3 C: Anatomy, Phys, and Path of Gall Bladder

Question 1

Which organ store and modified bile?

Answer 1

The gallbladder

Question 2

What secretes bile ?

Answer 2

-Bile is secreted by hepatocytes into the bile canaliculi, from which it flows in the right & left hepatic ducts, common hepatic duct & then into the gallbladder via the CYSTIC DUCT

Question 3

Bile is stored until when?

Answer 3

-Until stimulation of gall bladder contractions expels the bile back through the cystic duct into the common bile duct and via the sphincter of Oddi, into the duodenum

Question 4

How does CCK regulate bile?

Answer 4

Contraction of the gallbladder and relaxation of the sphincter of Oddi

Question 5

How does SECRETIN regulate bile?

Answer 5

This hormone stimulates ions & water secretion by the bile ducts

Question 6

How does Ach regulate bile?

Answer 6

Contraction of the gall bladder; A ParaNS response

Question 7

How is the gallbladder able to fill during the “Interdigestive” periods ?

Answer 7

It can fill because it is RELAXED (SNS–>Beta 2) and the sphincter of Oddi is CLOSED

Question 8

What is Acute Cholecystitis?

Answer 8

Refers to a syndrome of right upper quadrant pain, fever, and leukocytosis associated with gallbladder inflammation that is usually related to gallstone disease.

Question 9

What are characteristics of Acute Cholecystitis?

Where might pain be presenting?

Answer 9

• The pain may radiate to the right shoulder or back.

- Characteristic: Pain is steady and severe. Associated complaints may include nausea, vomiting, and anorexia

Question 10

What is Chronic Cholecystitis

Answer 10

Describes as chronic inflammatory cell infiltration of the gallbladder seen on histopathology.

Question 11

What is Chronic Cholecystitis associated with ?

Answer 11

Invariably associated with the presence of gallstones and is thought to be the result of mechanical irritation or recurrent attacks of acute cholecystitis leading to fibrosis and thickening of the gallbladder.

Question 12

What are complication of Cholecystitis left untreated?

Answer 12

• Symptoms of cholecystitis may abate within 7-10 days
• Can occur at alarmingly high rates, so urgent plans for Tx needed w/ suspected acute cholecystitis

***MOST COMMON = Development of gallbladder gangrene ( up to 20% of cases) w/ subsequent perforation (2% of cases)

Question 13

What is Cholelithiasis?

Answer 13

Presence of gallstones (common condition)

Question 14

Incidence of Cholelithiasis increase with what?

Answer 14

With age

-20% of women and 5% of men (50-65 yrs have gallstones)

***In the US & Europe, 90% of stones are cholesterol stones

Question 15

What are the 3 factors involved in the formation of cholesterol stones?

Answer 15

1) Bile stasis( sludge)
2) Supersaturation of bile w/ cholesterol
3) Inflammation

Question 16

How does Bile stasis( sludge) contribute to gallstones?

Answer 16

As stones from in the bile that is sequestered in the gallbladder rather than the bile that tis flowing in the bile ducts

Question 17

How does Supersaturation of bile w/ cholesterol contribute to gallstones ?

Answer 17

Cholesterol is very insoluble in bile, and it is maintained in solution in micelles only at certain concentration of bile salts & lecithin

Question 18

How does inflammation contribute to gallstones?

Answer 18

Inflammation of the gallbladder (cholecystitis)

Question 19

Do most people with gallstones have symptoms? Explain

Answer 19

No; Gallstones cause symptoms when they obstruct bile flow.

Question 20

Small stones (<8 mm in diameter) may pass into the common bile duct producing what kind of symptoms?

Answer 20

Symptoms of indigestion and biliary colic

Question 21

Large stones may pass into the common bile duct producing what kind of symptoms?

Answer 21

More likely to obstruct flow and cause jaundice

Question 22

What is Biliary Colic caused by?

Answer 22

The gallbladder contracting in response to hormonal or neural stimulation, due to a fatty meal, forcing a stone (or slide or microlithiasis) against the gallbladder outlet or cystic duct opening, and leading to increased intra-gallbladder pressure and right upper quadrant pain.

Question 23

The pain for biliary colic may be referred to ?

Answer 23

The thoracic or lumbar back, the right shoulder, and the right scapula or mid scapular region.

Question 24

What happens to the stones as the gallbladder relaxes?

Answer 24

The stones often fall back from the cystic duct

Question 25

What happens when the discomfort progresses ?

Answer 25

In less than an hour it progresses to a steady plateau that ranges from moderate to excruciating and remains constant for more than an hour, then slowly subsides over several hours.

Question 26

Why do patients often have several attacks before seeking medical attention?

Answer 26

In most patients the pain is not very severe

***The frequency of recurrent attacks is variable, ranging from years to hours

Question 27

Besides age, what are other risk factors for Cholelithiasis (having gallstones)?

Answer 27

1) gender
2) pregnancy
3) oral contraceptive use
4) family history/genetics (Native Americans)
5) obesity
6) rapid weight loss
7) diabetes mellitus

Question 28

How does pregnancy contribute to cholelithiasis?

Answer 28

Sex hormones may cause bile to become supersaturated with cholesterol

Question 29

How does obesity contribute to cholelithiasis?

Answer 29

A well-established risk factor for the development of cholesterol gallstones

Question 30

How does rapid weight loss contribute to cholelithiasis?

Answer 30

The mechanism by which this occurs in incompletely understood

Question 31

How does diabetes mellitus contribute to cholelithiasis?

Answer 31

Possible contributing factors are hyperlipidemia and autonomic neuropathy leading to biliary stasis due to gall bladder hypomotility

Question 32

How does gender contribute to cholelithiasis?

Answer 32

higher prevalence observed in women of all ages

Question 33

What are the possible factors for cholesterol stones?

Answer 33

Increased cholesterol concentration in bile, estrogens, obesity, age, high polyunsaturated fat diet, decreased bile acid synthesis, lleal disease or bypass, primary biliary cirrhosis, progestins, increased cholesterol in bile

Question 34

What are the possible factors for black pigment stones?

Answer 34

increased in levels of UNCONJUGATED bilirubin, congenital abnormalities, hemolysis, liver disease, fasting

Question 35

What are the possible factors for brown pigment stones?

Answer 35

infection of biliary tree resulting from surgical or endoscopic procedure or stasis

Question 36

Do we need a Gall Bladder?

Answer 36

There periodic discharge of bile from the gall bladder aids digestion but is NOT essential for it

Question 37

How do cholecystectomized patients maintain good health and nutrition?

Answer 37

With a constant slow discharge of bile into the duodenum. Eventually the common bile duct becomes somewhat dilated, and more bile tends to enter the duodenum after meals than at other times

Question 38

How is a laparoscopic cholecystectomy performed?

Answer 38

4 small incisions for a cannula (instrument) near the belly-button, laparoscope and tiny camera and other cannulas used to separate the gallbladder from what ist is attached to and remove it.

**Faster recovery time than open surgery, less painful, and less incisions compared to the 5-7 inch incision in abdomen.