Physiology: gall bladder and liver disorders

Question 1

Gall stones result from the crystallisation of:

Answer 1

Cholesterol and calcium salts in the gall bladder

Question 2

Causes of gallstones:
- Can too much absorption of water from bile cause?
- Can too much absorption of bile acids from bile cause?
- Can too much cholesterol in bile cause?
- Can inflammation of the epithelium cause?

Answer 2

Yes

Question 3

The effects of gall stones
- What happens during eating?
- What happens to skin?

Answer 3

During eating, food enters the duodenum and CCK causes the gall bladder to contract. However it contracts onto the gallstones, leading to pain

Gall stones can block the bile duct. This can lead to bilirubin accumulating in the blood, leading to jaundice

Question 4

Treatments for gallstones?

Answer 4

Dissolving with drugs
Pulverising with ultrasound vibration
Vaporising with lasers
Cholecystectomy

Question 5

Consequence of cholecystectomy?

Answer 5

ility to concentrate bile and secrete it in a coordinated way when meal enters duodenum; patients can’t tolerate fatty meals

Question 6

Causes of impaired liver function
- Acute liver failure?
- Hepatitis?
- Fibrosis?
- Cirrhosis?
- Portal hypertension?

Answer 6

Yes

Question 7

Is fibrosis reversible? What about cirrhosis?
Can fibrosis lead to cirrhosis

Answer 7

Yes, no.
Yes

Question 8

Describe the liver’s capacity to regenerate following isolated insults vs repetitive/chronic injury.

Answer 8

Great, poor

Question 9

Role of Kupffer and Stellate cells in fibrosis and cirrhosis?
Effect of this on permeability?
Effect on regenerated tissue?

Answer 9

Activation of Kupffer and Stellate cells –> fibrosis (deposition of excess collagen_ –> cirrhosis
Space of Diss is not as permeable with plasma
Due to fibrous collagen bands, regenerated tissue grows in nodules

Question 10

How does cirrhosis contribute to portal hypertension?
What is the compensatory mechanism?

Answer 10

Cirrhosis squeezes the hepatic portal vein –> hypertension
Collateral BV’s (varices) can form to surrounding structures (eg. lower oesophagus, bowel surface), causing blood to shunt away from the portal to systemic circulation. Varices are prone to rupture

Question 11

Impact of impaired liver function on
- Bilirubin processing
- Feces colour
- Urine colour
- Skin colour

Answer 11

Usually the liver conjugates bilirubin. But as this isn’t done as much, not as much can be sent to duodenum. Lacks this pigment resulting in light coloured feces. Instead, bilirubin stays in circulation –> goes to kidneys where it’s excreted, giving urine a dark colour. It also goes to the skin causing jaundice and itching.