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Physiology 1 > Bile, Gallbladder And Gallstones > Flashcards

Bile, Gallbladder And Gallstones Flashcards

1
Q

What is the ampulla of vater?

A

Where the common bile duct and the pancreatic duct join

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2
Q

What does the gallbladder do?

A

Stores and concentrates bile

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3
Q

How does the gallbladder concentrate bile?

A

Sodium ions and water are actively transported out and H+ is transported in

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4
Q

What does pancreatic juice contain?

A

Bile salts, bile pigments and dissolved substances in alkaline electrolytes

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5
Q

What are cholangiocytes?

A

Specific light junctions for adding water to bile

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6
Q

What happens in the ductules of the liver?

A

Glucose and amino acids are scavenged, GSH is hydrolysed and IgA, HCO3- and water are secreted

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7
Q

When are HCO3- and water secreted into the ductules?

A

In response to secretin in the postprandial period

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8
Q

When is the most bile being secreted?

A

During and after a meal

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9
Q

What influences the secretion of bicarbonate and water?

A

Secretin and ACh

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10
Q

What happens if there’s increased bile salt in the blood?

A

Increased bile salt synthesis and secretion into the bile canniculi

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11
Q

When does the sphincter of oddi contract and relax?

A

Contracts during fasting periods and relaxes during and after meals

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12
Q

Where is the sphincter of oddi found?

A

Where the bile duct reaches the duodenum

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13
Q

What can be secreted across the bile cannicular membrane?

A
  • bile acids
  • phosphatidylcholine
  • conjugated bilirubin
  • cholesterol
  • xenobiotics
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14
Q

What are xenobiotics?

A

Foreign stuff

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15
Q

What substances can enter bile by diffusing?

A

Water, glucose, calcium ions, GSH, amino acids and urea

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16
Q

What % of hepatic bile is water?

A

97

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17
Q

What else (not water) is in hepatic bile?

A

Cholesterol, lecithin, bile acids, bile pigments etc

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18
Q

What % of gallbladder bile is water?

A

89%

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19
Q

Where does bile go when the sphincter of oddi is closed?

A

To the gallbladder

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20
Q

What are the two biosynthetic pathways for bile acid formation?

A

Classic (natural) or alternative (acidic) pathway

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21
Q

Which pathway leads to 98% of bile acid formation?

A

Classic

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22
Q

What are examples of bile acids?

A

Cholic acid and chenodeoxycholic acid

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23
Q

What are bile acids made from?

A

Cholesterol

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24
Q

What does conjugation mean for bile acids?

A

Allows them to be secreted and decreases their cytotoxicity

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25
Q

What are bile acids synonymous with?

A

Bile salts

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26
Q

What are the four major bile acids in humans and their proportions?

A 
Cholic acid (50%)
Chenodeoxycholic acid (30%)
Deoxycholic acid (15%)
Lithocholic acid (5%)
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27
Q

Which bile acids are formed in the liver and what type of bile acid are they?

A

Primary

Cholic acid and chenodeoxycholic acid

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28
Q

Which bile acids are formed in the colon and what type of bile acids are they?

A

Secondary

Deoxycholic acid and lithocholic acid

29
Q

What are the major functions of bile?

A
  • elimination of cholesterol to bile acids
  • reduce cholesterol precipitation in gallbladder
  • facilitate fat soluble vitamin absorption
  • regulate their own transport and metabolism
  • facilitate the digestion of triglycerides
30
Q

What makes cholesterol more soluble in bile?

A

Bile acids and phospholipids

31
Q

Which vitamins are fat soluble?

A

A, D, E and K

32
Q

What does bile work together with that ensures the emulsification of fats?

A

Lecithin and monoglycerides

33
Q

What controls the release of bile?

A

Contraction of gallbladder

34
Q

What happens in the cephalic phase?

A

The taste, smell and presence of food in mouth -> impulses via the vagus nerve

35
Q

What happens in the gastric phase?

A

Distension of stomach generates impulses in vagus nerve

36
Q

What happens in the intestinal phase?

A

Period of gallbladder emptying

37
Q

What are some mediators for increased bile release?

A

CCK, secretin, ACh and ATP

38
Q

What is CCK released in response to?

A

Fats

39
Q

What is ACh released in response to?

A

Acidic chyme

40
Q

What is secretin released in response to?

A

Fats or acidic chyme

41
Q

What is the nerve signalling pathway to/from the gallbladder?

A

Vagal afferent -> dorsal vagal complex -> vagal efferents -> chemical release

42
Q

Which molecule can work directly on the gallbladder?

A

CCK

43
Q

What % of bile salts are reabosorbed?

A

95%

44
Q

How are bile salts reabsorbed?

A

Through Na+- Bile salt coupled transporters

45
Q

What happens to the remaining 5% of bile salts?

A

Returned to the liver and secreted into bile

46
Q

What is enterohepatic circulation?

A

Recycling of bile salts

47
Q

How often is the bile acid pool recycled?

A

Roughly twice per meal

48
Q

What happens if enterohepatic circulation is interrupted?

A

Liver will synthesise too much bile salts

And the kidneys will excrete the synthesised bile salts

49
Q

What is bile stasis?

A

A factor for gallstone formation - stones form in bile that is held into the gallbladder rather than bile flowing in the bile ducts into the duodenum

50
Q

What are some factors involved in gallstones formation?

A
  • Decreased amount of bile acids due to malabsorption
  • chronic infection
  • super saturation of bile with cholesterol
  • presence of nucleation factors or glycoproteins
51
Q

How long does it take for a gallstone to form in a patient who already suffers from gallstones?

A

2-3 days

52
Q

How long does it take for a gallstone to form in a patient who has never suffered from gallstones?

A

2 weeks

53
Q

Why does it take so much longer for a gallstone to form in patients who’ve never had gallstones?

A

Presence of anti-nucleation factors

54
Q

What are they symptoms of a gallstone being lodged in the opening of the gallbladder?

A

Right upper quadrant pain and jaundice

55
Q

What are the symptoms of gallstones lodging at the sphincter of oddi?

A

Pressure builds up- right quadrant pain and jaundice

56
Q

What do lodged bile stones cause?

A

Nutritional deficiency- fats can’t be digested properly

57
Q

How can you diagnose gallstones?

A
  • Ultrasonography and computer tomography
  • cholescintigraphy
  • endoscope retrograde cholangiopancreotopography
58
Q

What happens in ultrasonography and computer tomography?

A

Explore the right upper quadrant of gallbladder

59
Q

What happens in cholescintigraphy?

A

Administer technitium-99 labelled derivative of iminodiacetic acid and then you can get images of the gallbladder and ducts

60
Q

How does endoscope retrograde cholangiopancreotography work?

A

Inject contrast media from an endoscope channel and visualise the biliary tree

61
Q

What percentage of gallstone cases are asymptomatic?

A

85%

62
Q

How can gallstones be asymptomatic?

A

If the gallstones remain in the gallbladder

63
Q

What causes acute cholecystitis?

A

If the neck of the cystic duct is impaired

64
Q

What are the symptoms of acute cholecystitis?

A

Biliary pain of right upper quadrant

65
Q

What can gallstones impacting the common bile duct cause?

A

Obstruction of bile flow and cholestatic jaundice -> bacterial infections and right upper quadrant pain

66
Q

What is cholangitis?

A

Inflammation (infection) of the bile duct

67
Q

What can gallstones that block the duodena papilla cause?

A

Inappropriate activation of pancreatic juice and acute pancreatitis

68
Q

What happens if the gallbladder is inflamed?

A

It will secrete mucus and eventually rupture

Physiology 1 (65 decks)

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