Bile, Gallbladder And Gallstones

Question 1

What is the ampulla of vater?

Answer 1

Where the common bile duct and the pancreatic duct join

Question 2

What does the gallbladder do?

Answer 2

Stores and concentrates bile

Question 3

How does the gallbladder concentrate bile?

Answer 3

Sodium ions and water are actively transported out and H+ is transported in

Question 4

What does pancreatic juice contain?

Answer 4

Bile salts, bile pigments and dissolved substances in alkaline electrolytes

Question 5

What are cholangiocytes?

Answer 5

Specific light junctions for adding water to bile

Question 6

What happens in the ductules of the liver?

Answer 6

Glucose and amino acids are scavenged, GSH is hydrolysed and IgA, HCO3- and water are secreted

Question 7

When are HCO3- and water secreted into the ductules?

Answer 7

In response to secretin in the postprandial period

Question 8

When is the most bile being secreted?

Answer 8

During and after a meal

Question 9

What influences the secretion of bicarbonate and water?

Answer 9

Secretin and ACh

Question 10

What happens if there’s increased bile salt in the blood?

Answer 10

Increased bile salt synthesis and secretion into the bile canniculi

Question 11

When does the sphincter of oddi contract and relax?

Answer 11

Contracts during fasting periods and relaxes during and after meals

Question 12

Where is the sphincter of oddi found?

Answer 12

Where the bile duct reaches the duodenum

Question 13

What can be secreted across the bile cannicular membrane?

Answer 13

• bile acids
• phosphatidylcholine
• conjugated bilirubin
• cholesterol
• xenobiotics

Question 14

What are xenobiotics?

Answer 14

Foreign stuff

Question 15

What substances can enter bile by diffusing?

Answer 15

Water, glucose, calcium ions, GSH, amino acids and urea

Question 16

What % of hepatic bile is water?

Answer 16

97

Question 17

What else (not water) is in hepatic bile?

Answer 17

Cholesterol, lecithin, bile acids, bile pigments etc

Question 18

What % of gallbladder bile is water?

Answer 18

89%

Question 19

Where does bile go when the sphincter of oddi is closed?

Answer 19

To the gallbladder

Question 20

What are the two biosynthetic pathways for bile acid formation?

Answer 20

Classic (natural) or alternative (acidic) pathway

Question 21

Which pathway leads to 98% of bile acid formation?

Answer 21

Classic

Question 22

What are examples of bile acids?

Answer 22

Cholic acid and chenodeoxycholic acid

Question 23

What are bile acids made from?

Answer 23

Cholesterol

Question 24

What does conjugation mean for bile acids?

Answer 24

Allows them to be secreted and decreases their cytotoxicity

Question 25

What are bile acids synonymous with?

Answer 25

Bile salts

Question 26

What are the four major bile acids in humans and their proportions?

