Capsule of the Gallbladder
The gallbladder capsule is a protective covering consisting of loose connective tissue.
Structurally the coverings on the free surface and the hepatic surface are different. On the free surface the loose connective tissue is covered and protected by the peritoneum and it is called a serosa.. On the liver surface it is covered and protected by the liver and here it is called an adventitia. The fundus is totally surrounded by peritoneum. Occasionally the peritoneum almost totally surrounds the body of the gallbladder as well such that if one would place ones thumb over the anterior surface and ones index posteriorly they would meet separated only by a double layer of peritoneum. Usually though the gallbladder is bound down by the peritoneum so it remains snug and protected.
Fuctionally the serous membrane formed by visceral peritoneum covering is resilient, smooth and is richly endowed with nerves and lymphatics. It protects as well as connets the gallbladder with the other peritoneal covered organs of the abdomen. The adventitia acts more as aconduit to transmit fluids to and frm the mother organ the liver. It in fact is the hilum of the gallbladder.
The diseases of the coverings are really a mirror of disease in the peritoneal cavity, from withinn the gallbladder or from the liver. Serosal implants from peritoneal carcinomatosis, spread of inflammation from or to the liver, and spread of cancer of the gallbladder via the gallbladder fossa to the liver are some examples.
Treatments of the primary disease will therefore affect the way the capsule is treated.
04766b05b04.52k.8s gallbladder support protection peritoneum bare area gallbladder fossa normal anatomy gastrohepatic ligament peritoneum serosal surface adventitial surface Davidoff art copyright 2008
The histological sections seen below show the rough liver edge and the mesothelial covered free surface which is smooth
00139d.8s gallbladder histology normal gallbladder fossa free wall peritoneal lining whole mount mucosa histology Courtesy Ashley Davidoff MD copyright 2008
The following images of the gallbladder in longitudinal and transverse dimension show from an imaging perspective haw the visceral peritoneum encloses the liver , covers the fundus of the gallbladder, spreads over the body of the gallbladder, and then encloses the structures of the porta hepatis.
82428c06.8s gallbladder small normal transverse oval shape gallbladder fossa Glisson’s capsule gastrohepatic ligament normal anatomy body of the gallbladder green is wall attached to the liver orange is free wall peritoneum = pink serosa liver capsule USscan ultrasound copyright 2008 Courtesy Ashley DAvidoff MD
When there is peritoneal carcinomatosis metastattic disease is able to settle and grow on the gallbladder. In the case shown below a metastsasis is seen in the fundus of the gallbladder.
22704c01.8s gallbladder abdomen peritoneum peritoneal cavity fx mass fx calcification fx distortion dx metastatic colon carcinoma large bowel malignant primary compliacated by transperitoneal spread dx metastasis to the gallbladder fundus metastases metastattic fx ascites imaging radiology CTscan C+ CTscan Courtesy Ashley Davidoff MD copyright 2008