Biliary system

Question 1

what is the function of the biliary system?

Answer 1

production and delivery of bile and pancreatic enzymes

Question 2

what is bile?

Answer 2

fluid which emulsifies lipids to aid in the digestion and absorption of fat

Question 3

what is the gallbladder?

Answer 3

stores and concentrates bile, releases bile when fat is detected in the small intestine

Question 4

what is the pancreas?

Answer 4

produces enzymes to aid in the digestion of fat, carbohydrates and proteins in the small intestine

Question 5

what is Cholecystokinin (CCK)?

Answer 5

a hormone that is released when fats and proteins enter the small intestine (duodenum), causing the gallbladder and pancrease to contract and release enzymes and bile

Question 6

what enzymes does the pancreas produce?

3

Answer 6

• lipase
• amylase
• trypsin

Question 7

what is bile composed of?

5

Answer 7

• water (97%)
• bile pigments (conjugated bilirubin)
• bile salts
• cholesterol
• phospholipids

Question 8

what does a blockage to the flow of bile lead to?

Answer 8

build up of biliruin in the blood circulation resulting in jaundice

Question 9

how is bilirubin formed?

Answer 9

formed from the breakdown of haem in red blood cells

Question 10

where is conjugated bilirubin produced?

Answer 10

the liver converts unconjugated bilirubin to conjugated bilirubin then excretes it into the duodenum

Question 11

how does bilirubin leave the body?

2

Answer 11

• exits in faeces as stercobulin, giving faeces its brown colour
• small percentage exits in urine as urobilin, giving urine its yellow colour

Question 12

what are the symptoms if there is a blockage to the outflow of the biliary tract?

2

Answer 12

bilirubin cannot reach faeces or urine
* pale stools
* dark urine

build up of bile salts in the skin can also cause itching

Question 13

what is jaundice?

Answer 13

yellowish discolourisation of skin or sclera due to high levels of bilirubin in blood

Question 14

what are the three different types of jaundice and some of their causes?

Answer 14

• pre-hepatic (increased RBC breakdown, haemolytic anaemia, malaria)
• intra-hepatic (alcohol hepatitis, viral hepatitis, cirrhosis, HCC)
• post-hepatic (gallstones, pancreatic cancer)

Question 15

what are gallstones?

Answer 15

small stones that form in the gallbladder from concentrated bile salts and can block the flow of bile

Question 16

what are the risk factors of gallstones?

4

Answer 16

4F’s
* fair (caucasian)
* female
* forty +
* fat

Question 17

what can gall stones cause?

3

Answer 17

• pain
• jaundice
• pancreatitis

Question 18

how do you manage gallstones?

2

Answer 18

• imaging - ultrasound, CT scan, ERCP (endoscopic retrograde cholangio-Pancreatography)
• treatment - laparoscopic cholecystectomy (remove gall bladder)

Question 19

what are the functions of the pancreas?

2

Answer 19

• exocrine function - enzymes into pancreatic duct (lipase, amylase, tripsin)
• endocrine function - hormones into bloodstream (insulin, glucagon)

Question 20

what kind of cancer is pancreatic cancer?

Answer 20

adenocarcinoma - cancer of glandular tissue

Question 21

why does pancreatic cancer have a poor prognosis?

2

Answer 21

• late detection - deep in abdomen = asymptomatic
• early metastatic spread

Question 22

how can pancreatic cancer present? how does this occur?

Answer 22

as post-hepatic jaundice
* bile is produced in the liver and stored in the gall bladder
* compression of common bile duct from tumour
* leads to a back-up/backflow of bile in the liver and bloodstream

Question 23

how do you manage pancreatic cancer?

3

Answer 23

• palliative care (stent)
• chemotherapy
• surgery - Whipple’s procedure