gall bladder and bile

Question 1

What are the sources of blood supply to the liver

Answer 1

hepatic artery- 25%
hepatic portal vein- 75%
hepatic vein

Question 2

what nutrients can the liver metabolize

Answer 2

carbs, proteins, lipids

Question 3

What nutrients can the liver synthesize

Answer 3

plasma proteins, albumin, glucose, cholesterol, fatty acids, lipoproteins

Question 4

what nutrients can the liver store

Answer 4

glycogen, fats, irons, copper and vitamins

Question 5

what type of compunds is the liver good for detox

Answer 5

endogenous compunds like steroids

exogenous compounds like drugs and toxins

Question 6

What are the specialized phagocytes in the liver

Answer 6

Kupffer cells

Question 7

What compunds can the liver activate

Answer 7

Vit D

deiodination of thryoid hormone T4->T3

Question 8

can the liver produce bile

Answer 8

yes

Question 9

what is the gall bladder responsible for bile

Answer 9

storage, concentration and acidification

Question 10

why is bile greenish yello

Answer 10

bilirubin

Question 11

what molecules are found in bile

Answer 11

salts, proteins, cholesterol, hormones, enzymes and bilirubin

Question 12

what is bilirubin a breakdown product of

Answer 12

hemaglobin

Question 13

what causes jaundice

Answer 13

abnormally high levels bilirubin in the blood

Question 14

What is a liver lobule

Answer 14

functional units of liver, hexagonal arrangement surrounding a central vein with a hepatic a, portal vein and bile duct at each 6 corner

Question 15

what is a liver sinusoid

Answer 15

expanded capillary space between rows of hepatocytes

Question 16

each hepatocyte is in contact with what two passages

Answer 16

sinusoid and bile cannaliculus

Question 17

describe path of bile

Answer 17

hepatocyte->bile canaliculus->bile duct->common bile duct->duodenum

Question 18

Majority of the liver parenchyma is what

Answer 18

95% hepatocytes

Question 19

where are kupffer cells found

Answer 19

in the sinudoidal space

Question 20

What cells are in the spaces of Disse

Answer 20

stella cells, plasma solutes, kupffer cells

Question 21

What is a portal lobule

Answer 21

all hepatocytes drained by a single bile ductule

Question 22

Describe mergence of the biliary tree

Answer 22

bile canaliculi merge with terminal bile ductules->pertubular ducts-> interlobular ducts merge with septal ducts->lobar ducts->R and L hepatic duct

Question 23

Where is the sphincter of Oddi

Answer 23

on the hepatopancreatic ampulla

Question 24

Describe the 2 stages of bile secretion in liver

Answer 24

1) hepatoctes through normal passage
2) secretory epithelial cells in the ducts and ductules that secrete water solution with Na and HCO3 as well as bile
stimulate by secretin

Question 25

How would you describe the secretion of canalicular bile

Answer 25

active and isotonic

Question 26

How much of the bile synthesized is diverted to gallbladder

Answer 26

50%

Question 27

describe the bile that reaches the duodenum

Answer 27

dilute hepatic bile | concentrated gallbladder bile

Question 28

Desribe the flow of ions from gallbladder

Answer 28

Na secreted actively which co transports K, Cl, H2O

Question 29

The liver converts cholesterol into what

Answer 29

cholic acid and chenodeoxycholic

Question 30

Where are bile acids dehydroxylated

Answer 30

in the terminal ileum

Question 31

what are the secondary bile acids

Answer 31

deoxycholic and lithocholic acid

Question 32

Most of primary bile salts are conjugated into what by hepatocytes

Answer 32

glycine and taurine | sometimes sulfate or glucoronate

Question 33

What is the composition of fecal bile salts

Answer 33

majority is deoxycholic and a~30% lithocholic

Question 34

describe the composition of biliary bile salts

Answer 34

45% cholic, 40% chenodeoxycholic and then like | 15% desoxycholic

Question 35

are bile acids in feces conjugated or deconjugated

Answer 35

deconjugated

Question 36

What are the bile salts

Answer 36

cholates, chenodeoxycholate, deoxycholate

Question 37

What is the role of bile salts in the bile

Answer 37

dissolve dietary fat

Question 38

What are the fat soluble Vit

Answer 38

ADEK

Question 39

Disruption of bile excretion can lead to what

Answer 39

malabsorption, diarrhea, steatorrhea and deficiencies in Vit ADEK

Question 40

What is the role of bile phospholipids

Answer 40

enhance choelsterol solubizing properties

Question 41

Inefficient excretion of cholesterol can lead to what

Answer 41

increased serum cholesterol

Question 42

What are the 4 major components of bile

Answer 42

bile salts, cholesterol and phospholipids, bilirubin and protein.misc components

Question 43

What are the 2 main funcitons of bile

Answer 43

fat digestion and absorption | waste product excretion

Question 44

What is menat by enterohepatic circulation of bile

Answer 44

re-use, bile gets recycled back to the liver

Question 45

What does bile help excrete

Answer 45

bilirubin, cholesterol, lipophilic drugs, trace minerals

Question 46

What are the 2 actions of bile salts in intestinal tract

Answer 46

1) detergent action or emulsification on fat particles by decreasing SA and increasing agitation of the intestinal tract 2) absorption of FA, monoglycerides, cholesterol, lipids by forming small complexes called micelles

