CHOLELITHIASIS

ANATOMY AND PHYSIOLOGY Gastroinstestinal TractThe gastrointestinal tract (GIT) consists of a hollow muscular tube starting from the oral cavity, where food entersthe mouth, continuing through the pharynx, esophagus, stomach and intestines to the rectum and anus, where food isexpelled. There are various accessory organs that assist the tract by secreting enzymes to help break down food into itscomponent nutrients. Thus the salivary glands, liver, pancreas and gall bladder have important functions in the digestives ystem. Food is propelled along the length of the GIT by peristaltic movements of the muscular walls. The primarypurpose of the gastrointestinal tract is to break down food into nutrients, which can be absorbed into the body to provideenergy.Focus: GALLBLADDERThe gallbladder (or cholecyst, sometimes gall bladder) is a small organ whose function in the body is to harbor bile andaid in the digestive process. Anatomy Thecystic ductconnects the gall bladder to thecommon hepatic ductto form thecommon bile duct. The common bile romero duct then joins thepancreatic duct, and enters through thehepatopancreatic ampullaatthemajor duodenal papilla. Thefundus of the gallbladder is the part farthest from the duct, located by the lower border of theliver . It is at thesame level as thetranspyloric plane. Microscopic anatomy The different layers of the gallbladder are as follows: The gallbladder has asimple columnar epitheliallining characterized by recesses called Aschoff's recesses,which are pouches inside the lining.

Under the epithelium there is a layer of connective tissue( lamina propria ). Beneath the connective tissue is a wall of smooth muscle( muscularis externa ) that contracts in response tocholecystokinin, apeptidehormonesecreted by theduodenum. There is essentially nosubmucosaseparating the connective tissue fromserosaandadventitia.Size and Location of the Gallbladder The gallbladder is a hollow, pear-shaped sac from 7 to 10 cm (3-4 inches) long and 3 cm broad at its widest point.It consists of a fundus, body and neck. It can hold 30 to 50 ml of bile. It lies on the undersurface of the livers right lobeand is attached there by areolar connective tissue.Structure of the Gallbladder Serous, muscular, and mucous layers compose the wall of the gallbladder. The mucosal lining is arranged in foldscalled rugae, similar in structure to those of the stomach.Function of the Gallbladder The gallbladder stores bile that enters it by way of the hepatic and cystic ducts. During this time the gallbladder concentrates bile fivefold to tenfold. Then later, when digestion occurs in the stomach and intestines, the gallbladder contracts, ejecting the concentrated bile into the duodenum. Jaundice a yellow discoloration of the skin and mucosa,results when obstruction of bile flow into the duodenum occurs. Bile is thereby denied its normal exit from the body in thefeces. Instead, it is absorbed into the blood, and an excess of bile pigments with a yellow hue enters the blood and isdeposited in the tissues.The gallbladder stores about 50 mL (1.7 USfluid ounces/ 1.8 Imperial fluid ounces) of bile, which is releasedwhenfoodcontaining fat enters the digestive tract, stimulating thesecretionof cholecystokinin(CCK). Thebile,producedin theliver , emulsifies fats and neutralizes acids in partly digested food.After being stored in the gallbladder thebilebecomes more concentrated than when it left theliver,increasing itspotency and intensifying its effect on fats. Most digestion occurs in theduodenum.