Chapter 71 The Gallbladder and Bile Ducts

The gallbladder is a pear-shaped structure, 7.5–12 cm long, with a normal capacity of about 25–30 mL. Its anatomical divisions are fundus, body and neck, which terminates in a narrow infundibulum. The cystic duct is about 3 cm in length, but this is variable. The cystic duct joins the supraduodenal segment of the common hepatic duct in 80% of cases; however, the junction may be much lower in the retroduodenal or even retropancreatic part of the bile duct. The right hepatic artery can be tortuous and may lie very close to the gallbladder and the cystic duct before giving off a short cystic artery. The subserosal and submucosal lymphatic vessels of the gallbladder drain into the cystic lymph node of Lund, which lies in the fork created by the junction of the cystic and common hepatic ducts. A plain radiograph of the gallbladder will show radio-opaque stones in 10%.

Multiple Choice Questions
Weblinks

Guidelines

https://www.sages.org/safe-cholecystectomy-program/ (free; includes video and didactic modules)

Provides videos and guidelines for safe cholecystectomy as well tips for preventing bile duct injury.

https://onlinelibrary.wiley.com/doi/full/10.1002/jhbp.526/ (paid)

The article provides Tokyo guidelines for the management of acute cholecystitis and cholangitis.

https://academic.oup.com/bjs/article/93/2/158/6142455/ (free)

The article presents a review of management of bile duct injury in the current era. It also provides a schematic representation of the Strasberg classification of bile duct injuries.

https://www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf/ (free; needs registration)

This article presents guidelines for the management of gallbladder cancer along with the management of patients with incidental findings of gallbladder cancer on histopathology.

https://radiopaedia.org/articles/todani-classification-of-bile-duct-cysts/ (free; needs registration)

The Todani classification of bile duct cysts classically divides choledochal cysts into five groups.

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