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Physiology 1 : GI > Bile, gallbladder and gallstones > Flashcards

Bile, gallbladder and gallstones Flashcards

1
Q

What is the gallbladder for?

A

→Storage and concentration of bile

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2
Q

Why is bile concentrated?

A

→Concentrated because of active Na+ transport and H2O from the gallbladder

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3
Q

How does the pH of bile become acidic?

A

→pH of bile drops and becomes acidic as Na+ is exchanged for H+

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4
Q

What is pancreatic juice made from?

A

→ bile salts
→bile pigments
→dissolved substances in alkaline electrolytes
→ some come from the gallbladder and some come from the pancreas

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5
Q

Where is water added to bile?

A

→Water is added via specific tight junctions within ductules

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6
Q

What do the ductules do?

A

→The ductules scavenge glucose, amino acids

→GSH is hydrolyzed

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7
Q

What do ductules secrete and in response to what?

A

→ IgA (mucosal protection)
→HCO3-
→ H2O
→in response to secretin in the postprandial period

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8
Q

Describe the flow of bile

A 
Hepatocytes
   	↓ 
Bile canaliculi (merge to form ductules)
    	↓
Terminal bile ducts
   	↓
Hepatic ducts (left and right)
   	↓
Common bile duct
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9
Q

What 2 cell types secrete bile?

A

→Hepatocytes

→ Epithelial cells of bile ducts

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10
Q

What components of bile do hepatocytes secrete?

A

→cholesterol
→lecithin
→bile acids
→ bile pigments (bilirubin, biliverdin, urobilin)

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11
Q

What components of bile do epithelial cells secrete?

A

→ bicarbonate-rich salt solution

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12
Q

What does secretin influence?

A

→influences the secretion of bicarbonate rich salt solutions and H2O

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13
Q

When is secretion of bile the greatest?

A

→greatest during and after a meal

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14
Q

What does increased bile salt concentration in the blood mean?

A

→ ↑ bile salt secretion into bile canaliculi

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15
Q

When does the sphincter of Oddi contract?

A

→ during periods of fasting

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16
Q

When does the sphincter of Oddi relax?

A

→ relaxes during and after meals.

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17
Q

What are the substances secreted across the canalicular membrane?

A 
→ Bile acids 
→ Phosphatidylcholine
→ Conjugated bilirubin
→ Cholesterol
→ Xenobiotics
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18
Q

What substances enter the bile via diffusion?

A 
→water
→ glucose
→Ca2+
→ GSH
→amino acids 
→ urea
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19
Q

What is the composition of hepatic bile?

A 
→97% water
→cholesterol
→ lecithin
→ bile acids
→ bile pigments
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20
Q

What is the composition of gall bladder bile?

A 
→89% water
→HCO3-
→Cl-
→Ca2+
→ Mg2+
→Na+
→cholesterol
→bilirubin
→ bile salts
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21
Q

How many pathways are there for bile formation?

A

→ 2

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22
Q

What does bile do to cholesterol levels?

A

→ bile comes from cholesterol so bile formation reduces cholesterol levels.

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23
Q

What acids are formed from the neutral pathway and in what amounts?

A

→cholic acid

→ chenodeoxycholic acid

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24
Q

What are primary acid bile salts?