Question 47

What is the calculation for total bile flow

Answer 47

canalicular flow + ductular flow

Question 48

what is canalicular flow

Answer 48

independent flow + dependent (increases with bile secretion)

Question 49

What is ductular flow

Answer 49

constant from cholangiocytes into bile ducts

Question 50

What determines independent flow for bile

Answer 50

presence of organic compounds and osmotic force | ex: glutathione increases osmotic driving force for canalicular bile formation

Question 51

What determines dependent flow for bile

Answer 51

depends on negatively charged bile salts, in micellar form and out of solution- have low osmotic force

Question 52

What is a choleretic and give examples

Answer 52

something that stimulates release of bile, Secretin, glucagon, VIP and GRP

Question 53

What is the result of somatostatin on bile release

Answer 53

enhances fluid absorption or inhibits secretion

Question 54

How do secretin, glucagon, VIP and GRP increase secretion of bile

Answer 54

raise cAMP and stimulate apical Cl and Cl-HCO3 transporter | a Ca dependent Cl also gets activated

Question 55

How does somatostatin inhibit bile flow

Answer 55

lowering cAMP, increase fluid reabsorption could cause this

Question 56

What is the role of mucus secretion in gallbladder

Answer 56

protection from bile salt toxicity

Question 57

What could too much mucus lead to

Answer 57

cholesterol cholelithiasis (cholesterol gallstones) marked by increase of mucin release

Question 58

What is the result of CCK on gallbladder

Answer 58

contraction of gallbladder relaxation of sphincter of iddi increase bile flow

Question 59

what sitmulates CCK release

Answer 59

presence of Fatty foods in duodenum

Question 60

When the vagus N and intestinal enteric NS stimulates Ach release what happens

Answer 60

gallbladder is stimulated (not as strong as CCK)

Question 61

Where are most of the bile salts reabsorbed

Answer 61

terminal ileum and return via hepatic portal vein

Question 62

What percent of bile salts are lost each day in the stool

Answer 62

5%

Question 63

Of the bile salts reabsorbed in the lumen how much is by diffusion and how much by active transport

Answer 63

half in early SI is diffusion | half in late digestions through distal ileum

Question 64

Where do recycled bile salts first enter in liver

Answer 64

venous sinusoids

Question 65

Ingestion of supplemental bile salts can do what to bile secretion

Answer 65

increase by several hundreds milliliters per day

Question 66

The gallbladder can carry what strain of salmonella

Answer 66

salmonella typhi, typhoid fever

Question 67

What is cholestasis

Answer 67

suppression of bile secretion

Question 68

What does cholestasis cause

Answer 68

regurgitation of bile components into systemic circulation-->jaundice and pruritus (itching) damaged hepatocytes release liver enzymes (alkaline phosphotase) lipid digestion and absorption may be impaired

Question 69

obstucting extrahepatic ducts or impairing flow in intrahepatic ducts may lead to what

Answer 69

cholestasis

Question 70

What is cholelithiasis

Answer 70

formation of stones in gallbladder or biliary duct sytem

Question 71

what is cholecystitis

Answer 71

inflammation of gallbladder

Question 72

what is cholangitis

Answer 72

inflammation of biliary ducts

Question 73

What can cause gall stones

Answer 73

abnormal bile composition (too much absorption of water from bile, too much absorption of bile acids from bile, too much cholesterol) biliary stasis inflammation of gallbladder

Question 74

What are risk factors for cholesterol stones

Answer 74

female sex hormones, obesity, rapid weight reduction, gallbladder stasis, hyperlipidemia

Question 75

What are risk factors for the pigmented gall stones

Answer 75

asians usually, chronic hemolytic syndromes, biliary infection, GI disorders like crohn disease or CF

Question 76

What are the 4 contributin factors to cholelithiasis

Answer 76

supersaturation, gallbladder hypomotility, crystal nucleation, accretion within mucous layer

Question 77

What is the Tx for gallstones w/o symptoms

Answer 77

nothing

Question 78

what is the Tx for typical gallstones and symptoms

Answer 78

cholecystectomy

Question 79

what is the Tx for atypical symptons for gallstones

Answer 79

search for related cause of symptoms

Question 80

In a patient with typical biliary symptoms but no gallstones what should you Dx

Answer 80

suspicion for gallstone disease should be maintained

Question 81

what percentage of people with gallstones is asymptomatic

Answer 81

70-80%

Question 82

Which size of gallstones is the most dangerous

Answer 82

the small stones because they can tracel to enter cystic or common duct for obstruction

Question 83

Someone with cholelithiasis is increased risk for what

Answer 83

carcinoma of the gallbladder

Question 84

Symptomatic patients of cholelithiasis have what type of pain

Answer 84

biliary or colic pain