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1. WELCOME

2. Dewan Institute Of Rehabilitation Sciences
Shaheed Benazir Bhutto
Dewan University
2

3. GALL BLADDER:
o It is a small sac-shaped organ beneath the liver, in which bile
is stored after secretion by the liver and before release into
the intestine.
o The gallbladder squeezes stored bile into the small intestine
through a series of tubes called ducts.

4. POSITION:
o It lies just beneath the right lobe of the liver.
o In adults, the gallbladder measures
approximately 8 centimetres (3.1 in) in length
and 4 centimetres (1.6 in) in diameter when
fully distended.
o The gallbladder has a capacity of about
100 mL.

5. Fig. Gallbladder Position.

6. STRUCTURE :
o The gall bladder is a hollow organ.
o Its shaped is like a tapered sac, with the
open end opening into the biliary tree and
the cystic duct.

7. PARTS OF GALL
BLADDER :
Anatomically, the gallbladder is divided into three sections:

8. Fig. Parts of Gall bladder.

9. 1. Fundus:
The fundus is a rounded end that faces the front
of the body.
2. Body:
The body is in contact with the liver, lying in the
gallbladder fossa, a depression at the bottom of the
liver.

10. 3. Neck:
The neck tapers and is continuous with the cystic duct,
part of the biliary tree. The cystic duct unites with the
common hepatic duct to become the common bile duct.
At the junction of the neck of the gallbladder and the
cystic duct.

11. LAYER OF GALL
BLADDER:
The inner most layer is epithelium.
The submucosa is a thin layer of loose connective tissue
with smaller blood vessels.
The muscular layer, formed by smooth muscular tissue.
The serosa is a thick layer that covers the outer surface
of the gallbladder, and is continuous with the peritoneum.

12. Fig. Layers of Gall bladder.

13. FUNCTION OF
GALL BLADDER:
The main purpose of
the gall bladder is to
store bile, also called
gall. The gall bladder is
part of the biliary
system and serves as a
reservoir for bile, which
is produced by the liver.
The liver produces
the bile and then
it flows through
the hepatic
ducts into the
gallbladder.
The bile that is secreted by
the liver and stored in the
gallbladder is not the same
as the bile that is secreted
by the gallbladder. During
gallbladder storage of bile,
it is concentrated by
removal of some water and
electrolytes.

14. Lymphatic drainage of GB:
1. Terminate @ celiac nodes
2. Cystic node at neck of GB
a. Actually a hepatic node
b. Lies at junction of cystic
& common hepatic ducts
3. Other lymph vessels also drain into hepatic
nodes.

15. •
 Cystic artery
 Right hepatic artery
 Proper hepatic artery
 Common hepatic artery

16. Common Hepatic
Artery
Proper Hepatic
Artery
Gastroduodenal
Artery
Blood
Supply:

17.  Sympathetic and parasympathetic from celiac
plexus
 Parasympathetic ---- vagous nerve
 Hormone cholecystokini  duodenum

18. Extra hepatic biliary system
Rt. hepatic duct
+
Lt hepatic duct
↓
Common hepatic duct
+
Cystic duct
↓
Common bile duct
- 4cm
- Descend in free edge of lesser
omentum
- Supra duodenal part
Retro duodenal part
Retro pancreatic part
Common bile duct

19. -1st part
-Located in right free margin of
lesser omentum in front of the
opening into the lesser sac (Epiploic
opening) Rt to hepatic artery and
portal vein
-

20. -2nd part
-Behind the 1st part of the duodenum
-Rt to the gastroduodenal artery.
-3 rd part
-Posterior surface of the head of the
pancreas
-Contact with main pancreatic duct
-Related with IVC, gastroduodenal artery,
portal vein
-End in the half second part of duodenum
at ampulla of Vater

21. Fig. Layers of Gall bladder.

22. Ampulla of Vater with CBD and Pancreatic Duct
Ampulla of Vater

23. The ampulla of Vater, also known as the
hepatopancreatic ampulla,or as
hepatopancreatic duct, is formed by the union of
the pancreatic duct and the common bile duct.

24. Blood supply of CBD
Small arteries supplying CBD
a. Arise from cystic artery
b. Posterior branch of superior
pancreaticoduodenal artery

25. CLINICAL DISORDERS:
• GALL STONE:
(cholelithiasis)For unclear reasons, substances in bile
can crystallize in the gallbladder, forming gallstones.
Common and usually harmless, gallstones can
sometimes cause pain, nausea, or inflammation.
• Cholecystitis:
Inflammation of the gallbladder, often due to a
gallstone in the gallbladder. Cholecystitis causes
severe pain and fever, and can require surgery when
inflammation continues or recurs.

