Gallbladder+(ash&aiesh)

   The Gallbladder The gallbladder is a small organ positioned near the mid-abdominal area of the body 

 **FUNCTION OF THE GALLBLADDER:**  The main function of the gallbladder is to store the **bile** that comes from the liver.

  **WHAT IS BILE AND ITS FUNCTION?** Bile is a substance that helps in the digestion of fat. It is also a digestive liquid that is continually secreted by the liver. Since fat does not dissolve in water, something special is needed in the body in order to dissolve that fat. Bile plays that special role in the body where it emulsifies fat and neutralizes acids in partly digested food. Bile contains water, cholesterol, fats, salts, proteins, and bilirubin--a waste product. Bile salts break up fat, and bilirubin gives bile and stool a yellowish-brown color.

The wall of the gallbladder consists of a mucosa that is composed of a simple columnar epithelium of absorptive cells and a lamina propria, which is a thin irregular layer of smooth muscle cells. This is responsible for the contraction and expulsion of the stored bile in response to cholecystokinin, (which is a well developed perimuscular connective tissue layer), and the serosa. The mucosa is then extensively folded when the gallbladder is contracted and then is modestly folded when it is relaxed. However, it does not contain villi or tubular glands (crypts). The underlying connective tissue is also richly vascularized. There are four layers or coats called the serous, perimuscular, muscular, and finally a mucous coat.
 * FUNCTIONAL HISTOLOGY OF THE GALLBLADDER:**

1. Serous layer: It is the derivative of the peritoneal layer. All the places of the gallbladder are covered under this. 2. Perimuscular layer: this layer consists of thick layers of the tissues, mostly connective tissues, along with arteries, veins, nerves, and lymphatics. 3. Muscular layer: Made of smooth muscle fibers which are not only smooth but also irregular in shape. 4. Mucous layer: These have the appearance of the comb of the honey, and also have the layer of the single columnar epithelium. **FUNCTIONAL ANATOMY OF THE GALLBLADDER:** <span style="font-size: 90%; font-family: Tahoma,Geneva,sans-serif;"><span style="font-family: Tahoma,Geneva,sans-serif;">The gallbladder is the place for the storage and concentration of bile: The bile exits the liver through the **common hepatic duct**. During periods of fasting, tonic contraction of the sphincter of Oddi keeps the major duodenal papilla closed. The bile is shunted through the **cystic duct** into the gallbladder where it is stored until needed for digestion. Next is the expulsion of bile. This occurs when a meal is ingested, the sphincter of Oddi relaxes and the smooth muscle cells in the wall of the gallbladder contract to expel the bile through the cystic and **common hepatic duct** into the duodenum.

- hepatic ducts; which carry bile out of the liver - cystic duct; which takes bile to and from the gallbladder -common bile duct; which takes bile from the cystic and hepatic ducts to the small intestine**
 * In summary: the ducts that carry bile from the liver to the small intestine include the

<span style="font-size: 120%; color: rgb(255, 255, 255); background-color: rgb(0, 0, 0);">** DIGESTIVE PROCESS :** After food is digested in the body, it is being stored in the gallbladder. The bile becomes more concentrated than when it left the liver, which increases its potency and intensifying its effect on fats. Most of the digestion occurs in the duodenum, The gallbladder plays the role of storing and concentrating bile.

<span style="font-size: 90%; color: rgb(255, 255, 255); font-family: Tahoma,Geneva,sans-serif; background-color: rgb(0, 0, 0);"> Gallstones are small, pebble-like substances that develop in the gallbladder. Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material. There are two types of gallstones. Cholesterol stones and pigment stones. Cholesterol stones are usually yellow-green and pigment stones are small, dark stones made of bilirubin. Gallstones can be as small as a grain of sand or as large as a golf ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or a combination of the two. Gallstones can block the normal flow of bile if they move from the gallbladder and lodge in any of the ducts. If any of the bile ducts remain blocked for a significant period of time, severe damage or infection can occur in the gallbladder, liver, or pancreas. If it is left untreated, the condition can be fatal. Some warning signs of a serious problem are fever, jaundice, and persistent pain.
 * <span style="font-size: 140%; font-family: Tahoma,Geneva,sans-serif;">TYPES OF GALLBLADDER DISORDERS: **
 * 1. GALLSTONES (Choledocholithias):**

//**CAUSES:**// Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty completely or often enough. The reason these imbalances occur is not known. The mere presence of gallstones may cause more gallstones to develop. Other factors that contribute to the formation of gallstones, particularly cholesterol stones include: - YOUR SEX: women are prone to develop gallstones - FAMILY HISTORY -WEIGHT -DIET -RAPID WEIGHT LOSS -YOUR AGE -ETHNICITY - IF YOU HAVE DIABETES

//** SYMPTOMS:**// As gallstones move into the bile ducts and create blockage, pressure increases in the gallbladder and one or more symptoms occur. Symptoms of blocked bile ducts are often called a "gallbladder attacks." A typical attack can cause steady pain in the upper abdomen that increases rapidly and lasts from 30 to several hours. One can get pain in the back between the shoulder blades and pain in the right shoulder. Many people with gallstones have no symptoms; these gallstones are called "silent stones." They do not interfere with the gallbladder, liver, or pancreas function and do not need treatment.

//**DIAGNOSES:**// Gallstones can be diagnosed through: - (CT) scan - HIDA scan - ERCP scan - Blood tests

//**TREATMENT:**// Gallstones can be treated with surgery and also have a nonsurgical treatment. There are two types of nonsurgical therapies. Oral dissolution therapy and contact dissolution therapy. Oral dissolution therapy are drugs made from bile acid which are used to dissolve gallstones. There are drugs that work best for small cholesterol stones. Months or years of treatment may be necessary before all the stones dissolve. Contact dissolution therapy is an experimental procedure which involved with the injection of a drug directly into the gallbladder to dissolve cholesterol stones.

A relatively uncommon cancer. It is cured by removing the gallbladder, part of the liver, and some lymph nodes. It is a rare cancer that is still being studied and thought to be related to gallstones building up, which also can lead to calcification of the gallbladder, a condition also known as Porcelain gallbladder.
 * 2. GALLBLADDER CANCER**

- Abdominal Pain - Jaundice - Vomitting
 * //Symptoms://**

//**Treatment:**// - Surgical removal of the gallbladder - Endoscopic stenting of the biliary tree - Chemotherapy -Radiation

3. **CHOLECYSTITIS** Inflammation of the gallbladder. It is often caused by the gallstones in the gallbladder. The gallbladder's wall becomes inflamed. Extreme cases may result in necrosis and rupture. Inflammation often spreads to its outer covering, therefore irritating surrounding structures such as the diaphragm and bowel.

//SYMPTOMS:// - High fever - Shock - Jaundice - Develop gallstone ileus - Nausea


 * TWO TYPES OF CHOLECYSTITIS:**
 * ACUTE CHOLECYSTITIS;**
 * - Possible Causes:**
 * - Perforated peptic ulcer**
 * - Acute peptic ulcer exacerbation**
 * - Acute amoebic liver colitis

CHRONIC CHOLECYSTITIS; - Possible Disorders: - Peptic Ulcer - Hiatus hernia - Colitis

**

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