A

→cholic acid

→ chenodeoxycholic acid

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25
What are bile acids made from?
→ Cholesterol
26
What are bile acids conjugated with?
→Glycine | → Taurine
27
What does conjugation do to bile acids?
→Conjugation helps to increase the ability of bile acids to be secreted and reabsorbed and decreases their cytotoxicity
28
What are the 4 major bile acids present in humans and in what amounts are they present in?
→Cholic acid: 50% = quantitatively more important →Chenodeoxycholic acid: 30% →Deoxycholic acid: 15% →Lithocholic acid: 5%
29
Where are secondary bile acids formed?
→ In the colon
30
What are secondary bile acids?
→Deoxycholic acid | →Ursodeoxycholic acid
31
What are the conversions that intestinal bacteria do?
→Chenodeoxycholic acid → Lithocholic acid and Ursodeoxycholic acid →Cholic acid → Deoxycholic acid
32
What are the main functions of bile acids ?
→Elimination of cholesterol to bile acids (5% excreted in feces) → Reduce the precipitation of cholesterol in the gallbladder, bile acids and phospholipids help solubilize cholesterol in the bile →Facilitate the absorption of fat soluble vitamins A,D,E,K →Regulate their own transport and metabolism via enterohepatic circulation →Facilitate the digestion of triglycerides
33
What activates the cephalic phase?
→taste → smell →presence of food in mouth
34
What activates the gastric phase?
→distension of stomach generates impulses in vagus nerve
35
What does the gallbladder do during the intestinal phase?
→period of most gallbladder emptying
36
What does CCK cause?
→causes contraction of the gallbladder and relaxes the sphincter of Oddi
37
How is bile secreted into the duodenum?
→Distension of the duodenum triggers vagal innervation →Afferent impulses are sent to the DVC →They send the vagal efferent signal which produces ACh →CCK and secretin are secreted →CCK causes contraction of the gallbladder
38
What causes the Sphincter of Oddi to relax?
→NO and VIP cause the sphincter of Oddi to relax
39
Where are bile salts and lecithin synthesized?
→ In the liver
40
What neutralizes acids in the duodenum?
→HCO3- and other ions
41
How are most bile salts reabsorbed?
→by Na+-bile salt coupled transporters
42
How does the process of bile salt recycling occur and what is this called?
→Returned to the liver and secreted again into bile | →Recycling pathway from intestine to liver and back - →enterohepatic circulation
43
What does the liver secrete into the bile and how is this eliminated?
→ cholesterol | → eliminated in feces
44
What does interruption of enterohepatic circulation cause?
→Excess synthesis of bile salts by the liver | →Kidneys will excrete the synthesized bile and some cholesterol
45
What are gallstones made from?
→Bile salts (bile compounded with a cation Na+) cholesterol and phospholipids
46
What does a high cholesterol content of bile do?
→The higher the cholesterol content of bile the greater the concentrations of phospholipid and bile salts.
47
What causes increased cholesterol?
→Liver secretes excess →Reabsorption of salt and water →Cholesterol crystallizes and forms gallstones →Precipitation of bile pigments
48
What are the 2 types of gallstones?
→Cholesterol stones (85%) : obesity | →Calcium bilirubinate stones - due to increased conjugated bilirubin
49
What are the factors involved in gallstone formation?
→Bile stasis →Decreased amount of bile acids due to malabsorption →Chronic infection →Supersaturation of bile with cholesterol →Nucleation factors or glycoproteins
50
What is bile stasis?
→stones form in bile that is sequestered in gallbladder rather than bile that is flowing in bile ducts into duodenum
51
How is the gallbladder blocked in cystic fibrosis?
→cystic fibrosis gallbladder and cystic ducts can be blocked by thick mucus
52
How do small gallstones pass?
→ easy passage via bile duct
53
How do large gallstones pass?
→lodge in opening of gallbladder | duct from the pancreas joins bile ducts before it joins the duodenum
54
What does lodging of gallstones cause?
→stoppage of bile and pancreatic secretions
55
What are the symptoms of gallstones?
→‘Upper right quadrant pain’ →Pressure build up causes decreased secretion of bile →Jaundice
56
What are the 3 diagnostic methods used for gallstones?
→Ultrasonography and CT →Cholescintigraphy →ERCP
57
What is cholescintigraphy?
→ Getting an image of the bile ducts using technetium
58
What is ultrasonography and CT for?
→explore the upper right quadrant of gallbladder to detect gallstones
59
What is ERCP used for?
→Visualize the biliary tree by injecting contrast media from endoscope channel →Insert device and remove gallstone fragments that may be obstructing bile flow
60
What do gallstones that impact the common bile duct cause ?
→Obstruction of bile flow | →Cholestatic jaundice which can cause bacterial infections
61
What does the gallbladder do if it is inflamed?
→secrete mucus if inflamed and rupture
62
What can occur as a result of infections?
→Fevers can occur as a result of infections

Physiology 1 : GI (15 decks)

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