Lecture 14: Gallbladder

Question 1

Components of biliary tract and where it drains into duodenum

Answer 1

Gallbladder, cystic duct, R/L hepatic ducts, common hepatic duct, common bile duct, Sphincter of Oddi

Question 2

What’s in bile?

Answer 2

Mostly water, bile salts, some cholesterol, bile pigment

Question 3

How does the gallbladder modify bile?

Answer 3

Concentrated and acidified, also stores bile and regulates delivery (via CCK)

Question 4

Secretory and excretory functions

Answer 4

Secretory: micelle-forming bile acids; Excretory: cholesterol, bile pigments, other waste products

Question 5

What component of bile helps it flow?

Answer 5

Bile acids

Question 6

Bile salt formation with organs

Answer 6

LIVER: Cholesterol –> cholic acid via hydroxylations –> primary bile acids –> SMALL INTESTINE bacterial deconjugation and dehydroxylation –> secondary bile acids

Question 7

More than ___% of bile salts are actively transported by the intestines, mostly the __________

Answer 7

95%; ileum

Question 8

Four problems of the gall bladder

Answer 8

Sequester bile, obstruction (cholethiasis), infection (cholecystitis), cancerous

Question 9

Classification of cholestasis: three lesion sites and examples

Answer 9

Canaliculus/biliary ductules (cholestatic drugs, pregnancy), intrahepatic ducts (congential biliary atresia), extrahepatic ducts (common duct stone, cancer)

Question 10

Hepatic retention of biliary solutes

Answer 10

1. Retention of biliary solutes can lead to hepatocyte injury, jaundice, xanthomata; 2. Intestinal deficiency of bile acids –> malabsorption of fats

Question 11

Four causes of bile acid interruption

Answer 11

F

Question 12

Bile build up in GI organs causes…

Answer 12

Pain

Question 13

Define cholelithiasis

Answer 13

Stones in gallbladder

Question 14

Define choledocholithaisis

Answer 14

Stones in the bile ducts

Question 15

Types of gallstones

Answer 15

1. Cholesterol: crystal; 2. Pigment: amorphous concretion; 3. Mixed

Question 16

Pigmented gallstones: composition, where they arise, and clinical settings

Answer 16

Composed of bilirubin/Ca2+ precipitates where there are unconjugated bilirubin in bile; ARISE IN GALL BLADDER OR DUCTS; settings: liver disease, hemolysis, infected bile, starvation (causes cholestasis)

Question 17

What conjugates the bilirubin? What can deconjugate it?

Answer 17

Liver; high concentration of bacteria

Question 18

More likely to form stones in acidic/alkafied bile pH?

Answer 18

Alkafied

Question 19

Most common type of gall stones? Risk factors?

Answer 19

Cholesterol gallstones; female, forty, fat, fasting, feathers, family, multiparity, estrogen supplementation

Question 20

How do cholesterol crystal gallstones form?

Answer 20

Super saturate with cholesterol or lower bile salts

Question 21

Faster/slower bile flow more likely to form stones

Answer 21

Slower

Question 22

Triangle graph summary: what makes stones form

Answer 22

High cholesterol, slow flow, low bile salt pool, periods of fasting

Question 23

Steps of gallstone disease

Answer 23

1. Biliary colic (stuck stone wit pain) –> 2. Acute cholecystitis (inflammation/infection) CAN progress to 3. Bile duct obstruction (cholestasis + cholangitis [duct infection]) –> 4. Acute pancreatitis

Question 24

Surgical treatment of gallstones. Always effective?

Answer 24

Cholecystectomy; nope, can still get stones in the duct

Question 25

Non-surgical treatment of gallstones

Answer 25

Lithotripsy or ursodeoxycholic acid (moderately effective)

Question 26

Gallstones: dx

Answer 26

Sonography, X-ray, nuclear scan for patency of cystic duct (HIDA), bile analysis (for cholesterol crystals), endoscopy (ERCP)

Question 27

Define biliary sludge

Answer 27

Like mud, difficult to dx because hard to see, shows up like stones