The gallbladder is located in the upper right abdomen. There, it sits below the liver in the gallbladder fossa.
The liver and gallbladder are connected by a bridge of connective tissue. Below the gallbladder are the duodenum and the descending colon. Where the gallbladder does not lie directly against the liver or is not connected to it via connective tissue, it is covered by the peritoneum.
© Henrie / Fotolia
The gallbladder is 8 to 12 cm long and 4 to 5 centimeters wide. The wall thickness of the gallbladder is about 4 mm.
As a storage organ, the gallbladder holds 30 to 80 ml of bile. The anatomical structure of the gallbladder consists of the fundus, body, and neck of the gallbladder. The Heister valve, located in the cystic duct and the cystic duct opening, prevents the uncontrolled flow of bile and releases it only when needed.
Because bile is green in color, the gallbladder appears greenish.
This hollow organ, shaped like a pear, serves to store and concentrate the bile produced in the liver. Bile consists mainly of water, bile acids, phospholipids, cholesterol, bilirubin, and other pigments. The inside of the gallbladder is lined with a mucous membrane that protects it from the digestive enzymes in the bile. The wall of the gallbladder also contains muscle tissue.
Bile flows from the liver into the gallbladder via the common hepatic duct (ductus hepaticus communis). From there, it later passes through the opening of the gallbladder—the common bile duct (ductus choledochus)—into the duodenum.
In total, the liver secretes between 0.5 and 1 liter of yellow bile per day. This hepatic bile is converted into green gallbladder bile in the gallbladder. The color change occurs as the bile thickens in the gallbladder, with up to one liter of hepatic bile being converted into 50 to 60 ml of gallbladder bile.
The bile produced by the liver and released by the gallbladder plays an important role in the digestion of fats in the intestine. After a meal, the organ contracts, forcing the bile through the bile ducts into the duodenum. The gallbladder empties its contents through contraction of the muscles in its wall. This process is triggered by hormone-producing cells in the intestinal wall and by acetylcholine, which is released by the vagus nerve.
Once it reaches the duodenum, the bile begins its work: it breaks down dietary fats into droplets, which are then further broken down by enzymes.
Typical causes of gallbladder diseases are gallstones and inflammation, although gallbladder inflammation is often due to the presence of gallstones and, occasionally, to tumors or polyps in the gallbladder.
Gallstones
If the balance between the bile components—cholesterol and bile acids—is disrupted, solid deposits form in the form of gallstones. A gallstone that is small at first can grow as more material accumulates—ranging in size from a grain of sand to a cherry. Most gallstones consist largely of cholesterol.
The stones that accumulate in the gallbladder do not cause any problems, at least initially. Many people are unaware that they have gallstones and remain free of gallstone-related problems throughout their lives. In Germany, approximately 15% of all women and 7.5% of all men have gallstones. Of these, 75% experience no health problems as a result.
Health problems caused by gallstones occur when small stones enter the narrow bile ducts or when a large stone rolls in front of the opening of the gallbladder. Both situations block the flow of bile. The accumulated bile exerts pressure on the gallbladder wall, causing pain in the upper right abdomen that often escalates to almost unbearable colic.
High-fat meals contribute to this process, as the digestive system requires correspondingly large amounts of bile.
Removed gallstones © Jürgen Fälchle / Fotolia
Gallbladder Inflammation
Gallbladder inflammation, or cholecystitis, almost always occurs as a result of gallstone symptoms. The intense pressure exerted by the accumulated bile on the gallbladder wall eventually causes the gallbladder to become inflamed.
The resulting upper abdominal pain, which is usually cramp-like or colicky, can even radiate to the right shoulder. Other symptoms accompany cholecystitis:
When gallbladder inflammation is not caused by gallstones, it is referred to as “acalculous cholecystitis.” In addition to infections and major abdominal surgeries, accidents can also trigger this condition.
Inflammation of the bile ducts
The bile ducts can also become inflamed if gallstones that have entered them block the flow of bile. Less commonly, tumors or infections may be the cause of bile duct inflammation.
Possible Complications of Gallbladder Diseases
Gallbladder diseases are not merely unpleasant or bothersome; they can lead to life-threatening complications. Recurring symptoms caused by gallstones in the gallbladder or bile ducts suggest that surgical removal is necessary.
Through contractions, the gallbladder and bile ducts are often able to move a gallstone obstructing the flow into a more favorable position, causing the symptoms to subside. However, if this fails, the continuous flow of bile can create excess pressure that may cause the gallbladder to rupture. The bile that leaks into the abdominal cavity as a result can lead to life-threatening peritonitis.
Furthermore, chronic inflammation can cause the gallbladder to shrink. The constant mechanical irritation of the gallbladder and bile ducts by gallstones also increases the risk of developing carcinoma, or a malignant tumor.
A backup of bile can also affect the neighboring organs—the liver and pancreas.
Diagnosis of Gallstones and Cholecystitis
Based on the patient’s description of symptoms alone, the doctor will consider the possibility of gallstones or cholecystitis when making a diagnosis. The following diagnostic procedures provide further insight:
- Physical examination
- Ultrasound
- X-ray with contrast dye
- Blood tests: particularly liver function tests and markers of inflammation
For gallbladder symptoms requiring treatment, gallbladder removal is now the standard of care, whether the condition is gallbladder inflammation or “just” gallstones. Since gallstones often develop due to a genetic predisposition, they would recur after removal. Similarly, gallbladder inflammation is almost always caused by gallstones, which typically leads to a recommendation for gallbladder removal. Unlike with kidney stones, shock wave therapy for gallstones carries the risk that fragments of the stones will remain in the tissue, necessitating a follow-up surgery.
For surgical gallbladder removal—also known as cholecystectomy—two procedures are used:
In the conventional surgical method, which is rarely performed today, the gallbladder is removed through an abdominal incision below the right rib cage.
The current standard of care for gallbladder removal is laparoscopy, also known as keyhole surgery or minimally invasive surgery. This procedure involves making only four tiny incisions, three of which are used to insert instruments and cameras into the abdominal cavity, while the surgeon removes the gallbladder and its contents through the fourth incision.
Patients recover quickly afterward and can usually leave the hospital after 2 to 4 days. The bile, which continues to be produced by the liver, is now directed directly into the duodenum.
The gallbladder serves as a reservoir for the bile produced by the liver. Occasionally, gallstones form as a result. Gallbladder diseases are most often caused by such gallstones.
In many cases, the standard treatment for gallbladder diseases is minimally invasive removal of the gallbladder.
What is the function of the gallbladder?
The gallbladder serves as a storage organ for bile produced by the liver. Bile is concentrated there and released into the duodenum via the bile duct as needed. There, bile aids in the digestion of fats in the intestine.
Where is the gallbladder located in the body?
The gallbladder is located on the underside of the liver in the upper right abdomen. It lies within the abdominal cavity and is connected to the bile ducts via the cystic duct. Together with the liver and the bile ducts, it forms an important system for digestion.
What are gallstones?
Gallstones form when components of bile, such as cholesterol or bilirubin, crystallize. These stones can block the flow of bile and cause pain in the upper abdomen. Symptoms often occur in the right shoulder as well.
What is gallbladder inflammation?
Gallbladder inflammation, medically known as cholecystitis, is an inflammation of the gallbladder. It is often caused by gallstones that block the bile duct. Typical symptoms include pain in the upper abdomen, fever, and nausea.
Can you live without a gallbladder?
Yes, after surgical removal of the gallbladder—known as a cholecystectomy—the body can continue to produce bile. The bile produced by the liver then flows directly into the intestines. Many people are able to continue living a normal life after having their gallbladder removed.
