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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
What are bile acids made from?
→ Cholesterol | →helps to reduce cholesterol levels
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 | → primary in the liver
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 by acting as emulsifying agents that render fats accessible to pancreatic lipases eg →Work in concert with phospholipids(licithin) and monoglycerides
33
What activates the cephalic phase?
→taste → smell →presence of food in mouth →impulses via vagus nerve
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 are the key mediators for the release of bile and what are their roles?
→CCK in response to fats. Relaxes sphincter of Odii | →Secretin in response to acidic chyme, bicarbonate rich secretion
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 →resection means less capacity to recycle bile so there is excess bile
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 →Chronic infection – bacteria help in the formation of pigment stones
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 →dehydrated and acidic
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
63
What are cholangiocytes?
→epithelial cells of the bile duct.
64
What does motilin?
gallbladder motility and ↑ volume of gall bladder secretions
65
What happens with higher cholesterol of bile?
the greater the concentrations of phospholipid and bile acids/salts. If there’s deviation it may result in stones
66
What is the ampulla of vater?
where bile duct joins with pancreatic duct
67
What does stercobilin do?
colours faeces

P1: GI (15 decks)

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