Bile,Gall Bladder And Gallstones

Question 1

What is function of gallbladder?

Answer 1

Storage and concentration of bile

Question 2

What does pancreatic juice consist of?

Answer 2

Bile salts, bile pigments and dissolved substances in alkaline electrolytes

Question 3

Describe the flow of bile?

Answer 3

Hepatocytes-> bile canaliculi(merge to form ductules)-> terminal bile ducts-> common bile ducts

Question 4

What are 2 different cell types that secrete bile?

Answer 4

Hepatocytes and epithelial cells of bile ducts

Question 5

What does hepatocytes secrete?

Answer 5

Cholesterol, lecithin, bile acids, bile pigments (bilirubin,biliverdin, urobilin)

Question 6

What does epithelial cells of bile ducts secrete?

Answer 6

Bicarbonate rich salt solution

Question 7

What influences the secretion of bicarbonate rich salt solution?

Answer 7

Secretin

Question 8

When is Sphincter of Oddi contracted?

Answer 8

During periods of fasting

Question 9

When is Sphincter of Oddi relaxed?

Answer 9

During and after meals

Question 10

What substances are secreted across bile canalicular membrane?

Answer 10

Bile acids 
Phosphatidylcholine 
Conjugated bilirubin
Cholesterol 
Xenobiotics

Question 11

Describe the composition of hepatic bile?

Answer 11

97% water

Cholesterol, lecithin, bile acids, bile pigments etc

Question 12

Describe the composition of gallbladder bile?

Answer 12

89% water

HCO3-, Cl-, Ca2+, Mg2+, Na+, cholesterol, bilirubin, bile salts etc

Question 13

What are bile acids made from?

Answer 13

Made from cholesterol

Question 14

What is bile acids secreted into and conjugated to?

Answer 14

Secreted into bile and conjugated to glycine or taurine

Question 15

What are 4 major bile acids found in humans?

Answer 15

Cholic acid=50%
Chenodeoxycholic acid=30%
Deoxycholic acid=15%
Lithocholic acid=5%

Question 16

What are primary bile acids? Where are they formed?

Answer 16

Chenodeoxycholic acid
Cholic acid
Formed in the liver

Question 17

What are secondary bile salts? Where are they formed?

Answer 17

Lithocholic acid
Deoxycholic acid
Formed in the colon

Question 18

What converts the primary bile acids to secondary bile acids?

Answer 18

Anaerobic intestinal bacteria
Chenodeoxycholic acid -> lithocholic acid
Cholic acid-> deoxycholic acid

Question 19

What are main functions of bile/bile acids?

Answer 19

Elimination of cholesterol to bile acids
Reduce the precipitation of cholesterol in gallbladder; bile acids and phospholipids help solubilise cholesterol in bile
Facilitate absorption of fat soluble vitamins (ADEK)
Regulate their own transport and metabolism via enterohepatic circulation
Facilitate digestion of TGs

Question 20

What does CCK trigger in gallbladder?

Answer 20

Triggers contractions

Question 21

What does CCK cause in Sphincter of Oddi?

Answer 21

CCK causes relaxation

Question 22

What secretin in liver stimulate?

Answer 22

Stimulates duct cells

Question 23

What controls contraction of gallbladder and release of bile into duodenum?

Answer 23

Control of gallbladder motility
Presence of fatty meal stimulates secretion of CCK
Relaxation/opening of Sphincter of Oddi

Question 24

What is enterohepatic circulation?

Answer 24

Recycling process of bile acids

Recycling pathway from intestine to liver and back to intestine

Question 25

Where is bile acids, lecithin (phospholipids synthesised)?

Answer 25

Synthesised in liver

Question 26

What does interruption of enterohepatic circulation cause?

Answer 26

Excess synthesis of bile salts by liver | Kidneys will excrete the synthesised bile salts

Question 27

What are bile salts?

Answer 27

Bile compounded with a cation e.g. Na+, cholesterol and phospholipids

Question 28

What causes increased cholesterol?

Answer 28

Liver secretes excess | Reabsorption of salt and water

Question 29

What are 2 types of gallstones?

Answer 29

``` Cholesterol stones (85%): obesity; decrease bile acids vs decrease phospholipids Calcium bilirubinate stones: due to increase conjugated bilirubin (haemolytic anaemia) ```

Question 30

What are factors involved in gallstone formation?

Answer 30

Bile stasis Deceased amount of bile acids due to malabsorption Chronic infection Super saturation of bile with cholesterol

Question 31

Diagnoses of gallstones

Answer 31

Ultrasonography Cholescintigraphy Endoscope retrograde cholangiopancreotography

Question 32

What are the clinical features of gallstones?

Answer 32

Gallstone in cystic bile duct Gallstone blocking common bile duct Gallstone blocking duodenal papilla