Gall bladder

See also the page of homonymy Blister

The gall bladder (or cholécyste ) is a pyriforme body (in the pear shape) which stores the Bile until the body uses it for digestion. It constitutes the additional Bile Duct . It is connected to the Foie, with the Duodénum, the cholédoque Canal by the channel cystic.

Anatomy

It is a body under hepatic, coupled with the liver via the bed vésiculaire. The blister is located on the hepatic median fissure. It is vascularized by the cystic artery, connects clean hepatic artery. It is connected to cholédoque via the channel cystic: end and tortuous. There exists a rather significant number of anatomical variations in the meeting of the channel cystic.

Microscopic anatomy

Function

The gall bladder stores and concentrates the bile produced by the liver while waiting for that this one is necessary to digestion. The bile is made up of Mucus, of biliary pigments, biliary Sels, Cholestérol and Rock salt (calcium).

Biliary pathologies

Cholestase

Reduction or complete stop of the biliary excretion. (one distinguishes the intrahepatic cholestase, with reduction in biliary manufacture, and cholestase extra-hepatic, with stop of the biliary evacuation). The syndrome of cholestase appears by a Ictère, a prurit and a prurigo Lésions of scraping. Because of absence of excretion of the biliary pigments, the saddles take a faded aspect whereas the urines are strongly coloured. Since the absorption of the Vitamine K is dependant on biliary salts, there are a Carence in Vitamine K in the case of the syndrome of cholestase what involves a reduction in the rate of the dependant factors of the Coagulation vitamino-K (II, VII, IX, X, proteins C and S) and thus a reduction in the rate of prothrombine. The rate of dependant factor V, not vitamino-K, is unchanged. The reduction in the rate of prothrombine is corrigeable by the parenteral administration of vitamin K: test of Kohler.

Cholélithiase

In the blister, at the time of a hormonal modification (pregnancy) or in a fortuitous way, the elements of the bile can crystallize. There will be then coalition of calculations to carry out a biliary lithiasis, or calculation. It can contain mainly biliary calcium, cholesterol, or pigments, or be mixed. The cholélithiase is very frequent (20% of the population), often asymptomatic. It becomes complicated in limited an enough number of cases.

Biliary colic

Calculation thus made up can wedge in the Canal cystic. At the time of the meal, when the contraction of the blister tries to evacuate the bile towards the digestive tract, calculation will block the cystique one: the blister thus put in tension will become painful. The crisis will last a few hours, will stop spontaneously. The biliary colic appears on the clinical level by a pain sitting in the Hypochondre right, irradiant towards the right scapula. It can be accompanied by a surface breathing. The palpation of the hypochondre right does not highlight a Contracture but reveals the sign of Murphy: pain caused with palpation with respiratory inhibition.

Cholécystite

See the principal article: Cholécystite

Cholédocholithiase

A calculation can migrate through the Canal cystic towards the cholédoque Canal. It will butt then in cholédoque bottom, and will risk to block it, often in a transitory way: there will be then constitution of a Ictère (or jaundice), often fluctuating. The superinfection of the bile choledocian will involve the Angiocholite which appears by the succession in 48 hours of pain, fever, ictère. The liver is a very vascularized body, the infection of the intrahepatic bile involves a massive toxin discharge and bacteria towards blood, with fast risk of constitution of a septic Choc.

Biliary Ileus

Following a cholécystite, the blister weakened by the ignition can be perforated in the duodenum, and calculation to gain the digestive tract thus. A large calculation can then be wedged on the level of the valvule iléo-caecale (between small intestine and colonist), and determine an occlusion. The diagnosis is often made on a radio of abdomen without preparation, which will associate aérobilie, occlusion of hail, and sometimes visible radioopaque calculation.

Cancer of the blister (biliary)

(very rare, its frequency far from high does not justify the prophylactic ablation of the gall bladder)

Law of Courvoisier

External bonds

Illustration
Disease of the acute blister
Cholécystite

Simple: Gallbladder

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