Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

GI 2 > Gall Bladder Physiology > Flashcards

Gall Bladder Physiology Flashcards

(57 cards)

Start Studying
1
Q

Fuction of Gall Bladder

• The main function of the gallbladder is to_____and _____bile and deliver it into
the duodenum in response to meals
• The gallbladder bile ducts and sphincter of oddi act together to:

A

concentrate and store

store/regulate flow of bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Location of Gall Bladder

A

• Location: Nestled in fossa beneath liver at separation of
right/left liver lobes: 7 to 10cm length

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

• Components of Gall Bladder
–_____: Rounded blind end; extends 1-2cm beyond liver
margin. Contains majority smooth muscle
–_____: Main storage area; contains most elastic tissue
–______: Funnel shaped, deep in fossa (Hartmann’s Pouch)
connect to cystic duct

A

Fundus

Corpus

Neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

• Connection of Gall Bladder

A 
R/L hepatic ducts join to form the common
bile duct (CBD) 7-11cm long; 5-10mm diameter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

• Bile produced continuously by liver excretes into bile
canaliculi; 500-1000 ml daily
• Bile secretion increases with vagal stimulation; HCL,
digested proteins, fatty acids increase flow by
stimulating hormone______

A

secretin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  • Bile secretion decreases with _____ stimulation
  • Fasting state: ____bile stored in Gallbladder.
A

splanchnic

80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

________greatest absorptive power per unit
area of any body structure. Capacity: 30-50 ml; 300ml
when obstructed!

A

Gallbladder mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What changes do we see in Bile composition in gall bladder storage?

A

Na+ and Bile acids increase

Bicarb and Cl- decresae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What do we see for motility responses of the Fasting gall bladder , between meals

A

Hepatic secreation pressure 25-30 mg and we see receptive relazation during gallbladder filling

the phincter of Oddi at 11-30 mmHg between meals

*see overal pressure differnce

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Tonic contractions of the sphincter of oddi
(SO) create pressure gradient that directs flow into gallbladder

A

• Gallbladder filling:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Gallbladder emptying: Coordinated gallbladder contraction,
SO relaxation and meal intake gallbladder empties ______
contents in 30 to 40 minutes with eating; refills 60 to 90
minutes

A

50 to 70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

• Main stimuli to emptying of gall bladder: _________
released from duodenum in response to meals

A

Hormone cholecystokinin (CCK)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

• SO motility: Basal contractile pressure; Response to____
Mitigating myenteric complexes

A

CCK;

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Neurohormal control of the GB contraction and biliary secreation

A
  1. Nurtients in duodenum; release of CCK into the blood stream

–> CCK goes to Gall bladder to increase motility

–> CCK goes up vagal afferent to Doral vagal complex

–> vagal efferents relesase Ach to act on Gall bladder

Vagal efferents to act to release NO or VIP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

• Primary bile acids (BA) entering enterohepatic circulation
synthesized from cholesterol in hepatocyte (Cholate,
Chenodeoxycholate) conjugated with _______
• Secreted across ______; Carried in bile to
gallbladder; Concentrated during digestion

A

taurine/glycine

canalicular membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

• 95% BA actively absorbed from ______; 5% in colon, Bile
acid hydrolysis/dehydrogeneration performed by broad
spectrum of______ bacteria

A

terminal ileum

anaerobic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

•______ reabsorbs BA from simisordal blood carried through
to liver through portal vein via series of transporters
• BA’s aid in digestion/absorption of fat in the intestine

A

Hepatocyte

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

• Nerves arise from vagus/sympathetic branches that
pass through____ plexus
• Preganglionic sympathetic level _____and____

A

celiac

T8 and T9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

• Impulses from liver, gallbladder and bile ducts pass by
means of______ afferent fibers through
splanchnic nerves and mediate ______ pain
 Cannot differentiate specific biliary tract site by pain
pattern per se

A

sympathetic

“Biliary colic”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

• Two types of gallstones:
–_____ stones: Most common in Western countries
–____ stone: Bilirubin deposition

A

Cholesterol

Pigment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

• Cholesterol gallstones: Balance between normal ratio of
cholesterol to other biliary lipids is disrupted resulting in

A

Cholesterol hypersecretion: Hyposecretion BA’s or phospholipids
• Diminished BA pool of enterohepatic circulation
interrupted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

