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GI II > gall bladder and bile > Flashcards

gall bladder and bile Flashcards

1
Q

What are the sources of blood supply to the liver

A

hepatic artery- 25%
hepatic portal vein- 75%
hepatic vein

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2
Q

what nutrients can the liver metabolize

A

carbs, proteins, lipids

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3
Q

What nutrients can the liver synthesize

A

plasma proteins, albumin, glucose, cholesterol, fatty acids, lipoproteins

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4
Q

what nutrients can the liver store

A

glycogen, fats, irons, copper and vitamins

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5
Q

what type of compunds is the liver good for detox

A

endogenous compunds like steroids

exogenous compounds like drugs and toxins

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6
Q

What are the specialized phagocytes in the liver

A

Kupffer cells

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7
Q

What compunds can the liver activate

A

Vit D

deiodination of thryoid hormone T4->T3

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8
Q

can the liver produce bile

A

yes

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9
Q

what is the gall bladder responsible for bile

A

storage, concentration and acidification

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10
Q

why is bile greenish yello

A

bilirubin

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11
Q

what molecules are found in bile

A

salts, proteins, cholesterol, hormones, enzymes and bilirubin

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12
Q

what is bilirubin a breakdown product of

A

hemaglobin

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13
Q

what causes jaundice

A

abnormally high levels bilirubin in the blood

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14
Q

What is a liver lobule

A

functional units of liver, hexagonal arrangement surrounding a central vein with a hepatic a, portal vein and bile duct at each 6 corner

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15
Q

what is a liver sinusoid

A

expanded capillary space between rows of hepatocytes

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16
Q

each hepatocyte is in contact with what two passages

A

sinusoid and bile cannaliculus

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17
Q

describe path of bile

A

hepatocyte->bile canaliculus->bile duct->common bile duct->duodenum

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18
Q

Majority of the liver parenchyma is what

A

95% hepatocytes

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19
Q

where are kupffer cells found

A

in the sinudoidal space

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20
Q

What cells are in the spaces of Disse

A

stella cells, plasma solutes, kupffer cells

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21
Q

What is a portal lobule

A

all hepatocytes drained by a single bile ductule

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22
Q

Describe mergence of the biliary tree

A

bile canaliculi merge with terminal bile ductules->pertubular ducts-> interlobular ducts merge with septal ducts->lobar ducts->R and L hepatic duct

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23
Q

Where is the sphincter of Oddi

A

on the hepatopancreatic ampulla

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24
Q

Describe the 2 stages of bile secretion in liver

A

1) hepatoctes through normal passage
2) secretory epithelial cells in the ducts and ductules that secrete water solution with Na and HCO3 as well as bile
stimulate by secretin

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25
Q

How would you describe the secretion of canalicular bile

A

active and isotonic

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26
Q

How much of the bile synthesized is diverted to gallbladder

A

50%

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27
Q

describe the bile that reaches the duodenum

A

dilute hepatic bile

concentrated gallbladder bile

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28
Q

Desribe the flow of ions from gallbladder

A

Na secreted actively which co transports K, Cl, H2O

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29
Q

The liver converts cholesterol into what

A

cholic acid and chenodeoxycholic

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30
Q

Where are bile acids dehydroxylated

A

in the terminal ileum

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31
Q

what are the secondary bile acids

A

deoxycholic and lithocholic acid

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32
Q

Most of primary bile salts are conjugated into what by hepatocytes

A

glycine and taurine

sometimes sulfate or glucoronate

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33
Q

What is the composition of fecal bile salts

A

majority is deoxycholic and a~30% lithocholic

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34
Q

describe the composition of biliary bile salts

A

45% cholic, 40% chenodeoxycholic and then like

15% desoxycholic

35
Q

are bile acids in feces conjugated or deconjugated

A

deconjugated

36
Q

What are the bile salts

A

cholates, chenodeoxycholate, deoxycholate

37
Q

What is the role of bile salts in the bile

A

dissolve dietary fat

38
Q

What are the fat soluble Vit

A

ADEK

39
Q

Disruption of bile excretion can lead to what

A

malabsorption, diarrhea, steatorrhea and deficiencies in Vit ADEK

40
Q

What is the role of bile phospholipids

A

enhance choelsterol solubizing properties

41
Q

Inefficient excretion of cholesterol can lead to what

A

increased serum cholesterol

42
Q

What are the 4 major components of bile

A

bile salts, cholesterol and phospholipids, bilirubin and protein.misc components

43
Q

What are the 2 main funcitons of bile

A

fat digestion and absorption

waste product excretion

44
Q

What is menat by enterohepatic circulation of bile

A

re-use, bile gets recycled back to the liver

45
Q

What does bile help excrete

A

bilirubin, cholesterol, lipophilic drugs, trace minerals

46
Q

What are the 2 actions of bile salts in intestinal tract

A

1) detergent action or emulsification on fat particles by decreasing SA and increasing agitation of the intestinal tract
2) absorption of FA, monoglycerides, cholesterol, lipids by forming small complexes called micelles

