II.
ANATOMY AND PHYSIOLOGY
The digestive tract is one of the most extensive systems in the human body. In addition to
the primary segments that run from the mouth to the anus, there are numerous accessory
digestive organs that play a role in the production and absorption of micronutrients from ingested
macromolecules. One such organ is the gallbladder.
The gallbladder is a small, pear-shaped organ located in the upper right part of the
abdomen (belly) below the liver. It is one inch wide and 3-4 inches long. It is connected to your
digestive system by a system of hollow ducts called the Biliary system.
The biliary system, also known as the biliary tract, includes the gallbladder as well as
bile ducts inside and outside of the liver. It produces, transports, and stores bile. It also carries
waste products from your liver to your duodenum (the first section of your small intestine). Bile
is a fluid produced by the liver that aids in the digestion of fats found in food. Bile is a mixture of
mainly cholesterol, bilirubin, and bile salts. It is a relatively small but surgically significant organ
in the body. One of the most common surgical procedures performed around the world is
cholecystectomy (open or laparoscopic surgical removal of the gallbladder to treat stones).
The gallbladder plays a key role in digestion because it stores and concentrates bile. The liver
produces about 27-34 fluid ounces (oz) of bile daily. The gallbladder can store 30-50 milliliters
(mL) of it.
The body doesn't need to digest fat unless it is when eating. When we are not eating, or
fasting, about 75% of bile goes to the gallbladder for storage until it's needed. The gallbladder
makes the bile more concentrated by absorbing most of the water.
When we eat, the bile produced by the liver flows directly into the small intestine. If we eat
food that contains fat, the stomach and small intestine release cholecystokinin (CCK), a hormone
that causes the gallbladder to contract. This squeezes 50-75% of its stored bile into the small
intestine. This bile emulsifies (breaks down) the fat, which helps the body use it for energy.
Parts of the Gallbladder:
Fundus: The large end that stores the bile.
Body: It is where the gallbladder begins to taper; becoming narrower.
Neck: It is where the gallbladder tapers further and connects to the cystic duct, a tube that
leads to the common hepatic duct just outside the liver.
The cystic duct and gallbladder typically meet in an area known as Hartmann's pouch.
This is the area where gallstones could become stuck. The gallbladder also contains spiral valves
of Heister. These valves may promote gallbladder emptying via neural (nerve) and hormonal
stimulation.
The gallbladder has multiple layers, including:
Epithelium: A thin layer of cells that line the inner wall.
Lamina propia: A thin layer of connective tissue that, with the epithelium, forms the
inner layer called the Mucosa.
Muscularis: A layer of muscle that helps the gallbladder contract and move bile into the
bile ducts (tubular structures that carries bile to the small intestine)
Perimuscular tissue: Tissue around the muscularis
Serosa: The smooth, outermost layer
Pathophysiology of Cholelithiasis
Predisposing factors: Precipitating factors:
Obesity High-fat diet
Rapid weight loss Fasting or skipping meals
Female (gender) Rapid weight loss
Age Pregnancy
Pregnancy Medications
Genetic syndrome Obesity
Ethnicity Physical inactivity
High-fat diet Gastrointestinal disorders
Metabolic disorders Liver disease
Medications Previous abdominal surgery
Interpretation:
Cholelithiasis, or gallstone formation, arises from a multifactorial process involving disruptions
in bile composition, gallbladder motility, and inflammatory responses. The condition typically
develops when bile becomes supersaturated with cholesterol or bilirubin, leading to the
precipitation of solid particles within the gallbladder or bile ducts. Factors such as obesity, rapid
weight loss, and certain genetic predispositions can contribute to the development of gallstones
by altering bile chemistry or impairing gallbladder function. Chronic inflammation of the
gallbladder further exacerbates the formation of gallstones, creating a cycle of irritation and
obstruction.
