The gallbladder is nestled in the gallbladder fossa located on the undersurface of the liver between the right and left lobes.
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If we remove the gallbladder we expose the gallbladder fossa.
The liver is divided into 5 major segments based on the hepatic venous anatomy .(Couinard) The gallbladder lies between segment V of the right lobe and segment IVb (aka quadrate lobe or the medial segment of the left lobe ).
82220b01.2k05.82s liver gallbladder porta hepatis hepatic artery portal vein IVC inferior vena cava falciform ligament ligamentum teres bare area of the liver left lobe segment IV segment I caudate lobe quadrate lobe medial segment left ;obe lateral segment left lobe gastrohepatic ligament gallbladder right lobe hepatic Davidoff art copyright 2008
Its position and axis can also be described as lying within Cantlie’s line which is an oblique plane drawn from the middle of the gallbladder to left border of the inferior vena cava – generally and roughly considered a line of division between the right and left lobes.
71327s gallbladder liver left lobe right lobe position interlobar fissure middle hepatic vein normal anatomy USscan copyright 2008 Courtesy Ashley Davidoff MD
The plane of the gallbladder also lies in the same plane as the middle hepatic vein which is the true and more accurate division of the right and left lobes.
Middle Hepatic Vein, Plane of the Gallbladder
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The fundus of the gallbladder is the most anterior, lateral, and inferior part of the gallbladder.
28839.8s gallbladder liver normal anatomy MRI T2 weighted Courtesy Ashley Davidoff MD copyright 2008
The fundus lies just under the anterior abdominal wall and is the only portion of the gallbladder that lies unprotected. The exposed position of the fundus is well known to examining clinical hand as the being ” below the liver edge, in the midclavicular line, just below the 9the rib.”
82021c01.8s gallbladder normal anatomy size shape position character width 3.5cms length = 10cms pear shape pyriform shape fundus body neck fundus anterior neck posterior USscan ultrasound Courtesy Ashley Davidoff MD copyright 2008 pear shape
The body and neck lie medial, posterior, and superior to the fundus. In this position they are relatively protected by the liver. This is an important consideration since leakage of bile from traumatic injury into the peritoneal cavity can result in devastating and sometimes fatal peritonitis.
The position of the parts of the gallbladder in relation to each other is also very important in the functioning of the gallbladder. The body and and fundus lie inferior to the neck and they accumulate, concentrate and store bile making its SG a slightly higher value than the “new” incoming bile. As bile is concentrated it sinks to the dependant portion of the gallbladder, which in the upright position is in the fundus. Stratification thus occurs dividing the bile into “old”, “new”, and “fresh”, each relatively positioned in fundus, body and neck.
Position of the Gallbladder in Relation to Other Structures
The gallbladder’s immediate neighbours besides the the liver lobes, include the porta hepatis which contains the portal triad (hepatic artery, portal vein, bile duct), lyphatics and nerves, surrounded by Glisson’s capsule (extension of the gastrohepatic ligament). More posteriorly the intrahepatic portion of the IVC is present.
|82220b06.8s liver gallbladder porta hepatis hepatic artery portal vein IVC inferior vena cava falciform ligament ligamentum teres bare area of the liver left lobe segment IV segment I caudate lobe quadrate lobe gastrohepatic ligament gallbladder right lobe hepatic IVC Davidoff art copyright 2008|
Outside of the liver, an inferior neighour of the fundus is the hepatic flexure, while the neck and body lie in close association to the descending portion of the duodenum.
37957c01.8s gallbladder position relations colon duodenum abdomen normal anatomy CTscan Courtesy Ashley Davidoff MD copyright 2008
71326c01.8s gallbladder antrum duodenum anatomy normal relations position Courtesy Ashley Davidoff MD copyright 200871326c01.8s
The gallbladder is not usually papable but when enlarged it is felt just below the liver edge in the midclavicular line, below the 9th rib.
