GB and Biliary Tree Diseases (Nichols/Tomb) Flashcards Preview

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Flashcards in GB and Biliary Tree Diseases (Nichols/Tomb) Deck (61)
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1

Function of bile acids in bile?

solubilization of cholesterol
Modulation of Intestinal motility

2

Function of phospholipid in bile?

Solubilization of cholesterol

Protection of bile duct epithelium

3

Function of IgA and IgM in bile?

bacteriostasis

4

Function of mucus in bile?

prevention of bacterial adhesion

5

Function of glutathione in bile?

induction of bile flow

6

Most frequent type of gallstones?

Pured and mixed cholesterol stones

7

What are pure and mixed cholesterol stones comprised of?

- Monohydrate cholesterol crystals
- Matrix of mucin glycoprotein
- Ca salts of unconjugated bilirubin

8

What are brown pigmented stones comprised of?

Ca salts
deconjugated bilirubin
cytoeskeleton of bacteria

9

Brown pigmented stones most commonly occur in patients with:

previous srx
duodenal diverticula

10

Black pigmented stones most commonly occur in patients with:

liver disease, hemolysis, older age

11

What are black pigmented stones comprised of?

--Pure Ca bilirubinate
--calcium copper
--mucin glycoprotein

12

How does age cause cholesterol hypersecretion?

age-related decr in 7-alpha-hydroxylase

13

How does estrogen cause cholesterol hypersecretion?

Increased cholesterol uptake (Increased lipoprotein receptors B and E)

14

How does obesity cause cholesterol hypersecretion?

Incr cholesterol synthesis
(increase HMG coA activity)

15

How does progesterone cause cholesterol hypersecretion?

Increased free cholesterol
(Inhibitor of AcoA CAT, Decreased conversion of cholesterol to cholesteryl ester stores)

16

Bile acid Synthesis: The rate-limiting enzyme is :

7-alfa hydroxylase

17

How does marked weight reduction cause cholesterol hypersecretion?

Mobilization of tissue cholesterol

18

How does ileal disease/resection/bypass cause cholesterol hypersecretion?

Impaired bile acid absorption or excessive losses

19

What is "supersaturated" bile?

Bile that has a CSI greater than 1, which means the amt of cholesterol exceeds the max holding capacity of micelle

20

What are vesicles?

very large carriers of cholesterol, which do NOT contain bile salts

21

Multilamelar vesicles permit:

crystal formation

22

What is crystal formation?

Aggregation process by which a crystal particle is formed from supersaturated bile

23

How are crystals generated?

vesicular fusion and aggregation

24

What changes in bile composition enhance crystal formation?

high cholesterol saturation and an increased deoxycholate content

25

5 Factors which inhibit crystal formation:

1. low total lipid conc
2. decr cholesterol saturation
3. biliary proteins not binding Con-A
4. Apolipoprotein A-I and A-II
5. Ig

26

How does gallbladder emptying relate to gallstone formation?

delay in gallbladder emptying
= gallstone

27

4 GB-related abn that are risk factors for gallstones:

1. Defective acidification of gallbladder bile
2. > pH higher ppt of Ca salts
3. GB stasis can cause incr mucin, which interferes w/ mechanical emptying
4. Decr response to CCK

28

Cholesterol gallstone pathogenesis:

Hepatic chol hypersecretion causes:
1. GB hypomotility
2. mucin hypersecretion
3. chol gallstone formation

Incr intestinal conversion to deoxycholate,
1. directly causes GS formation
2. hepatic chol hypersecretion

29

Risk factors for black pigment stone formation:

Hemolysis
Advancing age
Long term TPN
Cirrhosis

30

GB-related risk factors for black pigment stone formation

1. decreases in bilirubin solubilizers
2. GB stasis
4. incr bilirubin secretion