Lecture 14: Gallbladder Flashcards Preview

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Flashcards in Lecture 14: Gallbladder Deck (27):
1

Components of biliary tract and where it drains into duodenum

Gallbladder, cystic duct, R/L hepatic ducts, common hepatic duct, common bile duct, Sphincter of Oddi

2

What's in bile?

Mostly water, bile salts, some cholesterol, bile pigment

3

How does the gallbladder modify bile?

Concentrated and acidified, also stores bile and regulates delivery (via CCK)

4

Secretory and excretory functions

Secretory: micelle-forming bile acids; Excretory: cholesterol, bile pigments, other waste products

5

What component of bile helps it flow?

Bile acids

6

Bile salt formation with organs

LIVER: Cholesterol --> cholic acid via hydroxylations --> primary bile acids --> SMALL INTESTINE bacterial deconjugation and dehydroxylation --> secondary bile acids

7

More than ___% of bile salts are actively transported by the intestines, mostly the __________

95%; ileum

8

Four problems of the gall bladder

Sequester bile, obstruction (cholethiasis), infection (cholecystitis), cancerous

9

Classification of cholestasis: three lesion sites and examples

Canaliculus/biliary ductules (cholestatic drugs, pregnancy), intrahepatic ducts (congential biliary atresia), extrahepatic ducts (common duct stone, cancer)

10

Hepatic retention of biliary solutes

1. Retention of biliary solutes can lead to hepatocyte injury, jaundice, xanthomata; 2. Intestinal deficiency of bile acids --> malabsorption of fats

11

Four causes of bile acid interruption

F

12

Bile build up in GI organs causes...

Pain

13

Define cholelithiasis

Stones in gallbladder

14

Define choledocholithaisis

Stones in the bile ducts

15

Types of gallstones

1. Cholesterol: crystal; 2. Pigment: amorphous concretion; 3. Mixed

16

Pigmented gallstones: composition, where they arise, and clinical settings

Composed of bilirubin/Ca2+ precipitates where there are unconjugated bilirubin in bile; ARISE IN GALL BLADDER OR DUCTS; settings: liver disease, hemolysis, infected bile, starvation (causes cholestasis)

17

What conjugates the bilirubin? What can deconjugate it?

Liver; high concentration of bacteria

18

More likely to form stones in acidic/alkafied bile pH?

Alkafied

19

Most common type of gall stones? Risk factors?

Cholesterol gallstones; female, forty, fat, fasting, feathers, family, multiparity, estrogen supplementation

20

How do cholesterol crystal gallstones form?

Super saturate with cholesterol or lower bile salts

21

Faster/slower bile flow more likely to form stones

Slower

22

Triangle graph summary: what makes stones form

High cholesterol, slow flow, low bile salt pool, periods of fasting

23

Steps of gallstone disease

1. Biliary colic (stuck stone wit pain) --> 2. Acute cholecystitis (inflammation/infection) CAN progress to 3. Bile duct obstruction (cholestasis + cholangitis [duct infection]) --> 4. Acute pancreatitis

24

Surgical treatment of gallstones. Always effective?

Cholecystectomy; nope, can still get stones in the duct

25

Non-surgical treatment of gallstones

Lithotripsy or ursodeoxycholic acid (moderately effective)

26

Gallstones: dx

Sonography, X-ray, nuclear scan for patency of cystic duct (HIDA), bile analysis (for cholesterol crystals), endoscopy (ERCP)

27

Define biliary sludge

Like mud, difficult to dx because hard to see, shows up like stones