• Supersaturation of cholesterol not necessarily sufficient for stone formation;______ must also occur, protein secretion may be nucleating agent

A

Nucleation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

GB epidemiology:

Study These Flashcards
A

women >50, white

men w/ stones increase with age and higher prevalance in American Indians

24
Q

Risk factors for Cholesterol Gallstones

Study These Flashcards
A
  • Increasing age
  • Female sex
  • Pregnancy and parity
  • Exogenous estrogens
  • Race
  • Family history
  • Obesity
  • Rapid weight loss
  • Physical inactivity
  • Serum lipid levels
25
How is strict dieting assoicated with gall stones?
overweight men/women on strict diet some pts with gastric bypasss w/in 49 months surgery women with weight loss of 9-22 lbs over 2 year are 44% more likely to devo stones
26
Cirrhosis, chronic hemolysis, ileal crohn’s disease at put pt at risk for;
black pigment stones
27
What is biliary sludge
Biliary Sludge (Calcium bilirubinate and cholesterol crystals embedded in mucus gel); Precursor to stone formation? Associated with drugs like ceftriaxone, octreotide, thiazide diuretics, parenteral nutrition
28
What is the link between pregnancy and Cholelithiasis
• Incidence of biliary sludge (Precursor to gallstones) and gallstones are 30% and 12% respectively during pregnancy and post partum • 1 – 3% post partum woman: Cholecystectomy within first year • Increased estrogen levels during pregnancy; Super saturated bile/sluggish GB motility • Majority: Sludge/gallstones dissolve spontaneously after partition
29
Inflammation of the gallbladder causing a syndrome of prolonged (\>4 to 6 hours) steady, right epigastric pain with fever, **leukocytosis** associated with **gallstone obstruction of the _cystic duct._**
Acute Cholelithiasis
30
what pts usually develop acute cholecystitis?
patients with a history of symptomatic gallstones
31
Pt is ill looking, feverish and tachycardic; they are lying very still and have a + murphys sign. What do you suspect of lab tests? What other tests do you order?
Patient is ill-appearing, febrile, tachycardia: lies still (Parietal Peritoneal Inflammation) seen in acute cholecystitis Liver function test usually normal Order ultrasonography/cholescintigraphy to confirm
32
How are ultrasonography and Cholescintigraphy (HIDA) used to dx acute cholecysitis
• Ultrasonography study: Detects stones; Gallbladder wall thickening (\> 4 to 5 mm) or edema. Sonographic “Murphy’s Sign” Test sensitivity 88%; Specifity 80% • Cholescintigraphy (HIDA scan): Technetium labeled hepatic iminodiacetic acid (HIDA) injected IV, taken up by hepatocyte, secreted into bile to determine system patency – or not. Visualization in 30 to 60 minutes
33
What do we do to tx pt with acute cholecystitis?
* Surgical treatment Laparoscopic Cholecystectomy * Positive Advance * Risks/Benefits of operation * Individuals aged 15 to 24 years: Cholecystectomy
34
Acute Cholangitis • Clinical syndrome featured by \_\_\_, \_\_\_\_\_, \_\_\_\_\_ (Charcot’s Triad); Results from stasis/infection in \_\_\_\_\_\_ • Severity ranges from mild to life-threatening
fever, jaundice and abdominal pain biliary tract
35
In acute Cholangitis, obstruction raises\_\_\_\_\_\_ pressure, increases permeability of \_\_\_\_\_, permits translocation of bacteria/toxins from portal circulation or ascending from the duodenum
intrabiliary bile ductules
36
Two most common causes of acute Cholangitis
``` Most common causes of biliary obstruction are CBD biliary calculi (28 to 70%) or benign stenosis (5 to 28%) ```
37
Common pathogens associated with Cholangitis
gram-negative bacterium: E. coli , Klebsiella, Enterobacteria • Major gram-positive bacterium; Enterococcus species 10 to 20%
38
• Charcot’s triad occurs in only 50 to 70% • Confusion/hypotension occur if suppurative ; Associated with significant morbidity and mortality; Septic shock/multi-organ failure can occur
Acute Cholangitis
39
Lab tests for cholangitis: Cholestatic pattern of LFT abnormalities; Elevation of ____ and ____ and \_\_\_\_ (GGT) and bilirubin; Blood cultures
WBC GGT Serum Alk Phos
40
Three methods to Dx acute cholangitis
