3 C: Anatomy, Phys, and Path of Gall Bladder Flashcards
Which organ store and modified bile?
The gallbladder
What secretes bile ?
-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
Bile is stored until when?
-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
How does CCK regulate bile?
Contraction of the gallbladder and relaxation of the sphincter of Oddi
How does SECRETIN regulate bile?
This hormone stimulates ions & water secretion by the bile ducts
How does Ach regulate bile?
Contraction of the gall bladder; A ParaNS response
How is the gallbladder able to fill during the “Interdigestive” periods ?
It can fill because it is RELAXED (SNS–>Beta 2) and the sphincter of Oddi is CLOSED
What is Acute Cholecystitis?
Refers to a syndrome of right upper quadrant pain, fever, and leukocytosis associated with gallbladder inflammation that is usually related to gallstone disease.
What are characteristics of Acute Cholecystitis?
Where might pain be presenting?
- The pain may radiate to the right shoulder or back.
- Characteristic: Pain is steady and severe. Associated complaints may include nausea, vomiting, and anorexia
What is Chronic Cholecystitis
Describes as chronic inflammatory cell infiltration of the gallbladder seen on histopathology.
What is Chronic Cholecystitis associated with ?
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.
What are complication of Cholecystitis left untreated?
- 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)
What is Cholelithiasis?
Presence of gallstones (common condition)
Incidence of Cholelithiasis increase with what?
With age
-20% of women and 5% of men (50-65 yrs have gallstones)
***In the US & Europe, 90% of stones are cholesterol stones
What are the 3 factors involved in the formation of cholesterol stones?
1) Bile stasis( sludge)
2) Supersaturation of bile w/ cholesterol
3) Inflammation
How does Bile stasis( sludge) contribute to gallstones?
As stones from in the bile that is sequestered in the gallbladder rather than the bile that tis flowing in the bile ducts
How does Supersaturation of bile w/ cholesterol contribute to gallstones ?
Cholesterol is very insoluble in bile, and it is maintained in solution in micelles only at certain concentration of bile salts & lecithin
How does inflammation contribute to gallstones?
Inflammation of the gallbladder (cholecystitis)
Do most people with gallstones have symptoms? Explain
No; Gallstones cause symptoms when they obstruct bile flow.
Small stones (<8 mm in diameter) may pass into the common bile duct producing what kind of symptoms?
Symptoms of indigestion and biliary colic
Large stones may pass into the common bile duct producing what kind of symptoms?
More likely to obstruct flow and cause jaundice
What is Biliary Colic caused by?
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.
The pain for biliary colic may be referred to ?
The thoracic or lumbar back, the right shoulder, and the right scapula or mid scapular region.
What happens to the stones as the gallbladder relaxes?
The stones often fall back from the cystic duct
What happens when the discomfort progresses ?
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.
Why do patients often have several attacks before seeking medical attention?
In most patients the pain is not very severe
***The frequency of recurrent attacks is variable, ranging from years to hours
Besides age, what are other risk factors for Cholelithiasis (having gallstones)?
1) gender
2) pregnancy
3) oral contraceptive use
4) family history/genetics (Native Americans)
5) obesity
6) rapid weight loss
7) diabetes mellitus
How does pregnancy contribute to cholelithiasis?
Sex hormones may cause bile to become supersaturated with cholesterol
How does obesity contribute to cholelithiasis?
A well-established risk factor for the development of cholesterol gallstones
How does rapid weight loss contribute to cholelithiasis?
The mechanism by which this occurs in incompletely understood
How does diabetes mellitus contribute to cholelithiasis?
Possible contributing factors are hyperlipidemia and autonomic neuropathy leading to biliary stasis due to gall bladder hypomotility
How does gender contribute to cholelithiasis?
higher prevalence observed in women of all ages
What are the possible factors for cholesterol stones?
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
What are the possible factors for black pigment stones?
increased in levels of UNCONJUGATED bilirubin, congenital abnormalities, hemolysis, liver disease, fasting
What are the possible factors for brown pigment stones?
infection of biliary tree resulting from surgical or endoscopic procedure or stasis
Do we need a Gall Bladder?
There periodic discharge of bile from the gall bladder aids digestion but is NOT essential for it
How do cholecystectomized patients maintain good health and nutrition?
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
How is a laparoscopic cholecystectomy performed?
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.
