Gall Bladder Flashcards
How many mls of bile does the liver produce each day?
About 500-600ml
What is the composition of bile?
Water, electrolytes, organic compounds: bile salts, bilirubin, phospholipids, cholesterol, drugs and drug metabolites, proteins
What is the major organic compound in bile? And what is it synthesized from?
Bile salts, synthesized from Cholestrol
Bile salts are transported from hepatocytes by active/ passive transport?
Active transport using transport proteins in the membranes of hepatocytes
What is the rate- limiting step in the transportation of bile salts?
Transport of bile salts from hepatocytes to canaliculi by transport membrane proteins
What is the function of bile?
To emulsify fatty acids and fat-soluble vitamins
What happens to bile in the gall bladder during fasting?
The gall bladder absorbs up to 90% of water in the bile there concentrating and storing it. This makes bile more potent.
The sphincter of oddi is highly sensitive to?
Cholecystokinin and other hormones as well as alterations to cholinergic tone
When eating, how much bile does the gallbladder empty into the small intestine?
50-75 %
The enterohepatic circulation happens how many times a day approximately?
10-12 times a day
About how much of bile salts is reabsorbed back to the liver and where does this happen ?
About 90-95%, in the terminal ileum
Primary biliary cholangitis vs primary sclerosing cholangitis
PBC- is an autoimmune disease, affects small bile ducts, diagnosis AMA
PSC- an inflammatory disease, affects both small and large bile ducts, diagnosis MRCP, ERCP
What is biliary colic? It is also known as?
It is severe pain of the abdomen caused by lodging of gallstones in the bile ducts. Gallbladder attack
What are the risks of gall stones?
- Female
- Pregnancy- Fertile
- Age- Fourty
- Obesity- Fat
4Fs
Symptoms of gallstones/ biliary colic ?
- RUQ/Epigastric pain which radiates to the upper shoulder
- Nausea
- Vomiting
- Sweating
What is the duration of pain in biliary colic?
Usually starts several hours after a meal about 1-3 hrs, then the pain intensity rises for about 15 minutes and remain constant for usually less than 6 hrs
Pain may also happen frequently at night because sleeping position makes it easier for the stone to get lodged in the cystic duct
When the gallstone in biliary colic persists it may lead to? Which symptoms are associated with it?
Acute Cholecystitis . Symptoms such as RUQ/Epigastric pain which may extend up to the right shoulder , Nausea, vomiting and FEVER due to inflammation
Diagnosis of biliary colic?
- Recurrent symptoms
- Ultrasound to confirm
Treatment of biliary colic?
- Management of pain and other symptoms
- Definitive treatment is cholecystectomy
Acalculous biliary colic is? What is the cause?
Is a condition where there is biliary colic without any detected gall stones
Cause:
microscopic stones, biliary dyskinesia, hypersensitivity of biliary tract, hypersensitivity of duodenum, sphincter of oddi dysfunction - papillary stenosis
How to diagnose acalculous biliary pain?
- Ultrasonography
- Endoscopic retrograde cholangiopacreatography -ERCP
- Sphincter of oddi manometry
Treatment for acalculous biliary pain?
Laparoscopic cholecystectomy
