Gallbladder and Biliary Tree

Question 1

What is the role of the gallbladder

Answer 1

Stores and concentrates bile

Question 2

Where does the gallbladder lie

Answer 2

Posteroinferior (visceral) surface of the liver

Lies close to the duodenum

Question 3

What are the parts of the gallbladder

Answer 3

Fundus
Body
Neck

Question 4

Where does the body of the gallbladder sit

Answer 4

Gallbladder fossa on the visceral surface of the liver

Tapers towards the neck, which communicates with the cystic duct

Question 5

Where is the surface marking of the fundus of the gallbladder

Answer 5

Fundus at the tip of the 9th costal cartilage at the point where the midclavicular line intersects the right costal margin

Question 6

Describe the production of bile

Answer 6

Continuously produced by hepatocytes in the liver

First excreted into bile canaliculi (small channels)

Drains into larger calibre

Ultimately converge to form right and left hepatic ducts that exit the liver at the porta hepatis

Question 7

Where does the bile duct run

Answer 7

Free edge of the lesser omentum

Question 8

What lies at the gallbladder neck and cystic duct

Answer 8

Spiral fold (spiral valve) at the junction

Question 9

What is the blood supply of the gallbladder

Answer 9

Cystic artery (arises from the right hepatic artery)

Question 10

What is the innervation of the gallbladder

Answer 10

Parasympathetic

Sympathetic

Question 11

Why might gallbladder pain be felt in the right shoulder

Answer 11

Irritates the diaphragm

Innervated by phrenic nerve C3-5

C3-5 also receive somatic sensory information from the skin over the shoulder

Question 12

What is visceral sensation of the gallbladder

Answer 12

T5-9

Pain referred to epigastrium

Question 13

What is another name for the hepatopancreatic ampulla

Answer 13

Ampulla of Vater

Question 14

What is the name of the major duodenal papilla

Answer 14

Regulated by a muscular valve - Sphincter of Oddi

Question 15

What are the components of bile

Answer 15

Bile acids
Cholesterol
Phospholipids
Bile pigments (bilirubin, biliverdin)
Electrolytes
Water

Question 16

What are the constituents of bile split up into

Answer 16

Bile acid-dependent

Bile acid-independent components

Question 17

What is the bile-acid dependent component produced by

Answer 17

Hepatocytes

Hepatocytes secrete bile acids, bile pigments and cholesterol into canaliculi

Question 18

What are the small channels that transport the bile acid dependent portion towards the bile ducts

Answer 18

Canaliculi

Question 19

Where is the bile acid-independent component made

Answer 19

Ductal cells that line bile ducts

Secrete alkaline solution (similar to the fluid made by the pancreatic duct cells)

Question 20

What hormone stimulate secretion of bile acid-independent components

Answer 20

Secretin

Question 21

What hormone stimulates bladder contraction and relaxes the sphincter of Oddi

Answer 21

Cholecystokinin - released by the duodenum after eating

Question 22

What are the two primary bile acids

Answer 22

Cholic acid
Chenodeoxycholic acid

Question 23

What amino acids are conjugated with to form bile salts

Answer 23

Glycine
Taurine

Question 24

What are bile salts

Answer 24

Amphipathic - hydrophobic and hydrophilic

Question 25

Why is the structure of bile salts important

Answer 25

Emulsify fats into small droplets - increasing surface area for lipids to be broken down

Question 26

How do bile acids go back to the liver

Answer 26

Enterohepatic circulation

Question 27

What is the reason for jaundice

Answer 27

Accumulation of bilirubin in the blood

Question 28

Where are most of bile acids reabsorbed

Answer 28

Terminal ileum Returned to the liver via the hepatic protal vein