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P1: GI > Bile, Gallbladder and Stones > Flashcards

Bile, Gallbladder and Stones 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
→cholangiocytes secrete bicarbonate as well

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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 synthesis and secretion into bile canaliculi

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15
Q

When does the sphincter of Oddi contract?

A

→ during periods of fasting

→bile returns to gallbladder

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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
→enter the bile by diffusion
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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
→NaCl and H2O loss → increased solid content
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21
Q

How many pathways are there for bile formation and what are they?

A

→ 2
→Classic (neutral) pathway ending with cholic acid
→quantitatively more important
→Both cholic acid and chenodeoxycholic acid are formed by the neutral pathway in same amounts.

→Alternative pathway
ending with chenodeoxycholic

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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
Q

What are bile acids made from?

A

→ Cholesterol

→helps to reduce cholesterol levels

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26
Q

What are bile acids conjugated with?

A

→Glycine

→ Taurine

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27
Q

What does conjugation do to bile acids?

A

Conjugation helps to increase the ability of bile acids to be secreted and reabsorbed and decreases their cytotoxicity

28
Q

What are the 4 major bile acids present in humans and in what amounts are they present in?

A

→Cholic acid: 50% = quantitatively more important
→Chenodeoxycholic acid: 30%
→Deoxycholic acid: 15%
→Lithocholic acid: 5%

29
Q

Where are secondary bile acids formed?

A

→ In the colon

→ primary in the liver

30
Q

What are secondary bile acids?

A

→Deoxycholic acid

→Ursodeoxycholic acid

31
Q

What are the conversions that intestinal bacteria do?

A

→Chenodeoxycholic acid → Lithocholic acid and Ursodeoxycholic acid

→Cholic acid → Deoxycholic acid

32
Q

What are the main functions of bile acids ?

A

→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 by acting as emulsifying agents that render fats accessible to pancreatic lipases eg →Work in concert with phospholipids(licithin) and monoglycerides

33
Q

What activates the cephalic phase?

A

→taste
→ smell
→presence of food in mouth
→impulses via vagus nerve

34
Q

What activates the gastric phase?

A

→distension of stomach generates impulses in vagus nerve

35
Q

What does the gallbladder do during the intestinal phase?

A

→period of most gallbladder emptying

36
Q

What are the key mediators for the release of bile and what are their roles?

A

→CCK in response to fats. Relaxes sphincter of Odii

→Secretin in response to acidic chyme, bicarbonate rich secretion

37
Q

How is bile secreted into the duodenum?

A

→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
Q

What causes the Sphincter of Oddi to relax?

A

→NO and VIP cause the sphincter of Oddi to relax

39
Q

Where are bile salts and lecithin synthesized?

A

→ In the liver

40
Q

What neutralizes acids in the duodenum?

A

→HCO3- and other ions

41
Q

How are most bile salts reabsorbed?

A

→by Na+-bile salt coupled transporters

42
Q

How does the process of bile salt recycling occur and what is this called?

A

→Returned to the liver and secreted again into bile

→Recycling pathway from intestine to liver and back - →enterohepatic circulation

43
Q

What does the liver secrete into the bile and how is this eliminated?

A

→ cholesterol

→ eliminated in feces

44
Q

What does interruption of enterohepatic circulation cause?

A

→Excess synthesis of bile salts by the liver
→Kidneys will excrete the synthesized bile and some cholesterol
→resection means less capacity to recycle bile so there is excess bile

45
Q

What are gallstones made from?

A

→Bile salts (bile compounded with a cation Na+) cholesterol and phospholipids

46
Q

What does a high cholesterol content of bile do?

A

→The higher the cholesterol content of bile the greater the concentrations of phospholipid and bile salts.

47
Q

What causes increased cholesterol?

A

→Liver secretes excess
→Reabsorption of salt and water
→Cholesterol crystallizes and forms gallstones
→Precipitation of bile pigments

48
Q

What are the 2 types of gallstones?

A

→Cholesterol stones (85%) : obesity

→Calcium bilirubinate stones - due to increased conjugated bilirubin

49
Q

What are the factors involved in gallstone formation?

A

→Bile stasis
→Decreased amount of bile acids due to malabsorption
→Chronic infection
→Supersaturation of bile with cholesterol
→Nucleation factors or glycoproteins
→Chronic infection – bacteria help in the formation of pigment stones

50
Q

What is bile stasis?

A

→stones form in bile that is sequestered in gallbladder rather than bile that is flowing in bile ducts into duodenum

51
Q

How is the gallbladder blocked in cystic fibrosis?

A

→cystic fibrosis gallbladder and cystic ducts can be blocked by thick mucus
→dehydrated and acidic

52
Q

How do small gallstones pass?

A

→ easy passage via bile duct

53
Q

How do large gallstones pass?

A

→lodge in opening of gallbladder

duct from the pancreas joins bile ducts before it joins the duodenum

54
Q

What does lodging of gallstones cause?

A

→stoppage of bile and pancreatic secretions

55
Q

What are the symptoms of gallstones?

A

→‘Upper right quadrant pain’
→Pressure build up causes decreased secretion of bile
→Jaundice

56
Q

What are the 3 diagnostic methods used for gallstones?

A

→Ultrasonography and CT
→Cholescintigraphy
→ERCP

57
Q

What is cholescintigraphy?

A

→ Getting an image of the bile ducts using technetium

58
Q

What is ultrasonography and CT for?

A

→explore the upper right quadrant of gallbladder to detect gallstones

59
Q

What is ERCP used for?

A

→Visualize the biliary tree by injecting contrast media from endoscope channel
→Insert device and remove gallstone fragments that may be obstructing bile flow

60
Q

What do gallstones that impact the common bile duct cause ?

A

→Obstruction of bile flow

→Cholestatic jaundice which can cause bacterial infections

61
Q

What does the gallbladder do if it is inflamed?

A

secrete mucus if inflamed and rupture

62
Q

What can occur as a result of infections?

A

→Fevers can occur as a result of infections

63
Q

What are cholangiocytes?

A

→epithelial cells of the bile duct.

64
Q

What does motilin?

A

gallbladder motility and ↑ volume of gall bladder secretions

65
Q

What happens with higher cholesterol of bile?

A

the greater the concentrations of phospholipid and bile acids/salts. If there’s deviation it may result in stones

66
Q

What is the ampulla of vater?

A

where bile duct joins with pancreatic duct

67
Q

What does stercobilin do?

A

colours faeces

P1: GI (15 decks)

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