Gallbladder !

The gallbladder is a small pear-shaped sac under the liver, in the upper right belly, that stores bile; gallstones form in it.

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What it is

A small pear-shaped sac under the liver that stores and concentrates bile.

What it does

Squeezes bile into the duodenum after fatty meals to help digest fat.

Key facts

Where: Gallbladder fossa on visceral liver surface (between segments IV and V); fundus at tip of right 9th costal cartilage, midclavicular line
Blood supply: Cystic artery (usually from right hepatic artery); cystic veins drain into liver bed and portal branches
Nerve: Hepatic plexus (celiac sympathetic, vagal); right phrenic nerve to its peritoneum (pain referred to right shoulder)
Function: Stores and concentrates bile (about 30–50 ml); contracts under CCK after fatty meals

Relations

Above: Gallbladder fossa on the visceral surface of the liver, between liver segment IV (IVb) and liver segment V, attached by connective tissue without peritoneum on that side
In front: The fundus projects beyond the lower edge of the liver against the anterior abdominal wall
Below: First and second parts of the duodenum and the transverse colon, which explains cholecystoduodenal and cholecystocolic fistulas
Medial: Neck near the porta hepatis and the hepatoduodenal ligament, where the cystic artery reaches it and the cystic duct leaves it

How to find it

The fundus lies where the lateral border of the right rectus abdominis meets the costal margin. A normal gallbladder cannot be felt; a large, smooth, non-tender one in a jaundiced person is the Courvoisier sign.

Examination

Murphy sign: the examiner presses under the right costal margin at the gallbladder point while the person breathes in deeply; pain that cuts the breath short suggests acute cholecystitis
Sonographic Murphy sign: most tenderness when the ultrasound probe presses right over the gallbladder seen on screen; supports acute cholecystitis
Courvoisier sign: a palpable, non-tender gallbladder with jaundice points to a tumour below the cystic duct (often the pancreatic head) rather than stones, which leave a scarred, shrunken gallbladder

On imaging

Ultrasound first: stones are bright foci with posterior acoustic shadowing that move with position; acute cholecystitis adds wall thickening, fluid around the gallbladder and a sonographic Murphy sign. On hepatobiliary scintigraphy (HIDA), a gallbladder that never fills means a blocked cystic duct. CT misses many stones but shows complications.

Common problems

Gallstones: very common (more in women, after pregnancy, with obesity, and in some Latin American populations); many cause no symptoms.
Biliary colic: pain under the right ribs after meals when a stone blocks the outlet.
Cholecystitis: an inflamed, infected gallbladder with fever.

How it is diagnosed

Ultrasound; blood tests.

Treatment

Removal of the gallbladder by laparoscopy (cholecystectomy) for symptomatic stones.

Clinical notes

Critical view of safety in laparoscopic cholecystectomy: the hepatocystic (Calot) triangle cleared of fat and fibrous tissue, the lower gallbladder lifted off the liver bed, and only two structures (cystic duct and cystic artery) entering it before anything is clipped
Bile duct injury, usually from taking the common bile duct for the cystic duct, is the feared complication; inflammation and variant anatomy make it more likely
Gallstone ileus: a large stone passes through a cholecystoduodenal fistula and blocks the terminal ileum; air in the bile ducts, small-bowel obstruction and an ectopic stone form Rigler triad

Anatomical variants

Phrygian cap: a folded fundus, the most common shape variant; harmless, but it can mimic a septum on ultrasound
Rare: double gallbladder, agenesis, an intrahepatic gallbladder, or a 'floating' gallbladder on a long mesentery that can twist

Development

Grows from the caudal part of the hepatic diverticulum of the foregut; its lumen is at first filled with cells and later hollows out, which helps explain septa and duplications.

Memory aid

Classic gallstone risk factors: female sex, pregnancies, age around 40 or more and obesity (the old English «4 Fs»), plus ancestry, rapid weight loss and family history

Test yourself

Think of the answer, then tap the question to see it.

Where is the fundus of the gallbladder on the surface?

Where the lateral border of the right rectus abdominis meets the costal margin, at the tip of the right 9th costal cartilage.

What is Mirizzi syndrome?

A stone impacted in Hartmann pouch at the gallbladder neck presses on the common hepatic duct and causes jaundice.

What is the Courvoisier sign?

A large, smooth, non-tender gallbladder that can be felt in a jaundiced person; a normal gallbladder cannot be felt.

What is the critical view of safety in laparoscopic cholecystectomy?

Calot triangle cleared, lower gallbladder lifted off the liver bed, and only two structures (cystic duct and cystic artery) entering it before clipping.

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Educational information, not medical advice. For any symptom, see a health professional.

Its names

Official Latin (TA2): vesica biliaris TA2 3081
Official Spanish (DeCS): Vesícula biliar DeCS D005704
English (TA2): Gallbladder

Sources: Terminologia Anatomica (TA2); DeCS; Anatomy, Abdomen and Pelvis: Gallbladder.

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Representative model, for educational purposes only.

Gallbladder highlighted on the Durgical 3D model