82304c01.8s 80f s/p cardiac cath spontaneous anterior wall muscle bleed (arrow) distended gallbladder huge large dilated distended cholestasis CTscan copyright 2008 Courtesy Ashley Davidoff MD
Courvoisier’s sign is a palpable gallbladder in the presence of obstructive jaundice most commonly caused by pancreatic cancer, but sometimes caused by a cancer at the ampulla..
The close relationship of the gallbladder to the liver, creates a potential pathway for the spread of disease. Thus exension of the inflammatory and infectious process of acute cholecystids will be identified in the liver.
11921.8b05b037.8s gallbladder cystic duct gallstones cholelithiasis stone impacted in the cystic duct distended enlarged hyperemic wall complex fluid in the gallbladder fossa tumefactive bile cholestasis sludge acute cholecytitis abscess formation Davidoff Art copyright 2008
Similalrly when gallbladder cancer spreads, its closest neighbour, the liver is invvolved, though sometimes, and usually at a later stage the colon may be involved as well. The reverse is also true when colon carcinoma of the hepatic flexure can spread to the gallbladder.
16254c02b.8s gallbladder anterior wall liver invasion space occupatopn obstruction bile ducts aggressive gallbladder carcinoma complicated by direct invasion metastasis liver windows narroe windws tumor settings gallbladder fossa GBF CTscan Courtesy Ashley Davidoff copyright 2008
Sometimes patients are born with an abnormal position of the gallbladder. This occurs with situs inversus but also occurs in rare instances in situs ambiguus states such as asplenia and polysplenia syndromes.
82222.8s liver gallbladder bilateral right lobe asplenia syndrome Ivemark syndrome central gallbladder situs ambiguus congenital position gross pathology Courtesy Ashley DAvidoff MD copyright 2008
Cavity and Spaces:
The gallbladder lies within the abdominal cavity and in the peritoneal cavity on the undersurface of the right lobe of the liver in the gallbladder fossa.
Rightward and Leftward Positioning:
It is a right sided structure.
The fundus of the gallbladder usually projects below the inferior margin of the liver and lies in midclavicular line just below the right 9th rib.
As a relatively anterior structure, it lies in close contact with the anterior abdominal wall.
The infundibulum is medial and superior while the fundus is inferior and lateral.
Its axis follows the axis of the middle hepatic vein and is obliquely and mostly vertically oriented. divides the liver into right and left lobes
The body of the gallbladder is directed upwards backward and to the left.
The neck becomes continuous with the cystic duct which turns into the lesser omentum to join the right side of the common hepatic duct to form the common bile duct.
The average position is at the level of the lower third of the second lumbar vertebra.
Touches and indents the duodenum
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Overall, the most important and relevant relations of the gallbladder are to the anterior abdominal wall, the liver surface, the portal triad, the porta heptis, amd the duodenum
The anterior abdominal wall and the inferior surface of the liver.
The transverse colon and the first and second parts of the duodenum.
The fundus is 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.
Anatomically, the gallbladder can touch the liver, duodenum, transverse colon, and the posterior surface of the anterior abdominal wall. Because of its close proximity to all these structures and due to the fact that it does not have a natural capsule, gallbladder disease is often reflected by abnormalities in these structures. For example, in cholecystitis, the fundus can irritate the peritoneum of the anterior abdominal wall leading to a positive Murphy’s sign on deep palpation of the right upper quadrant of the abdomin as the patient inhales. Liver function tests are often abnormal in gallbladder disease. An ileus can also manifest in the setting of gallbladder problems.
|27094c01.8s 77 male liver gallbladder bile ducts narrowed dilated atrophy right lobe abnormal position abnormal axis of the gallbladder sclerosing cholangitis MRI FSE T1 weighted T2 weighted gallstone cholelithiaisis filling defect Courtesy Ashley Davidoff MD copyright 2008|
16854 Courtesy Ashley Davidoff MD code pancreas + code liver right lobe left lobe interlobar plane fx normal + dx normal + code gallbladder imaging radiology CTscan
16792.8s gallbladder fx malposition naked dx cirrhosis sclerosing cholangitis liver imaging radiology CTscan spleen splenomegaly Courtesy Ashley DAvidoff MD copyright 2008