Art of the Gallbladder

The Common Vein Copyright 2008

Gallbladder

04766b04.800 gallbladder bile duct cystic duct common hepatic duct common bile duct normal anatomy applied biology TCV Davidoff art Davidoff MD

Gallbladder in Blue

17082b06b01.8s gallbladder still life pear in blue MRI T1 weighted distended gallbladder choledocholithiaisis Courtesy Ashley Davidoff MD copyright 2008

Gallbladder in Red

17082b06b01.8s gallbladder still life pear in blue MRI T1 weighted distended gallbladder choledocholithiaisis Courtesy Ashley Davidoff MD copyright 2008

Obstructive Jaundice – In the Wrong Place at the Wrong Time

17082b04.8s gallbladder distended enlarged dilated cystic duct stone choledocholithiasis obstruction obstructed MRI T2 weighted Courtesy Ashley DAvidoff MD copyright

 

 VAlves of Heister and the Archimedes Waterscrew

82656b20.8s gallbladder Archimedes water screw cystic duct gravity upright spiral valves of Heister filling ampulla of VAter closed neck body fundus distended sympathetic bile duct Davidoff art Copyright 2008

 Valves of Heister and the Archimedes Waterscrew

82656b23.8s  gallbladder Archimedes water screw cystic duct gravity upright spiral valves of Heister filling ampulla of VAter closed neck body fundus distended sympathetic bile duct Davidoff art Copyright 2008

 Valves of Heister and the Archimedes Waterscrew

82656b15.8s gallbladder Archimedes water screw cystic duct gravity upright spiral valves of Heister filling ampulla of VAter closed neck body fundus distended sympathetic bile duct Davidoff art Copyright 2008

Blood Supply

78240b8b01gs gastroduodenal artery stent placement hepatic artery proper right hepatic artery cystic artery blood supply gallbladder anatomy angiogram angiography Davidoff ART Copyright 2008

Structures of the Biliary System

04766b05b02.8s gallbladder cystic duct right hepatic duct left hepatic duct common hepatic duct common bile duct pancreatic duct ampulla sphincter of Oddi normal anatomy Davidoff art copyright 2008

 

Gracile and Graceful Shapes of the Biliary System

04766b05b04.3k.8s gallbladder cystic duct right hepatic duct left hepatic duct common hepatic duct common bile duct pancreatic duct ampulla sphincter of Oddi normal anatomy Davidoff art copyright 2008

 

Parts of the Gallbladder

04766b05b10.2k.8s gallbladder parts fundus = dark green body = green neck = light green normal anatomy Davidoff Art Copyright 2008

Dusk

24761b01.202.8S gallbladder night dark dusk Degas sleeping Davidoff art copyright 2008

Dusk

24761b01.203.8S gallbladder night dark dusk Degas sleeping Davidoff art copyright 2008

Sunrise

24761b01.204.8S gallbladder night dark dusk sunset Degas sleeping Davidoff art copyright 2008

Summer Morning

24761b01.205.8S gallbladder morning spring summer Degas sleeping Davidoff art copyright 2008

Putting the GAllbladder to Bed Peritoneal Covering

04766b05b04.52k.8s gallbladder support protection peritoneum bare area gallbladder fossa normal anatomy gastrohepatic ligament peritoneum serosal surface adventitial surface Davidoff art copyright 2008

Winter

24761b01.209.8S gallbladder winter Degas sleeping Davidoff art copyright 2008

Red Hot!

24761b01.99.8s gallbladder inflammation red cholecystitis acalculous calculous hemorrhagic rubor hyperemia dolor calor Davidoff art Courtesy Ashley Davidoff MD copyright 2008

The Pear

Classical Gallbladder Shape

85370pb01.8s pear fruit food gallbladder shape Davidoff photography Davidoff art Copyright 2008

Tear Drop Shape of the Gallbladder

02504pb03 water droplets window glass teardrop shape Davidoff photography water

Phrygian Cap

11921.8b05b014b01.8s gallbladder shape normal anatomy phrygian cap Davidoff art Copyright 2008

Fold in the Fundus

Phrygian in Green

04487.84s.8s gallbladder fundus fundal fold fold normal variant anatomy shape cystic duct phrygian cap Davidoff art copyright 2008

Phrygians of Northern and Central Asia Minor 1000-2000BC

The phrygian cap is a common normal variant of gallbladder shape characterized a fundus that is folded forward.  It was first described by Bartel in 1916.  The Phrygians were a primitive race that migrated into northern and central Asia Minor in the second millenium BC.  The Greeks knew of the cap as an Oriental headgear that was tight fitting and conical in shape and it has been depicted in their art. (Ober WB Wharton RN On the “phrygian cap.”  255:571-572 New England Journal of Medicine 1956   The cap was a symbol of freedom and the pursuit of liberty.The cap was worn by King Midas who was cursed with donkey ears by Apollo.  He used the Phrygian cap to hide his ears.  It was subsequently worn by the Trojan hero Paris, was a symbol of freedom in the French and American revolutions, was depicted on coinage in the US and on variety of seals and flags throughout the world.

