Bile

Question 1

What are the layers of the gall bladder?

Answer 1

Mucosa, tunica muscularis and adventitia

Question 2

Mucosa of gall bladder

Answer 2

Simple columnar epithelia, basement membrane and lamina propia

Question 3

Tunica muscularis of gall bladder

Answer 3

Smooth muscle, connective tissue and nerves

Question 4

Adventitia

Answer 4

Connective tissue layer connecting gall bladder to the liver. The connective tissue not in contact with the liver is the mesothelium and is loose.

Question 5

Common site of gallstone formation

Answer 5

Hartmann’s pouch is a patch of mucosa in the neck region of the gall bladder where gallstones commonly form and get lodged, leading to cholestasis.

Question 6

What is a gallstone?

Answer 6

Gallstones are formed of Cholesterol, calcium and biliverdin. It is mainly cholesterol due to diet or issues with hepatic metabolism.

Question 7

Symptoms of cholelithiasis

Answer 7

Biliary colic pain in the upper right quadrant which spreads to the right shoulder. Nausea, loss of appetite and intolerance to fatty foods.

Question 8

What is bilirubin?

Answer 8

A bile pigment formed by haemolysis.

Question 9

What are the types of bilirubin?

Answer 9

Unconjugated bilirubin which is insoluble and conjugated bilirubin which is soluble.

Question 10

Reticuloendothelial cells

Answer 10

Phagocytic cells such as endothelial cells and Kupffer cells in the liver.

Question 11

Bilirubin synthesis

Answer 11

Reticuloendothelial cells such as Kupffer carry out haemolysis to produce iron and unconjugated bilirubin. This must be bound to albumin for transport in the bloodstream.

Question 12

Bilirubin conjugation

Answer 12

Once in the liver, unconjugated bilirubin undergoes glucorinidation by glucorynyl transferase to form conjugated bilirubin, which is soluble and can be excreted with bile out the common hepatic duct and eventually enter the duodenum.

Question 13

Bilirubin excretion

Answer 13

Bacteria in the small intestine deconjugates bilirubin. Unconjugated bilirubin -> urobilinogen, a brown-yellow bile pigment.

Question 14

Excretion

Answer 14

Most of urobilinogen is oxidised into stercobilin and excreted into the faeces. Lesser proportion is recycled via enterohepatic circulation back to the liver to be recycled as bile.

Question 15

Low/no urobilinogen in the blood

Answer 15

Obstruction of the gall bladder

Question 16

High urobilinogen

Answer 16

Haemolytic anaemia

Question 17

Symptoms of liver disease

Answer 17

Nausea/vomiting, loss of appetite, jaundice, dark coloured urine and light coloured stool.

Question 18

What makes faeces brown?

Answer 18

Bilirubin

Question 19

Dark urine and pale stools

Answer 19

Liver disease. Bilirubin is excreted into the urine. It is not converted to urobilinogen -> stercobilin to give faeces its brown colour

Question 20

Tail of pancreas

Answer 20

End of the pancreas on the left side of the body which ends near the spleen

Question 21

Clusters of pancreatic endocrine cells

Answer 21

Islets of Langerhan

Question 22

Pancreatic epithelia

Answer 22

Simple columnar epithelia mainly with stratified columnar and stratified cuboidal

Question 23

Septa

Answer 23

Collagenous capsule surrounding the pancrees which forms lobules. Contains digestive enzymes rather than RBC.

Question 23

Septa

Answer 23

Collagenous capsule surrounding the pancrees which forms lobules. Contains digestive enzymes rather than RBC.