26. CLINICAL DISORDERS:
• Gallbladder cancer:
Although rare, cancer can affect the gallbladder. It is
difficult to diagnose and usually found at late stages
when symptoms appear. Symptoms may resemble
those of gallstones.
• Gallstone pancreatitis:
An impacted gallstone blocks the ducts that drain
the pancreas. Inflammation of the pancreas results,
a serious condition.

27. REMOVAL OF GALL BLADDER:
• A cholecystectomy is a procedure in which the
gallbladder is removed. It may be removed
because of recurrent gallstones, and is
considered an elective procedure. A
cholecystectomy may be an open procedure,
or one conducted by laparoscopy. In the
surgery, the gallbladder is removed from the
neck to the fundus.

28. Definition:

29. POSITION:
The
pancreas is
located deep
in the
abdomen.
The head of
the pancreas is
on the right
side of the
abdomen.
It is
connected to
the upper
end of the
small
intestine.
The narrow
end of the
pancreas,
called the tail,
extends to the
left side of the
body.

30. STRUCTURE:
o The pancreas is a secretory structure with
an internal hormonal role (endocrine) and
an external digestive role (exocrine).
o It has two main ducts, the main pancreatic
duct, and the accessory pancreatic duct.
o These drain enzymes through the ampulla
of Vater into the duodenum.

31. PARTS OF PANCREAS:
There are four parts of Pancreas. They are:
1. Head.
2. Neck.
3. Body.
4. Tail.

32. Fig. Parts of Pancreas.

33. 1. Head:
-It is disc shaped
- lies within the concavity of the duodenum
- A part of the head extends to the left behind the superior
mesenteric vessels and is called the Uncinate process.
2. Neck:
- It is the constricted portion of the pancreas
- connects the head to the body.
- It lies in front of the
beginning of the portal vein.

34. Fig. Parts of Pancreas.

35. 3. Body:
-Runs upward and to the left across the midline
- It is somewhat triangular in cross section.
-Three surfaces:
a. Anterior
b. Posterior
c. inferior.

36. a. Anterior Surface:
1- Covered by peritoneum of post. Wall of lesser sac
2- Tuber omental :
where the ant. surface of pancreas join the neck.
b. Posterior Surface:
- devoid of peritoneum
- in contact with
1- the aorta
2- the splenic vein
3- the left kidney and its vessels
4- the left suprarenal gland
5- the origin of the superior mesenteric artery

37. c. Inferior Surface:
- Narrow on the right but broader on the left
-Covered by peritoneum of greater omentum
- lies upon the duodenojejunal flexure
- Some coils of the jejunum
- its left extremity rests on the left colic flexure .
4. Tail:
- Anatomically left with the hilum of the spleen.

38. Fig. Parts of Pancreas.

39. Fig. Parts of Pancreas.

40. Pancreatic Ducts:
The Main Duct:
-Begins in the tail and runs the length of the gland
-Receiving numerous tributaries on the way .
- It opens into the second part of the duodenum at about its middle
with the bile duct on the major duodenal papilla

41. Fig. Pancreatic Ducts.

42. Pancreatic Ducts:
The Accessory Duct:
- When present, drains the upper part of the head
-Then opens into the duodenum a short distance above the main
duct on the minor duodenal papilla .
- The accessory duct frequently communicates with the main
duct

43. Fig. Pancreatic Ducts.

44. Blood Supply Of
Pancreas:
Arteries
The splenic artery.
The superior pancreaticoduodenal artery.
Inferior pancreaticoduodenal arteries artery.
Veins
The corresponding veins drain into the portal system.

45. Fig. Pancreatic Blood Supply.

46. Lymphatic Drainage
• Lymph nodes are
situated along
the arteries that
supply the gland.
• The efferent
vessels
ultimately drain
into the celiac
and superior
mesenteric
lymph nodes.

47. Nerve supply
• Sympathetic and parasympathetic chain
• Parasympathetic = vagus nerve

48. Congenital defects
of pancreas
• Annular Pancreas.
• Ectopic Pancreas.

49. • Annular Pancreas:
Pancreas encircle Duodenum.
It is a rare type.
• Ectopic Pancreas.
Outside the Gastrointestinal Tract.
It is the most common type.

50. Acute Pancreatitis:
• Common acute abdomen
• Local inflammatory change in pancreas
• Life-threatening inflammatory disorder of the
pancreas
• Variable severity and duration

51. Acute Pancreatitis:
laboratory test
• Amylase level in serum and in urine
• Liver function, PaCO2 ,serum calcium.
• Diagnostic paracentesis

52. Acute Pancreatitis:
Image findings
• BUS
• CT
• ERCP
• MRCP
• Abdomen plain film

53. Severe Acute Pancreatitis
• Severe Acute pancreatitis (SAP)
– Complicated with MODS(Multiple organ disorder
syndrome.
– Necrosis, abscess, pseudocyst
– Or both

54. Q?
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