82407b14.8s gallbladder Phrygian cap freedom liberty shape symbol Davidoff art Copyright 2008

 

Choledocholithiasis, Obstructive Jaundice

When Green is Held Up – Yellow Ensues

17083c02.3kb04.8s 82 female presents with obstructive jaundice sepsis gallbladder duct enlarged distended distension dilated dilatation choledocholithiasis stone obstruction obstructive jaundice MRI T2 weighted Courtesy Ashley Davidoff MD Davidoff art copyright 2008

Choledocholithiasis, High Fever, Sepsis

When Green Gets Held Up for Too Long Red Ensues

17083c02.3kb03.8s01 82 female presents with obstructive jaundice sepsis gallbladder duct enlarged distended distension dilated dilatation choledocholithiasis stone obstruction obstructive jaundice MRI T2 weighted Courtesy Ashley Davidoff MD Davidoff art copyright 2008

Zuchini (Italian) Gallbladder

76764c.81s elderly female gallbladder elongated sausage shape zuchini shape transverse dimension 4.5 cms longitudinal dimension 12.5cms aging gallbladder vs enlarged? food in the body CTscan Courtesy Ashley DAvidoff MD Davidoff art Davidoff photography copyright 2008

Character of Bile

Yellow/Green Color of Bile

04766b05b04.32k.8s gallbladder cystic duct right hepatic duct left hepatic duct common hepatic duct common bile duct pancreatic duct ampulla sphincter of Oddi normal anatomy Davidoff art copyright 2008

A Little More Concentrated

04766b05b04.31k.8s gallbladder cystic duct right hepatic duct left hepatic duct common hepatic duct common bile duct pancreatic duct ampulla sphincter of Oddi normal anatomy Davidoff art copyright 2008

Stone Imapacted in the Cystic Duct

04766b05b04b.35k.8s gallbladder cystic duct stone impacted obstruction enlarged gallbladder acute calculous cholecystitis Davidoff art copyright 2008

Stone Imapacted in the Cystic Duct

04766b05b04b.36k.8s gallbladder cystic duct stone impacted obstruction enlarged gallbladder acute calculous cholecystitis Davidoff art copyright 2008

 Fiery Flamenco Dance

82595.8s gallbladder bile duct inflammation flamenco dance fiery fire acute calculous cholecystitis Courtesy Ashley Davidoff MD copyright 2008

Galen’s Concept of the Organs and their Faculties

Heat plays a central role part in the theory of Galen. The three ?faculties? of the body are the nutritive, vital and logical faculties. The nutritive faculty is related to the stomach which “cooks” the food and converts it into chyle. The chyle is transported to the liver by the portal vein. In the liver further heat converts the food into blood and adds natural spirit. Some of the blood is transported via the veins to the heart where more heat is added to create vital spirit. The blood becomes thinner is distributed to the body by the arteries giving warmth and enables growth. The vital spirit is measured through the pulse. The brain adds psychic pneuma, which provides the rational and logical faculty in the form of thought will and choice. These are distributed to the body via the nerves. The logical faculty reigns supreme and is followed in orderof importance by the vital and nutrtive faculties. The transport systems of the body include the nerves which transmit the logical faculty, the arteries which transport the vital spirit, and the veins which transport the blood with nutritive faculty from the liver. Galen faculties of the body nutrition portal vein stomach liver vein heart vital faculty pneuma lungs brain logical faculty animal spirits Davidoff art Copyright 2008 13169c18b01.8s

Witchdoctor – Sangoma

Gallbladders in Headress

The Zulu witchdoctors (Sangomas) of South Africa have a special repect for the gallbladder which they believe has special powers.   It has the the same shape as the uterus and they have been interpreted as givers and receivers of life.  The sangoma weras a headress that contains the dried gallbladders of goats.  This image is dedicated to the Sangomas of South Africa, country of my birth.  The whole image has been recreated by repetitive use of a gallbladder mount as seen below.

