Gall bladder and bile Flashcards

1
Q

Functions of bile

A

Cholesterol homeostasis
Absorption of vitamins/dietary lipids
Toxin excretion eg cholesterol metabolites, adrenocortical, and other steroid hormones

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2
Q

What substances are secreted into bile

A

Adrenocortical and other steroid hormones
Drugs/xenobiotics
Cholesterol
Alkaline phosphatase

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3
Q

What colour is bile and why is it that colour?

A

billirubin and biliverdin make it yellow/green

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4
Q

What secretes bile?

A

Hepatocyes - liver cells

Cholangiocytes - biliary epithelial cells

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5
Q

What drains bile? Through what?

A

Bile drains from liver
through bile ducts
into duodenum
at duodenal papilla

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6
Q

How much bile is secreted daily?

A

500ml

In average healthy adult

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7
Q

What does bile produced in cholangiocytes do?

A
alters pH
water moves into bile via osmosis
reabsorption of sugars and acids
secretion of HCO3- and Cl-
IgA exocytosed
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8
Q

How is biliary excretion of bile salts and toxins performed?

A

By transporters on apical surface of hepatocytes + cholangiocytes

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9
Q

What else do biliary transports also goven?

A

Rate of bile flow

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10
Q

What does a dysfunction in biliary transporters lead to

A

Cholestasis

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11
Q

What are the main transporters of bile?

A
  • bile salt excretory pump (BSEP)
  • MDR related proteins (MRP1 and MRP3)
  • products of the familial intrahepatic cholestasis gene
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12
Q

How much bile is made from the hepatocytes and the cholangiocytes?

A

Hepatocytes 60%

Cholangiocytes 40%

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13
Q

What does the BSEP bile transporter do?

A

Active transport of bile acids across hepatocyte canalicular membranes into bile, and secretion of bile acids is a major determinant of bile flow

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14
Q

What does the MDR1 bile transporter do?

A

Mediates canalicular excretion of xenobiotics and cytotoxins

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15
Q

What does the MDR3 bile transporter do?

A

Encodes a phospholipid transporter protein that translocates phosphatidylcholine from inner to outer leaflet of canalicular membrane

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16
Q

What are bile salts?

A

Sodium and potassium salts of bile acids

17
Q

What are bile acids synthesised from?

A

Cholesterol

18
Q

What are the two primary bile acids? Where are they made?

A

In liver by hepatocytes
Cholic acid
Chenodeoxycholic acid

19
Q

What are the two secondary bile acids? How are they made

A

Deoxycholic acid
Lithocholic acid
Converted by gut bacteria from primary bile acids

20
Q

What do bile salts do?

A

Reduce surface tension of fats

Emulsify fat preparatory to its digestion/absorption

21
Q

How do bile salts form micelles?

A

Bile salts amphipathic
One surface has hydrophilic domains - facing out
2nd has hydrophobic domains facing in
free fatty acids and cholesterol inside
thus transported into GIT epithelial cells for absorption

22
Q

What’s the problem with bile salts?

A

The detergent like actions make bile salts potentially cytotoxic in high concentrations
Can cause gut irritation/diarrhoea if not reabsorbed properly

23
Q

How is the ampulla of the bile duct controlled?

A

Sphincter of Oddi

Circular muscle that opens and closes

24
Q

What does the ampulla of bile do?

A

Let bile from the common bile duct enter the duodenum

25
What does cholecystokinin do?
When you eat it is released Causes sphincter of oddi to relax, opening the hole Causes gall bladder to squeeze and pump into duodenum Bile there to help digest fat
26
Anatomy of biliary system
Each hepatocyte apposed to several bile canaliculi These drain into intralobular bile ducts coalesce into interlobular ducts form right and left hepatic duct join outside liver to form common hepatic duct Cystic duct drains the gall bladder and unites with the common hepatic duct to form common bile duct CBD joined by pancreatic duct before entering duodenal papilla
27
Where does bile go between meals? How does this happen?
Bile divered into gall bladder for storage | Duodenal orifice closed dur to sphincter of Oddi contracted
28
What percentage of bile salts are reabsorbed and undergo enterohepatic circulation
95% absorbed from small terminal ileum
29
How do bile salts go through the enterohepatic circulation?
By Na+/bile salt co-transport Na+/K+ ATPase system 5% converted into secondary bile acids in the colon Deoxycholate absorbed lithocholae 99% excreted in stool Absorbed bile salts go through portal vein back to liver and re-excreted in bile
30
What happens in terminal ileal resection/disease?
``` Less bile salt reabsorption more stool (fat) bc enterohepatic circulation interrupted and liver can't increase rate of bile salt production enogh to make it up ```
31
What would happen if bile stopped entering the gut
Up to 50% ingested fat appears in faeces | Malabsorption of fat soluble vitamins A,D,E,K
32
What does the gall bladder do?
Stores bile - 50ml and released after meal for fat digestion Acidifies bile Concentrates bile by H2O diffusion following net absorption of Na+, Cl-, Ca2+, HCO3- (intra-cystic pH) gall bladder can reduce volume of stored bile by 80-90%
33
What happens if a patient gets a cholecystectomy?
Periodic discharge of bile from gallbladder aids digestion but is not essential Normal health and nutrition exists with continuous slow bile discharge from duodenum Avoid food with high fat content