47
Q

What is the calculation for total bile flow

A

canalicular flow + ductular flow

48
Q

what is canalicular flow

A

independent flow + dependent (increases with bile secretion)

49
Q

What is ductular flow

A

constant from cholangiocytes into bile ducts

50
Q

What determines independent flow for bile

A

presence of organic compounds and osmotic force

ex: glutathione increases osmotic driving force for canalicular bile formation

51
Q

What determines dependent flow for bile

A

depends on negatively charged bile salts, in micellar form and out of solution- have low osmotic force

52
Q

What is a choleretic and give examples

A

something that stimulates release of bile, Secretin, glucagon, VIP and GRP

53
Q

What is the result of somatostatin on bile release

A

enhances fluid absorption or inhibits secretion

54
Q

How do secretin, glucagon, VIP and GRP increase secretion of bile

A

raise cAMP and stimulate apical Cl and Cl-HCO3 transporter

a Ca dependent Cl also gets activated

55
Q

How does somatostatin inhibit bile flow

A

lowering cAMP, increase fluid reabsorption could cause this

56
Q

What is the role of mucus secretion in gallbladder

A

protection from bile salt toxicity

57
Q

What could too much mucus lead to

A

cholesterol cholelithiasis (cholesterol gallstones) marked by increase of mucin release

58
Q

What is the result of CCK on gallbladder

A

contraction of gallbladder
relaxation of sphincter of iddi
increase bile flow

59
Q

what sitmulates CCK release

A

presence of Fatty foods in duodenum

60
Q

When the vagus N and intestinal enteric NS stimulates Ach release what happens

A

gallbladder is stimulated (not as strong as CCK)

61
Q

Where are most of the bile salts reabsorbed

A

terminal ileum and return via hepatic portal vein

62
Q

What percent of bile salts are lost each day in the stool

A

5%

63
Q

Of the bile salts reabsorbed in the lumen how much is by diffusion and how much by active transport

A

half in early SI is diffusion

half in late digestions through distal ileum

64
Q

Where do recycled bile salts first enter in liver

A

venous sinusoids

65
Q

Ingestion of supplemental bile salts can do what to bile secretion

A

increase by several hundreds milliliters per day

66
Q

The gallbladder can carry what strain of salmonella

A

salmonella typhi, typhoid fever

67
Q

What is cholestasis

A

suppression of bile secretion

68
Q

What does cholestasis cause

A

regurgitation of bile components into systemic circulation–>jaundice and pruritus (itching)
damaged hepatocytes release liver enzymes (alkaline phosphotase)
lipid digestion and absorption may be impaired

69
Q

obstucting extrahepatic ducts or impairing flow in intrahepatic ducts may lead to what

A

cholestasis

70
Q

What is cholelithiasis

A

formation of stones in gallbladder or biliary duct sytem

71
Q

what is cholecystitis

A

inflammation of gallbladder

72
Q

what is cholangitis

A

inflammation of biliary ducts

73
Q

What can cause gall stones

A

abnormal bile composition (too much absorption of water from bile, too much absorption of bile acids from bile, too much cholesterol)
biliary stasis
inflammation of gallbladder

74
Q

What are risk factors for cholesterol stones

A

female sex hormones, obesity, rapid weight reduction, gallbladder stasis, hyperlipidemia

75
Q

What are risk factors for the pigmented gall stones

A

asians usually, chronic hemolytic syndromes, biliary infection, GI disorders like crohn disease or CF

76
Q

What are the 4 contributin factors to cholelithiasis

A

supersaturation, gallbladder hypomotility, crystal nucleation, accretion within mucous layer

77
Q

What is the Tx for gallstones w/o symptoms

A

nothing

78
Q

what is the Tx for typical gallstones and symptoms

A

cholecystectomy

79
Q

what is the Tx for atypical symptons for gallstones

A

search for related cause of symptoms

80
Q

In a patient with typical biliary symptoms but no gallstones what should you Dx

A

suspicion for gallstone disease should be maintained

81
Q

what percentage of people with gallstones is asymptomatic

A

70-80%

82
Q

Which size of gallstones is the most dangerous

A

the small stones because they can tracel to enter cystic or common duct for obstruction

83
Q

Someone with cholelithiasis is increased risk for what

A

carcinoma of the gallbladder

84
Q

Symptomatic patients of cholelithiasis have what type of pain

A

biliary or colic pain

GI II (12 decks)

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