00139c25.8s gallbladder histology normal gallbladder fossa free wall peritoneal lining whole mount mucosa histology shape face of the gallbladder mask sangoma witchdoctor gallbladders in the headress Davidoff art copyright 2008

The Gallbladder and the Witchdoctor

Giver and Receiver of Life

00139c20b.8s gallbladder histology normal gallbladder fossa free wall peritoneal lining whole mount mucosa histology shape face of the gallbladder mask sangoma witchdoctor Davidoff art copyright 2008

Face of a Sangoma in Training

00139c15.9s gallbladder histology normal gallbladder fossa free wall peritoneal lining whole mount mucosa histology shape face of the gallbladder mask Davidoff art copyright 2008

Gallbladder and Lime

04699b13.1k gallbladder cystic duct hyperemic mucosa hyperplastic mucosa hyperplastic cholecystosis hyperplastic cholecystoses cholesterolosis adenomyomatosis Aschoff Rokitansky sinuses Davidoff art copyright 2008

Liver with Jello Consistency

24719 liver gallbladder + fx normal + anatomy + drawing

Gallbladder Flower

11906e03.8s gallbladder histology mucosa normal Davidoff art copyright 2008

Acute Cholecystitis

Clogged Drain

04766b08.8s gallbladder stones cholelithiasis acute cholecystitis distended enlarged bile ducts Davidoff art copyright 2008

Gallbladder Stones

Green Pepper, Bananas and Seeds

00404b01.800 gallbladder gallstones cystic duct cholelithiasis greenpepper banana Davidoff Art Davidoff MD

Cholelithiais

Environmental Effects

00404 W 2 gallbladder stones bananas greenpepper seeds cholelithiasis cystic duct art Courtesy Ashley Davidoff MD Davidoff art

Mardi Gras Liver and Connections

Gallbladder Dressed in Pink

42646b03 liver histology gallbladder bile duct normal anatomy histology Davidoff art copyright 2008

Strawberry Gallbladder

04761.800 gallbladder strawberry gallbladder greenpepper yellow cholesterolosis hyperplastic cholecystoses cholecytosis Davidoff Art

Endoderm of the Foregut

The Beginning of the Biliary System

In the 4th week of gestation, the primitive endoderm gives rise to a foregut diverticulum called the hepatic diveticulum at the junction of the of the foregut and midgut. The hepatic diverticulum is the precursor for the liver bile ducts and gallbladder. hepatic diverticulum pars hepatica and pars cystica.

liver bile ducts pars cystica gallbladder and cystic duct. endodermal bud solid cord growth and resorbtion gallbladder embryology normal Davidoff art copyright 2008

82219b01.8s

Embryology of the Liver Bile Ducts, Gallbladder and Pancreas

The Beginning of the Biliary System in Color

In the 4th week of gestation, the primitive endoderm gives rise to a foregut diverticulum called the hepatic diveticulum at the junction of the of the foregut and midgut. The hepatic diverticulum is the precursor for the liver bile ducts and gallbladder. hepatic diverticulum pars hepatica and pars cystica.

liver bile ducts pars cystica gallbladder and cystic duct. endodermal bud solid cord growth and resorbtion gallbladder embryology normal Davidoff art copyright 2008

82219b08.8s

Undersurface of the Liver

Gallbladder is the Middle of it All

82220b01.2k02.8s liver gallbladder porta hepatis hepatic artery portal vein IVC inferior vena cava falciform ligament ligamentum teres bare area of the liver left lobe segment IV segment I caudate lobe quadrate lobe gastrohepatic ligament right lobe hepatic Davidoff art copyright 2008

Histopathology of a Gallstone in Blue

This is a medium ?power photomicrograph of a tiny gallstone which was present in a gallbladder and was included in the microscopic section of that gallbladder. The yellow color is the natural color of the stone, and there appears to be some linear or crystalline structure. Only the gallstone is present in the picture, no gallbladder tissue can be seen.

gallbladder dx cholelithiasis histology histopathology Courtesy Barbara Banner MD 11921.8b05bs

Minerals of a Gallstone – Artistic Rendition

11921.8b05b04.8s gallstones cholelithiasis stone Davidoff Art copyright 2008

Large Cholesterol Stone Forming in Bile

11921.8b05b09.8s large gallstone cholesterol gallbladder cholelithiasis stone Davidoff Art copyright 2008

Strawberry Gallbladder

04776b02 gallbladder strawberry gallbladder greenpepper yellow cholesterolosis hyperplastic cholecystoses cholecytosis Davidoff Art Davidoff

Out of Shape

00139c06.8s gallbladder histology normal gallbladder fossa free wall peritoneal lining whole mount mucosa histology shape Davidoff art copyright 2008

Small Pigmented Stones Lying Dependantly in the Gallbladder

3 Drops in the Depths of the Bile Ocean

11921.8b05b018.8s gallbladder cystic duct gallstones cholelithiasis Davidoff Art copyright 2008

Stone Impacted in the Cystic Duct Causing Obstruction

This Little Stone Ventured to Market and Two Little Stones Stayed Home

One Little Stone Got Trapped…

11921.8b05b019.8s gallbladder cystic duct gallstones cholelithiasis stone impacted in the cystic duct distended enlarged Davidoff Art copyright 2008

Inflammation of the Gallbladder Wall

One Little Stone Got Trapped…And Nobody Lived Happily Forever After.

