Gall Bladder

Question 1

How many mls of bile does the liver produce each day?

Answer 1

About 500-600ml

Question 2

What is the composition of bile?

Answer 2

Water, electrolytes, organic compounds: bile salts, bilirubin, phospholipids, cholesterol, drugs and drug metabolites, proteins

Question 3

What is the major organic compound in bile? And what is it synthesized from?

Answer 3

Bile salts, synthesized from Cholestrol

Question 4

Bile salts are transported from hepatocytes by active/ passive transport?

Answer 4

Active transport using transport proteins in the membranes of hepatocytes

Question 5

What is the rate- limiting step in the transportation of bile salts?

Answer 5

Transport of bile salts from hepatocytes to canaliculi by transport membrane proteins

Question 6

What is the function of bile?

Answer 6

To emulsify fatty acids and fat-soluble vitamins

Question 7

What happens to bile in the gall bladder during fasting?

Answer 7

The gall bladder absorbs up to 90% of water in the bile there concentrating and storing it. This makes bile more potent.

Question 8

The sphincter of oddi is highly sensitive to?

Answer 8

Cholecystokinin and other hormones as well as alterations to cholinergic tone

Question 9

When eating, how much bile does the gallbladder empty into the small intestine?

Answer 9

50-75 %

Question 10

The enterohepatic circulation happens how many times a day approximately?

Answer 10

10-12 times a day

Question 11

About how much of bile salts is reabsorbed back to the liver and where does this happen ?

Answer 11

About 90-95%, in the terminal ileum

Question 12

Primary biliary cholangitis vs primary sclerosing cholangitis

Answer 12

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

Question 13

What is biliary colic? It is also known as?

Answer 13

It is severe pain of the abdomen caused by lodging of gallstones in the bile ducts. Gallbladder attack

Question 14

What are the risks of gall stones?

Answer 14

1. Female
2. Pregnancy- Fertile
3. Age- Fourty
4. Obesity- Fat

4Fs

Question 15

Symptoms of gallstones/ biliary colic ?

Answer 15

1. RUQ/Epigastric pain which radiates to the upper shoulder
2. Nausea
3. Vomiting
4. Sweating

Question 16

What is the duration of pain in biliary colic?

Answer 16

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

Question 17

When the gallstone in biliary colic persists it may lead to? Which symptoms are associated with it?

Answer 17

Acute Cholecystitis . Symptoms such as RUQ/Epigastric pain which may extend up to the right shoulder , Nausea, vomiting and FEVER due to inflammation

Question 18

Diagnosis of biliary colic?

Answer 18

1. Recurrent symptoms
2. Ultrasound to confirm

Question 19

Treatment of biliary colic?

Answer 19

1. Management of pain and other symptoms
2. Definitive treatment is cholecystectomy

Question 20

Acalculous biliary colic is? What is the cause?

Answer 20

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

Question 21

How to diagnose acalculous biliary pain?

Answer 21

1. Ultrasonography
2. Endoscopic retrograde cholangiopacreatography -ERCP
3. Sphincter of oddi manometry

Question 22

Treatment for acalculous biliary pain?

Answer 22

Laparoscopic cholecystectomy