Gallstones & Bile Flashcards
Which part of the intestine produces cholecystokinin (CCK)
Duodenum
What are the exocrine (secrete into ducts) cells of the pancreas
Acinar cells
What stimulates the secretion of digestive enzymes from the acinar cells of the pancreas
CCK release from duodenum in response to food (fat) from stomach
Somatostatin what does it do
Inhibitory hormone: Slows digestion & red. stomach acid production
What is the ampulla of vater
Where the bile and pancreatic duct join
Elderly smoker presents with painless jaundice and wt loss over months - concern?
Pancreatic cancer
18 yr old at A&E with severe upper abdo pain through to his back, vomiting and collapse. Has been drinking heavily for 2 days
Acute pancreatitis
This is produced by endocrine cells in the duodenum and stimulates the pancreas to produce bicarbonate, increasing duodenal pH (ie becomes LESS acidic in duodenum)
Secretin
Put these steps in the correct order.
- Duodenum detects reduced pH and produces secretin.
- Stomach produces chyme into duodenum, pH drops.
- CCK stimulated by presence of amino acids, is produced by duodenum endocrine cells, acts on pancreas.
- Gall bladder stimulated by CCK to release bile.
- Pancreas produces digestive enzymes eg lipase, amlyase from acinar cells - secreted into duodenum.
- Acinar cells stimulated to produce bicarb into duodenum - neutralises pH.
- Stomach produces chyme into duodenum, pH drops.
- Duodenum detects reduced pH and produces secretin.
- Acinar cells stimulated to produce bicarb into duodenum - neutralises pH.
- CCK stimulated by presence of amino acids, is produced by duodenum endocrine cells, acts on pancreas.
- Pancreas produces digestive enzymes eg lipase, amlyase from acinar cells - secreted into duodenum.
- Gall bladder stimulated by CCK to release bile.
(these last 2 happen together)
What is the basic function of bile acids
To soluble-ise fats
What do Colipase lipase, Phospholipase A2 and Cholesterol Esterase all do in the first stage of lipid breakdown
Turn it into a multilamellar vesicle (emulsion droplet)
Cholic acid and chenodeoxycholic acid are the 2 most common what?
Bile acids
7 alpha hydroxylase is important in the conversion of cholesterol to what
Cholic acid
What do bile acids such as cholic acid do to multilammellar vesicles
Turn into bile acid micelles - deposit lipd at brush border of duodenum cells, where is absorbed.
Three types of gallstones
Cholesterol, pigment stones (excess bilirubin) and mixed stones
3 main possible causes of jaundice
- Excess haemolysis (haemolytic anaemia, Gilbert’s syndrome etc.)
- Bile duct obstruction - gallstones, stricture, tumour (head of pancreas)
- Liver damage (tumour, hepatitis)
Patient with 24hrs RUQ pain, tender / guarding, worse after eating burger, fever. WBC incr on bloods, USS shows acoustic shadow.
Acute cholecystitis (secondary to gallstones hence acoustic shadow on US) - gallstones block gallbladder, tissue necrosis - infection.
Sudden onset RUQ pain, radiates to shoulder tip & back. Nausea and vomiting. No signs of fever / infection.
Acute biliary colic - gallstones
Complication of acute cholecystitis - gallstone ileus, what is this
Inflammed GB adheres to ileum - erosion & stone enters bowel, large stone can cause sm. bowel obstruction.
In acute cholecystitis without jaundice or steatorrhea, where are the likely sites of the obstructing gallstone
Gallbladder neck or cystic duct
In acute cholecystitis WITH jaundice and steatorrhea, where are the likely sites of the obstructing gallstone
Common Bile Duct
Where is somatostatin produced? (2)
D cells in stomach (antrum) and Duodenum
Pancreas islets of langerhans
D cells are found where? (2)
Duodenum
Antrum of stomach
Chief cells - where are they found, what do they produce
Body / fundus of stomach Produce Pepsinogen (=pepsin precursor)