11921.8b05b020.8s gallbladder cystic duct gallstones cholelithiasis stone impacted in the cystic duct distended enlarged hyperemic wall acute cholecytitis Davidoff Art copyright 2008

Complex Fluid in the Gallbladder Fossa

And The Situation Got Worse…

11921.8b05b031.8s gallbladder cystic duct gallstones cholelithiasis stone impacted in the cystic duct distended enlarged hyperemic wall complex fluid in the gallbladder fossa tumefactive bile cholestasis sludge acute cholecytitis Davidoff Art copyright 2008

Cholecystitis Complicated by Abscess Formation in the Gallbladder Fossa

…and Worse…

11921.8b05b037.8s gallbladder cystic duct gallstones cholelithiasis stone impacted in the cystic duct distended enlarged hyperemic wall complex fluid in the gallbladder fossa tumefactive bile cholestasis sludge acute cholecytitis abscess formation Davidoff Art copyright 2008

Thin Sludge

No Stimulation and No Excercise .. The Plot Thickens..

11921.8b05b039.8s gallbladder distended enlarged dilated fluid fluid level gravity specific gravity sediment sludge cholestasis stasis Davidoff art copyright 2008

Tumefactive Bile

…..and Thickens and The Story Becomes Bleeker and Blacker

11921.8b05b043..8sb01 gallbladder distended tumefactive bile crank case oil thick sludge enlarged dilated fluid fluid level gravity specific gravity sediment sludge black cholestasis stasis Davidoff art copyright 2008

Acalculous Cholecystitis Crankcase Oil

…And Bleeker and Blacker Adding a Hint of Red and Fire

11921.8b05b043.8s gallbladder distended tumefactive bile thick sludge enlarged dilated fluid fluid level gravity specific gravity sediment sludge cholestasis stasis inflammation acalculous cholecystitis Davidoff art copyright 2008

11921.8b05b043..8kb03.jpg

Wall Rupture

Integrity Is Lost…

11921.8b05b043..8kb03 gallbladder distended tumefactive bile crank case oil thick sludge enlarged dilated fluid fluid level gravity specific gravity sediment sludge black cholestasis stasis wall inflammation acalculous cholecystitis complicated by perforation Davidoff art copyright 2008

Wall Rupture Focal Peritonitis

Svere Local Reaction to the Vile Bile Which Has Escaped

11921.8b05b043.8b05s gallbladder distended tumefactive bile crank case oil thick sludge enlarged dilated fluid fluid level gravity specific gravity sediment sludge black cholestasis stasis wall inflammation acalculous cholecystitis complicated by perforation Davidoff art copyright 2008

Rupture with Diffuse Bile Peritonitis

The Fire Spreads Like Wildfire … Vile Bile on the loose

11921.8b05b046.8b05 gallbladder distended tumefactive bile crank case oil thick sludge enlarged dilated fluid fluid level gravity specific gravity sediment sludge black cholestasis stasis wall inflammation acalculous cholecystitis complicated by perforation and bile peritonitis Davidoff art copyright 2008

Ductal Systems

Calm and Colorful on a Summer Day

22391 R W3 liver duodenum pancreas pancreatic duct bile duct gallbladder normal anatomy drawing Davidoff art

Foregut

Connections All Intact

41774 liver bile duct gallbladder pancreas spleen splenic vein splenic artery portal vein hepatic artery fx normal anatomy drawing art Courtesy Ashley Davidoff MD Davidoff art

Gallbladder Cancer and Stones

11528b.8 gallbladder food in the body green pepper cancer carcinoma gall stones cholelithiasis Davidoff art Davidoff photography copyright

Gallbladder and Lemon

04699b14.1k gallbladder cystic duct hyperemic mucosa hyperplastic mucosa hyperplastic cholecystosis hyperplastic cholecystoses cholesterolosis adenomyomatosis Aschoff Rokitansky sinuses Davidoff art copyright 2008

Hyperplastic Cholecystoses

04699b10.1k gallbladder cystic duct hyperemic mucosa hyperplastic mucosa hyperplastic cholecystosis hyperplastic cholecystoses cholesterolosis adenomyomatosis Aschoff Rokitansky sinuses Davidoff art copyright 2008

 

Gallbladder at Christmas

04699b11.1k gallbladder cystic duct hyperemic mucosa hyperplastic mucosa hyperplastic cholecystosis hyperplastic cholecystoses cholesterolosis adenomyomatosis Aschoff Rokitansky sinuses Davidoff art copyright 2008

Gallbladder at the Beach

04699b12.1k gallbladder cystic duct hyperemic mucosa hyperplastic mucosa hyperplastic cholecystosis hyperplastic cholecystoses cholesterolosis adenomyomatosis Aschoff Rokitansky sinuses Davidoff art copyright 2008