Gallbladder-Gallstones-Acute Cholecystitis-Cholecystectomy and the Arterial Supply to the Gallbladder-Gangrene of the Gallbladder-

Gallbladder

The gallbladder has a capacity of 30 to 50 mL and stores bile it  is a pear-shaped sac lying on the undersurface of the liver. It, which it concentrates by absorbing water.
The gallbladder is divided into the fundus, body, and neck. The fundus is rounded and projects below the inferior margin of the liver, where it comes in contact with the anterior abdominal wall at the level of the tip of the 9th right costal cartilage. The body lies in contact with the visceral surface of the liver and is directed upward, backward, and to the left. The neck becomes continuous with the cystic duct, which turns into the lesser omentum to join the common hepatic duct, to form the bile duct

Gallstones

Gallstones are usually asymptomatic; however, they can give rise to gallstone colic or produce acute cholecystitis.

Acute Cholecystitis

Acute cholecystitis produces discomfort in the right upper quadrant or epigastrium. Inflammation of the gallbladder may cause irritation of the subdiaphragmatic parietal peritoneum, which is supplied in part by the phrenic nerve (C3, 4, and 5). This may give rise to referred pain over the shoulder, because the skin in this area is supplied by the supraclavicular nerves (C3 and 4).

Cholecystectomy and the Arterial Supply to the Gallbladder

the surgeon must be aware of the many variations in the arterial supply to the gallbladder and the relationship of the vessels to the bile ducts Before attempting a cholecystectomy operation,. Unfortunately, there have been several reported cases in which the common hepatic duct or the main bile duct have been included in the arterial ligature with disastrous consequences

Gangrene of the Gallbladder

Unlike the appendix, which has a single arterial supply, the gallbladder rarely becomes gangrenous. In addition to the cystic artery, the gallbladder also receives small vessels from the visceral surface of the liver. Sonograms can now be used to demonstrate the gallbladder

Surface Landmarks of the Abdominal Viscera-Gallbladder-Spleen-Liver-Pancreas-Kidneys-Stomach-Aorta

Surface Landmarks of the Abdominal Viscera

Gallbladder

The gallbladder is a pear-shaped sac,The fundus of the gallbladder lies opposite the tip of the right ninth costal cartilage—that is, where the lateral edge of the right rectus abdominis muscle crosses the costal margin

 

Spleen

It lies in the left upper quadrant and lies under cover of the 9th, 10th, and 11th ribs. Its long axis corresponds to that of the 10th rib, and in the adult it does not normally project forward in front of the midaxillary line. In infants, the lower pole of the spleen may just be felt

Liver

The liver is a large organ that occupies the upper part of the abdominal cavity is covered under  the lower ribs, and most of its bulk lies on the right side.
In infants, until about the end of the third year, the lower margin of the liver extends one or two fingerbreadths below the costal margin. In the adult who is obese or has a welldeveloped right rectus abdominis muscle, the liver is not palpable. In a thin adult, the lower edge of the liver may be felt a fingerbreadth below the costal margin. It is most easily felt when the patient inspires deeply and the diaphragm contracts and pushes down the liver.

 

Pancreas

The pancreas lies across the transpyloric plane. The head lies below and to the right, the neck lies on the plane, and the body and tail lie above and to the left.

 

Kidneys

the left kidney lies at a slightly  higher level than The right kidney (because of the bulk of the right lobe of the liver), and the lower pole can be palpated in the right lumbar region at the end of deep inspiration in a person with poorly developed abdominal muscles. Each kidney moves about 1 in. (2.5 cm) in a vertical direction during full respiratory movement of the diaphragm. The normal left kidney, which is higher than the right kidney, is not palpable. On the anterior abdominal wall, the hilum of each kidney lies on the transpyloric plane, about three fingerbreadths from the midline. On the back, the kidneys extend from the 12th thoracic spine to the 3rd lumbar spine, and the hili are opposite the 1st lumbar vertebra

Stomach

The stomach is a dilated part of the alimentary canal between the esophagus and the small intestine ,The cardioesophageal junction lies about three fingerbreadths below and to the left of the xiphisternal junction (the esophagus pierces the diaphragm at the level of the10th thoracic vertebra).

The pylorus lies on the transpyloric plane just to the right of the midline. The lesser curvature lies on a curved line joining the cardioesophageal junction and the pylorus. The greater curvature has an extremely variable position in the umbilical region or below.

Aorta

The aorta lies in the midline of the abdomen and bifurcates below into the right and left common iliac arteries opposite the 4th lumbar vertebra—that is, on the intercristal plane. The pulsations of the aorta can be easily palpated through the upper part of the anterior abdominal wall just to the left of the midline.