Section 3C

Question 0

How does Secretin act on the gall bladder?

Answer 0

This hormone stimulates ion & water secretion by the bile ducts. It does not stimulate gall bladder directly

Question 1

How does CCK act on the gall bladder and the sphincter of oddi?

Answer 1

It contracts the gall bladder (smooth muscle contracts)

It relaxes the Sphincter of Oddi

Question 2

How does acetylcholine act on the gall bladder?

Answer 2

It contracts the gall bladder

This is basically a parasympathetic response

Question 3

What happens in the gall bladder during the “inter-digestive” periods?

Answer 3

It can fill because it is relaxed (SNS–> B2) and the sphincter of Oddi is closed

Question 4

What is cholelithiasis?

Answer 4

presence of gallstone

Question 5

What is incidence of cholelithiasis especially in men vs women?

Answer 5

Its incidence increases with age, 20% of women and 5% of men between the ages of 50 and 65 have gallstones.

Question 6

In the US and Europe, 90% of the gall stones are what type of stones?

Answer 6

Cholesterol stones

Question 7

What three factors appear to be involved in the formation of cholesterol stones?

Answer 7

1. Bile Stasis (sludge)
2. Supersaturation of bile with cholesterol
3. Inflammation of gall bladder

Question 8

Besides age, cholelithiasis has what 7 other risk factors?

Answer 8

1. Gender - more in women
2. Pregnancy
3. Oral contraceptive use
4. Family history/genetics (especially Native americans)
5. Obesity
6. Rapid weight loss
7. Diabetes Mellitus

Question 9

Does the gall bladder produce bile?

Answer 9

It stores and modifies bile but does not produce it

Question 10

Outline the flow of bile and the course it takes before it enters the gallbladder

Answer 10

1. Bile is secreted by hepatocytes into bile canaliculi
2. Flows into the right and left hepatic duct
3. Common hepatic duct
4. Into the gallbladder via the cystic duct

Question 11

Outline the course bile takes from the gallbladder to the duodenum

Answer 11

1. Bile exits through cystic duct
   2 .Enters common bile duct
2. Passes through the sphincter of oddi into the duodenum

Question 12

What is acute cholecystitis?

Answer 12

A syndrome of the right upper quadrant pain, fever, and leukocytosis associated with gallbladder inflammation that is usually related to gallbladder disease

Question 13

Where is the pain located in acute cholecystitis?

Answer 13

It radiates to the right shoulder or back

Question 14

What are other complains of acute cholecystitis?

Answer 14

May include nausea, vomiting and anorexia

Question 15

What is chronic cholecystitis?

Answer 15

Chronic inflammatory cell infiltration of the gall bladder. Associated with gallstones and is thought to be the result of mechanical irritation or recurrent attacks of acute cholecystitis leading to fibrosis and thickening of the gallbladder

Question 16

What is the most common complication of cholecystitis?

Answer 16

Development of gallbladder gangrene (up to 20% of cases) with subsequent perforation (2% of cases)

Question 17

Do people with gallstones have symptoms? If not, when do symptoms begin to appear?

Answer 17

People do not have symptoms until they block bile flow. The symptoms may be indigestion and biliary colic.

Question 18

What different symptoms may different sizes of gallstones produce

Answer 18

Small stones produce symptoms of indigestion and biliary colic
Large stones obstruct flow and cause jaundice

Question 19

What is Biliary colic?

Answer 19

When a stone is pressed up against the gallbladder outlet or cystic duct opening which increases intra-gallbladder pressure and right upper quadrant pain.

Question 20

Do we need a gallbladder?

Answer 20

The discharge of bile aids in digestion but is not essential for it

Question 21

Patients who have had their gallbladder removed experience what things as result?

Answer 21

They maintain good health and nutrition with a constant flow of bile into duodenum. After time, the common bile duct becomes dilated and more bile tends to enter the duodenum after meals than normal.