Gallstones & Bile

Question 1

Which part of the intestine produces cholecystokinin (CCK)

Answer 1

Duodenum

Question 2

What are the exocrine (secrete into ducts) cells of the pancreas

Answer 2

Acinar cells

Question 3

What stimulates the secretion of digestive enzymes from the acinar cells of the pancreas

Answer 3

CCK release from duodenum in response to food (fat) from stomach

Question 4

Somatostatin what does it do

Answer 4

Inhibitory hormone: Slows digestion & red. stomach acid production

Question 5

What is the ampulla of vater

Answer 5

Where the bile and pancreatic duct join

Question 6

Elderly smoker presents with painless jaundice and wt loss over months - concern?

Answer 6

Pancreatic cancer

Question 7

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

Answer 7

Acute pancreatitis

Question 8

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)

Answer 8

Secretin

Question 9

Put these steps in the correct order.

1. Duodenum detects reduced pH and produces secretin.
2. Stomach produces chyme into duodenum, pH drops.
3. CCK stimulated by presence of amino acids, is produced by duodenum endocrine cells, acts on pancreas.
4. Gall bladder stimulated by CCK to release bile.
5. Pancreas produces digestive enzymes eg lipase, amlyase from acinar cells - secreted into duodenum.
6. Acinar cells stimulated to produce bicarb into duodenum - neutralises pH.

Answer 9

1. Stomach produces chyme into duodenum, pH drops.
2. Duodenum detects reduced pH and produces secretin.
3. Acinar cells stimulated to produce bicarb into duodenum - neutralises pH.
4. CCK stimulated by presence of amino acids, is produced by duodenum endocrine cells, acts on pancreas.
5. Pancreas produces digestive enzymes eg lipase, amlyase from acinar cells - secreted into duodenum.
6. Gall bladder stimulated by CCK to release bile.

(these last 2 happen together)

Question 10

What is the basic function of bile acids

Answer 10

To soluble-ise fats

Question 11

What do Colipase lipase, Phospholipase A2 and Cholesterol Esterase all do in the first stage of lipid breakdown

Answer 11

Turn it into a multilamellar vesicle (emulsion droplet)

Question 12

Cholic acid and chenodeoxycholic acid are the 2 most common what?

Answer 12

Bile acids

Question 13

7 alpha hydroxylase is important in the conversion of cholesterol to what

Answer 13

Cholic acid

Question 14

What do bile acids such as cholic acid do to multilammellar vesicles

Answer 14

Turn into bile acid micelles - deposit lipd at brush border of duodenum cells, where is absorbed.

Question 15

Three types of gallstones

Answer 15

Cholesterol, pigment stones (excess bilirubin) and mixed stones

Question 16

3 main possible causes of jaundice

Answer 16

1. Excess haemolysis (haemolytic anaemia, Gilbert’s syndrome etc.)
2. Bile duct obstruction - gallstones, stricture, tumour (head of pancreas)
3. Liver damage (tumour, hepatitis)

Question 17

Patient with 24hrs RUQ pain, tender / guarding, worse after eating burger, fever. WBC incr on bloods, USS shows acoustic shadow.

Answer 17

Acute cholecystitis (secondary to gallstones hence acoustic shadow on US) - gallstones block gallbladder, tissue necrosis - infection.

Question 18

Sudden onset RUQ pain, radiates to shoulder tip & back. Nausea and vomiting. No signs of fever / infection.

Answer 18

Acute biliary colic - gallstones

Question 19

Complication of acute cholecystitis - gallstone ileus, what is this

Answer 19

Inflammed GB adheres to ileum - erosion & stone enters bowel, large stone can cause sm. bowel obstruction.

Question 20

In acute cholecystitis without jaundice or steatorrhea, where are the likely sites of the obstructing gallstone

Answer 20

Gallbladder neck or cystic duct

Question 21

In acute cholecystitis WITH jaundice and steatorrhea, where are the likely sites of the obstructing gallstone

Answer 21

Common Bile Duct

Question 22

Where is somatostatin produced? (2)

Answer 22

D cells in stomach (antrum) and Duodenum

Pancreas islets of langerhans

Question 23

D cells are found where? (2)

Answer 23

Duodenum

Antrum of stomach

Question 24

Chief cells - where are they found, what do they produce

Answer 24

Body / fundus of stomach
Produce Pepsinogen (=pepsin precursor)

Question 25

G cells- found where, what do they produce

Answer 25

Antrum of stomach, produce Gastrin

Question 26

Parietal cells - found where, what do they produce (2)

Answer 26

Fundus / body of stomach.
Produce HCL, hydrochloric acid - acts on pepsinogen to produce pepsin
Also produce Intrinsic factor

Question 27

What is the function of pepsin

Answer 27

Breaks down proteins into amino acids

Question 28

Function of Intrinsic Factor?

Answer 28

Required for Vit B12 absorption in gut - forms B12 / IF complex

Question 29

Vasoactive intestinal peptide - prod where and acts where

Answer 29

Produced: Enteric NS neurones
Acts on:
SI and pancreas: ↑ secretions
SI: relaxes smooth muscle