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GB > 7. Bile and Jaundice > Flashcards

7. Bile and Jaundice Flashcards

1
Q

What hormone regulates the release of bile?

A

Cholecystokinin

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2
Q

Is bile in the liver or bile in the gall bladder more concentrated?

A

Gall bladder

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3
Q

What are some of the substances excreted by bile?

A

Bile pigments (degradation of haem)
Cholesterol
Bile acids/salts
Drugs and metabolites

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4
Q

How does bile carry out digestion?

A

Bicarbonate neutralises acidity of gastric content
Bile salts and phospholipids emulsify fats
Activates pancreatic hydrolase precursors

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5
Q

What is cholesterol broken down into in the liver?

A

Cholic acid

Chenodeoxycholic acid

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6
Q

What are primary bile acids conjugated with?

A

Glycine

Taurine

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7
Q

What are the secondary bile acids?

A

Deoxycholic acid

Lithocholic acid

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8
Q

What is bilirubin?

A

Natural degradation product of haem

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9
Q

What is the function of haptoglobin?

A

Forms a haemoglobin-haptoglobin complex

Prevents loss of iron in the urine

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10
Q

What is the function of haemopexin?

A

Binds free haem

Iron is stored bound to ferrin

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11
Q

What urobilinogen is excreted in the urine?

A

Urobilin

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12
Q

What urobilinogen is excreted in faeces?

A

Stercobilin

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13
Q

What is the name of the intermediate product from the breakdown of haem?

A

Biliverdin

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14
Q

What cytoplasmic proteins does bilirubin bind to to prevent transport back out of the liver?

A

Glutathione S-transferases

Protein Y

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15
Q

What de-conjugates bilirubin in the intestine?

A

Glucoronidases

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16
Q

What is jaundice?

A

Yellow discolouration of the skin and sclera due to hyperbilirubinaemia

17
Q

What are the 3 types of jaundice?

A

Pre-hepatic
Intra-hepatic
Post-hepatic

18
Q

What is pre-hepatic jaundice?

A

Bilirubin production exceeds uptake capacity of liver

19
Q

What is intra-hepatic jaundice?

A

Bilirubin cannot be taken up, conjugated and/or secreted because hepatocytes are somehow damaged

20
Q

What is post-hepatic jaundice?

A

Obstruction to biliary flow

21
Q

What are other names for pre-hepatic jaundice?

A

Haemolytic

Hematogenous

22
Q

What are common causes of of pre-hepatic jaundice?

A

Haemolytic disease of newborn
Sickle cell disease
Autoimmune disease

23
Q

How is pre-hepatic jaundice diagnosed?

A

High plasma levels of uconjugated bilirubin

24
Q

What are other names for intra-hepatic jaundice?

A

Hepatic

Hepatocellular

25
Q

How is intra-hepatic jaundice diagnosed?

A

Hyperbilirubinaemia

Combined with elevated AST and ALT

26
Q

What are other names for post-hepatic jaundice?

A

Obstructive

Cholestatic

27
Q

How is post-hepatic jaundice diagnosed?

A

Pale stools
Dark urine
Urobilin may be absent from urine

28
Q

What are the causes of newborn jaundice?

A

Immature or impaired hepatic uptake or conjugation of bilirubin
Red blood cell destruction

29
Q

What is kernicterus?

A

A rare form of brain damage caused by unconjugated bilirubin deposited in the brain

30
Q

How is newborn jaundice treated?

A

Phototherapy converts bilirubin to a water soluble non-toxic form
Exchange blood transfusion to remove excess bilirubin
Maternal phenobarbitone

31
Q

What is Gilbert’s syndrome?

A

Mild, fluctuating hyperbilirubinaemia

Caused by reduced UDP-glucuronyl transferase or a defect in blirubin uptake

32
Q

How is Gilbert’s syndrome treated?

A

Small doses of phenobarbitone

Stimulates UDP-glycuronyl transferase activity

33
Q

What is Crigler-Najjar syndrome?

A

Autosomal recessive disorder

Severe unconjugated hyperbilirubinaemia

34
Q

What is the cause of Crigler-Najar syndrome?

A

Mutation in the gene coding for UDP-glucuronyl transferase

35
Q

What is the treatment for type one Crigler-Najar syndrome (complete absence of enzyme)?

A

Liver transplant by age 5

36
Q

What is the treatment for type two Crigler-Najar syndrome (reduction in enzyme activity)?

A

Phenobarbitone

Phototherapy

37
Q

What are Dubin-Johnson and Rotor’s syndromes?

A

Autosomal recessive disorders
Conjugated hyperbilirubinaemia
Impaired biliary secretion of conjugated bilirubin

38
Q

What is Dubin-Johnson syndrome caused by?

A

Mutation in the gene coding for MRP-2

GB (15 decks)

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