Lecture 14: Gallbladder Flashcards
Components of biliary tract and where it drains into duodenum
Gallbladder, cystic duct, R/L hepatic ducts, common hepatic duct, common bile duct, Sphincter of Oddi
What’s in bile?
Mostly water, bile salts, some cholesterol, bile pigment
How does the gallbladder modify bile?
Concentrated and acidified, also stores bile and regulates delivery (via CCK)
Secretory and excretory functions
Secretory: micelle-forming bile acids; Excretory: cholesterol, bile pigments, other waste products
What component of bile helps it flow?
Bile acids
Bile salt formation with organs
LIVER: Cholesterol –> cholic acid via hydroxylations –> primary bile acids –> SMALL INTESTINE bacterial deconjugation and dehydroxylation –> secondary bile acids
More than ___% of bile salts are actively transported by the intestines, mostly the __________
95%; ileum
Four problems of the gall bladder
Sequester bile, obstruction (cholethiasis), infection (cholecystitis), cancerous
Classification of cholestasis: three lesion sites and examples
Canaliculus/biliary ductules (cholestatic drugs, pregnancy), intrahepatic ducts (congential biliary atresia), extrahepatic ducts (common duct stone, cancer)
Hepatic retention of biliary solutes
- Retention of biliary solutes can lead to hepatocyte injury, jaundice, xanthomata; 2. Intestinal deficiency of bile acids –> malabsorption of fats
Four causes of bile acid interruption
F
Bile build up in GI organs causes…
Pain
Define cholelithiasis
Stones in gallbladder
Define choledocholithaisis
Stones in the bile ducts
Types of gallstones
- Cholesterol: crystal; 2. Pigment: amorphous concretion; 3. Mixed
Pigmented gallstones: composition, where they arise, and clinical settings
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)
What conjugates the bilirubin? What can deconjugate it?
Liver; high concentration of bacteria
More likely to form stones in acidic/alkafied bile pH?
Alkafied
Most common type of gall stones? Risk factors?
Cholesterol gallstones; female, forty, fat, fasting, feathers, family, multiparity, estrogen supplementation
How do cholesterol crystal gallstones form?
Super saturate with cholesterol or lower bile salts
Faster/slower bile flow more likely to form stones
Slower
Triangle graph summary: what makes stones form
High cholesterol, slow flow, low bile salt pool, periods of fasting
Steps of gallstone disease
- 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
Surgical treatment of gallstones. Always effective?
Cholecystectomy; nope, can still get stones in the duct
Non-surgical treatment of gallstones
Lithotripsy or ursodeoxycholic acid (moderately effective)
Gallstones: dx
Sonography, X-ray, nuclear scan for patency of cystic duct (HIDA), bile analysis (for cholesterol crystals), endoscopy (ERCP)
Define biliary sludge
Like mud, difficult to dx because hard to see, shows up like stones