Answer 26

``` Cholic acid (50%) Chenodeoxycholic acid (30%) Deoxycholic acid (15%) Lithocholic acid (5%) ```

Question 27

Which bile acids are formed in the liver and what type of bile acid are they?

Answer 27

Primary | Cholic acid and chenodeoxycholic acid

Question 28

Which bile acids are formed in the colon and what type of bile acids are they?

Answer 28

Secondary | Deoxycholic acid and lithocholic acid

Question 29

What are the major functions of bile?

Answer 29

- elimination of cholesterol to bile acids - reduce cholesterol precipitation in gallbladder - facilitate fat soluble vitamin absorption - regulate their own transport and metabolism - facilitate the digestion of triglycerides

Question 30

What makes cholesterol more soluble in bile?

Answer 30

Bile acids and phospholipids

Question 31

Which vitamins are fat soluble?

Answer 31

A, D, E and K

Question 32

What does bile work together with that ensures the emulsification of fats?

Answer 32

Lecithin and monoglycerides

Question 33

What controls the release of bile?

Answer 33

Contraction of gallbladder

Question 34

What happens in the cephalic phase?

Answer 34

The taste, smell and presence of food in mouth -> impulses via the vagus nerve

Question 35

What happens in the gastric phase?

Answer 35

Distension of stomach generates impulses in vagus nerve

Question 36

What happens in the intestinal phase?

Answer 36

Period of gallbladder emptying

Question 37

What are some mediators for increased bile release?

Answer 37

CCK, secretin, ACh and ATP

Question 38

What is CCK released in response to?

Answer 38

Fats

Question 39

What is ACh released in response to?

Answer 39

Acidic chyme

Question 40

What is secretin released in response to?

Answer 40

Fats or acidic chyme

Question 41

What is the nerve signalling pathway to/from the gallbladder?

Answer 41

Vagal afferent -> dorsal vagal complex -> vagal efferents -> chemical release

Question 42

Which molecule can work directly on the gallbladder?

Answer 42

CCK

Question 43

What % of bile salts are reabosorbed?

Answer 43

95%

Question 44

How are bile salts reabsorbed?

Answer 44

Through Na+- Bile salt coupled transporters

Question 45

What happens to the remaining 5% of bile salts?

Answer 45

Returned to the liver and secreted into bile

Question 46

What is enterohepatic circulation?

Answer 46

Recycling of bile salts

Question 47

How often is the bile acid pool recycled?

Answer 47

Roughly twice per meal

Question 48

What happens if enterohepatic circulation is interrupted?

Answer 48

Liver will synthesise too much bile salts | And the kidneys will excrete the synthesised bile salts

Question 49

What is bile stasis?

Answer 49

A factor for gallstone formation - stones form in bile that is held into the gallbladder rather than bile flowing in the bile ducts into the duodenum

Question 50

What are some factors involved in gallstones formation?

Answer 50

- Decreased amount of bile acids due to malabsorption - chronic infection - super saturation of bile with cholesterol - presence of nucleation factors or glycoproteins

Question 51

How long does it take for a gallstone to form in a patient who already suffers from gallstones?

Answer 51

2-3 days

Question 52

How long does it take for a gallstone to form in a patient who has never suffered from gallstones?

Answer 52

2 weeks

Question 53

Why does it take so much longer for a gallstone to form in patients who’ve never had gallstones?

Answer 53

Presence of anti-nucleation factors

Question 54

What are they symptoms of a gallstone being lodged in the opening of the gallbladder?

Answer 54

Right upper quadrant pain and jaundice

Question 55

What are the symptoms of gallstones lodging at the sphincter of oddi?

Answer 55

Pressure builds up- right quadrant pain and jaundice

Question 56

What do lodged bile stones cause?

Answer 56

Nutritional deficiency- fats can’t be digested properly

Question 57

How can you diagnose gallstones?

Answer 57

- Ultrasonography and computer tomography - cholescintigraphy - endoscope retrograde cholangiopancreotopography

Question 58

What happens in ultrasonography and computer tomography?

Answer 58

Explore the right upper quadrant of gallbladder

Question 59

What happens in cholescintigraphy?

Answer 59

Administer technitium-99 labelled derivative of iminodiacetic acid and then you can get images of the gallbladder and ducts

Question 60

How does endoscope retrograde cholangiopancreotography work?

Answer 60

Inject contrast media from an endoscope channel and visualise the biliary tree

Question 61

What percentage of gallstone cases are asymptomatic?

Answer 61

85%

Question 62

How can gallstones be asymptomatic?

Answer 62

If the gallstones remain in the gallbladder

Question 63

What causes acute cholecystitis?

Answer 63

If the neck of the cystic duct is impaired

Question 64

What are the symptoms of acute cholecystitis?

Answer 64

Biliary pain of right upper quadrant

Question 65

What can gallstones impacting the common bile duct cause?

Answer 65

Obstruction of bile flow and cholestatic jaundice -> bacterial infections and right upper quadrant pain

Question 66

What is cholangitis?

Answer 66

Inflammation (infection) of the bile duct

Question 67

What can gallstones that block the duodena papilla cause?

Answer 67

Inappropriate activation of pancreatic juice and acute pancreatitis

Question 68

What happens if the gallbladder is inflamed?

Answer 68

It will secrete mucus and eventually rupture