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Alim 1 > bile, gall bladdder, gallstones > Flashcards

bile, gall bladdder, gallstones Flashcards

1
Q

primary function of gallbladder

A

concentration and storage of bile

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2
Q

how does the gallbladder concentrate bile

A

active na+ transport from gallbladder is followed actively by water

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3
Q

how does bile in the GB become acidic

A

Na+ exchanged for protons

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4
Q

how does {Na+] increase in bile stroage

A

more Cl- and HCO3- are lost

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5
Q

what makes up pancreatic juice

A

bile salts, pigments, dissolved substances in alkaline electrolytes

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6
Q

which substances are secreted across the bile canalicular membrane

A 
bile acids
phosphatidylcholine (PC)
conjugated bilirubin
cholesterol
xenobiotics
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7
Q

how do water, glucose, GSH, AA, urea etc enter the bile

A

diffusion

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8
Q

what is the correct ratio of bile acids:phosphatidylcholine:cholesterol in canalicular bile

A

10:3:1

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9
Q

what happens if the normal acid ratio for acid:PC:cholesterol is altered

A

formation of cholesterol gallstones

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10
Q

where is the bile modified

A

larger ductules and ducts

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11
Q

how is bile composition modified

A

water may be added by specific junctions w/in the ductules

- ductules scavenge glu, AA, - GSH is hydrolysed

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12
Q

why do ductules secrete IgA

A

mucosal protection

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13
Q

why do ductules secrete HCO3-

A

response to secretin in the postprandial period

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14
Q

what are bile salts made of

A

bile + cation e.g. Na+

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15
Q

what are the four main human bile acids

A

cholic acid
chenodeoxycholic acid
deoxycholic acid
lithocholic acid

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16
Q

what happens to bile acids when they reach the intestine

A

deconjugated by bacteria, then excreted or reabsorbed

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17
Q

how are bile acids removed by the intestine

A

by portal circulation into the liver

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18
Q

what do anaerobic bacteria in the colon do to 1* bile acids

A

modify them to 2* bile acids e.g cholic > deoxycholic acid

chenodeoxycholic acid > lithocholic acid

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19
Q

what are bile acids made from

A

cholesterol

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20
Q

what happens to bile acids before they’re secreted into bile

A

conjugated to glycine or tauring

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21
Q

what does conjugation do

A

increase the ability of bile acids to be secreted, decreases their cytotoxicity

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22
Q

metabolic functions of bile acids

A

reduce precipitation of cholesterol in the gall bladder
allow fat digestion via emulsification
allow fat soluble vitamins to be absorbed
regulate lipid and glucose metabolism

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23
Q

what makes up hepatic bile

A

97% water
cholesterol
lecithin
bile acids, pigments

24
Q

what makes up gallbladder bile

A 
89% water 
bicarb
Cl-
Ca2+
mg, na, cholesterol, bilirubin
25
Q

which 2 types of cells secrete bile

A

hepatocytes, epithelial cells of bile ducts

26
Q

what does secretin do

A

influences secretion of bicarb-rich salt solutions and water

27
Q

when is bile secretion greatest

A

during and after eating

28
Q

what does the sphincter of Oddi do during fasting periods

A

contracts - no communication between duodenum and pancreas

29
Q

when does the sphincter of Oddi relax

A

during and after meals

30
Q

how is contraction of the gallbladder controlled

A

impulses via vagus nerve - gastric phase (stomach distension) and cephalic phase

31
Q

what is the intestinal phase

A
  • period of most gallbladder emptying - CCK and secretin
32
Q

what does motilin modulate

A

gallbladder motility and volume

33
Q

what stimulates secretion of cholecystokinin (CCK)

A

presence of fatty meal

34
Q

what is stimulated by a rise in plasma CCK

A

gallbladder contraction

relaxation of sphincter of Oddi

35
Q

what is caused by gallbladder contraction

A

increased bile flow into Common bile duct

36
Q

what does increased flow into CBD and relaxation of sphincter of Oddi cause

A

increased flow of bile into duodenum

37
Q

where are bile salts and lecithin synthesized

A

liver

38
Q

where do HCO3- and other ions act

A

duodenum - synthesise acids

39
Q

how are bile salts related to GI function

A

really fucking important

40
Q

what reabsorbs bile salts

A

Na+/bile salt coupled transporters

41
Q

how do bile salts get recycled

A

returned to liver and secreted back into the bile

42
Q

what is the recycling pathway from intestine to liver to intestine called

A

enterohepatic circulation

43
Q

how often can the contents of the body’s bile acid pool get recylced

A

up to twice per meal

44
Q

what ultimately happens to the cholesterol in bile

A

excreted in the faeces

45
Q

what can interruption of the enterohepatic circulation cause

A

excess synthesis of bile salts by liver

excretion by the kidneys of bile salts, plus some cholesterol

46
Q

fancy name for gallstones

A

cholelithiasis

47
Q

gender ratio of incidence of gallstones

A

2:1 (F:M)

48
Q

what happens to concentration of phospholipids and bile salts in bile if the cholesterol content is increased

A

the phospholipid and bile salt concentration is increased

49
Q

how does cholesterol form gallstones

A

crystallization, precipitation of bile pigments

50
Q

what are the 2 types of gallstones

A

calcium bilirubinate

cholesterol

51
Q

factors in formation of gallstones

A

bile stasis - sequesteration in gallbladder
decreased amount of bile acids due to malabsorption
chronic infection
supersaturation of bile with cholesterol

52
Q

why is bile yellow

A

bilirubin

53
Q

where do larger gallstones lodge

A

opening of the gallbladder

54
Q

what happens if gallstones lodge at the point where the bile duct joins the duodenum

A

stoppage of bile and pancreatic secretions

55
Q

what is jaundice

A

increased accumulation of bilirubin in the blood caused by pressure build up causing decreased bile secretion

56
Q

how are gallstones diagnosed

A

ultrasound/CT in upper right quadrant of gallbaldder

57
Q

clinical features of gallstones

A

if neck of cystic duct is impaired, there will be biliary pain
common bile duct - bile flow obstruction - cholestatic jaundice which can cause infection

Alim 1 (11 decks)

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