cholangitis, and biliary atresias among many others.

The gallbladder is a hollow, pear-like-shaped (piriform) organ that lies on the cystic plate (gallbladder bed) under the liver segments IVB and V. The cystic plate is a fibroareolar tissue that attaches the superior surface of the gallbladder to the liver.

Anatomy

Function

Vasculature

Innervation

Cholecystitis causes referred pain to the right shoulder region because the phrenic nerve originates from spinal nerves C3–C5, which also provide somatic sensation to the shoulder area.

Layers of the gallbladder wall [1]

Anatomy

The biliary tree is divided into the intrahepatic and extrahepatic bile ducts.

Intrahepatic bile ducts

  • Bile canaliculi intrahepatic bile ductules (canals of Hering) → segmental bile ducts → sectional ducts
    • Right posterior duct (RPD): drains segment VI and VII
    • Right anterior duct (RAD): drains segment V and VIII
      • Right posterior and anterior ducts connect and form the right hepatic duct (RHD).
      • Bile ducts from segments II–IV connect and form the left hepatic duct (LHD).
  • Common hepatic duct (CHD): formed by the right and left hepatic ducts

Extrahepatic bile ducts

The portal triad consists of the hepatic artery, portal vein, and common bile duct.

Composition

Bile is a secretion produced by the liver and stored in the gallbladder that aids in digestion, neutralization of gastric acid, fat absorption, and excretion of bilirubin and cholesterol.

A deficiency of bile acids can result in fat malabsorption and cholesterol stones in the gallbladder.

Function

Enterohepatic circulation

Substances metabolized in the liver are excreted into the bile.

Gallstones

There are different types of gallstones (see “Cholelithiasis” and “Cholecystitis” for more information):

References:[1][2]

Disorders of the biliary tract

Disorders of the bile

Disorders of the intestine

  1. Standring S. Gray's Anatomy: The Anatomical Basis of Clinical Practice. Elsevier Health Sciences ; 2016
  2. Hall JE. Guyton and Hall Textbook of Medical Physiology. Elsevier ; 2016
  3. Chung KW. Gross Anatomy. Lippincott Williams & Wilkins ; 2005