• Transabdominal ultrasonography to detect ductal dilation or stones; Small calculi difficult • Magnetic resonance cholangiopancreatography (MRCP) helps with minute stones • ERCP (Endoscopic retrograde cholangiopancreatography) is useful for diagnosis and most importantly, drainage (sometimes immediately)
41
tool is useful for diagnosis and most importantly, drainage (sometimes immediately)
ERCP (Endoscopic retrograde cholangiopancreatography)
42
Obstructive stones in the distal CBD or at the ampulla of vater may cause \_\_\_\_\_
acute pancreatitis -- may need to use ERCP to extract and train ducts in case of concurrent cholangitis
43
Clinically identifiable to acute cholecystitis but not associated with gallstones: Usually occurs in critically ill patients. Accounts for 10% of acute cholecystitis. High morbidity and mortality
Acalculous Cholecystitis
44
Chronic progressive disorder of unknown etiology. Characterized by inflammation, fibrosis, stricturing of **medium/large ducts** in i**ntrahepatic/extra-hepatic biliary tree**
Primary Sclerosing Cholangitis (PSC)
45
Lots of pts with Primary Sclerosing Cholangitis (PSC) have what underlying condition? how long do they liver after transplant?
underlying ulcerative colitis 10-12 yrs
46
What is on this image? specifically what disease and where do you see sclerosis
Primary Sclerosing Cholangitis: Periductal Sclerosis
47
Biliary “colic” is a misnomer; The distress is typically \_\_\_\_\_\_in nature; Episodic
constant
48
Where is biliary or GB pain located? how is it different then cardiac pain?
Begins usually **mid-epigastrium** as dull, pressure-like. Intense within 15 to 30 minutes: Severe, steady 3 to 5 hours. (Right shoulder/interscapular area) • Unlike cardiac pain, the patient is “**restless**”, moves about and re-positions in an effort to obtain relief
49
referred pain from GB
Right shoulder, straight back adn RUQ
50
The truth about biliary pain and meals
• Biliary pain often unrelated to meal time events; may occur without clear precipitating events. Nocturnal pain episodes (2 a.m. to 5 a.m.) are a classic feature
51
Misconceptions on biliary pain
• GI symptoms such as dyspepsia, heartburn, bloating and fatty food intolerance are not suggestive of gallbladder disease per se • Biliary pain not a chronic continuous process • Biliary pain not associated with eliminations
52
RUQ pain sight in gall bladder
• Chronic RUQ pain (often accentuated after meals) is almost never caused by gallbladder disease • Nonetheless: Physicians always suspect gallbladder disease. Inevitable US study Stones = Postcholecystectomy Syndrome!! • 22 patients with chronic RUQ pain \>10 years. Balloon inflations up/down GI tract. Pain reproduce in remote site in ALL; reproduced in 2 sites in half of group • Be suspicious of RUQ pain syndrome!!
53
Challenge with gall bladder for physicians
The most important challenge to the physician evaluating a patient with upper GI tract symptoms in whom gallstones are detected is whether **cholelithiasis** is the *cause of* symptoms or an incidental finding!
54
Group I: Pts with Ypical biliary symptoms/stones; • Very likely to develop recurrent severe symptoms. Risk of further symptoms/complications about \_\_\_\_ within 2 years after presentation • Rₓ: \_\_\_\_\_\_\_
70% Cholecystectomy
55
Group II. Patients with Atypical Symptoms/Stones;
• Worrisome group: Symptom relief post-op occurs most likely in patients with biliary pain • 2481 patients who had elective cholecsytectomy; Symptom persistence of gas/flatulence 40% • Patients require comprehensive search for nonstone related causes; surgery with caution • Post-cholecystectomy syndrome in the making
56
III. Patients with Stones and No Symptoms
• Gallstones are present in approximately 20% of US adults! • The vast majority of these people are never bothered by this information • Educate about gallstone symptom/disease • No surgery
57
IV. Pts with typical biliary sypmtpoms without stones; detect these pts with what test?
Gall bladder ejection fraction (GBEF) to get best diagnosis; shold be able to eject die w/in 30 mins

GI 2 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions