Bile, Biliary Tree and Gall Stones Pathophysiology

Question 1

What lies at the centre of liver lobules?

Answer 1

Central vein

Question 2

What carries blood to the central veins?

Answer 2

Sinusoids

Question 3

Which cells produces bile?

Answer 3

Hepatocytes

Question 4

What conducts bile into the interlobular bile ducts?

Answer 4

Bile canaliculi

Question 5

What shape are liver lobules?

Answer 5

Hexagons

Question 6

What structure lies in 3 corners of the liver lobule?

Answer 6

Interlobular portal triad

Question 7

What constitutes the interlobular portal triads?

Answer 7

1) . Interlobular hepatic portal vein
2) . Interlobular hepatic artery
3) . BInterlobular biliary duct

Question 8

What are the 3 parts of the gall bladder?

Answer 8

1) . Fundus
2) . Body
3) . Neck

Question 9

What duct conducts bile from the gall bladder?

Answer 9

Cystic duct

Question 10

Describe the constitution of bile?

Answer 10

Approx:

• 70% bile salts and acids
• 10% cholesterol
• 5% Phopholipids
• 5% Proteins
• 1% Conjugated Bilirubin
• The rest is water, bicarbonate and electrolytes (E.g. Ca2+)

Question 11

What are the 2 types of stones?

Answer 11

1) . Cholesterol stones

2) . Pigmented stones (bilirubin stones)

Question 12

What percentage of stones are cholesterol stones?

Answer 12

75-90%

Question 13

What is the purpose? of bile

Answer 13

To emulsify fats

Question 14

What is the name of a molecule with both a water-soluble portion and a lipid-soluble portion?

Answer 14

Amphipathic

Question 15

What are bilirubin stones usually made from?

Answer 15

Unconjugated bilirubin + Ca2+

Question 16

Are cholesterol stones radio-opaque?

Answer 16

Not usually although sometimes they can be?

Question 17

How might a cholesterol stone become radio-opaque?

Answer 17

Adoption of CaCO3

Question 18

Are bilirubin stones radio-opaque?

Answer 18

Yes - because of the calcium in them

Question 19

What kind of bilirubin is usually in bilirubin stones?

Answer 19

Unconjugated bilirubin (1-2% of total bilirubin in the bile is unconjugated)

Question 20

How can bacteria cause stones?

Answer 20

Bacteria (such as E. Coli) tend to hydrolyse bilirubin and cause more unconjugated bilirubin that becomes pigmented stones

Question 21

Name 3 risk factors for stones and say why

Answer 21

1. Being female (+ being on the contraceptive pill)
   
   • Linked to estrogen

2) . Obesity
- Increased cholesterol

3) . Rapid weight loss
- Increased lipids