what produces bile
hepatocytes and bile duct
where is bile stored between meals
gall bladder
during a meal what causes gallbladder to contract opening sphincter of oddi for bile to enter duodenum
chyme
4 functions of bile
micelle formation
neutralisation of chyme
pH adjustment for digestive enzyme action
protects mucosa
what ducts does bile travel through to enter the duodenum
cystic duct
common bile duct
where do hepatocytes secrete primary juice to
canaliculi
what is in primary juice secreted by hepatocytes
bile acids water electrolytes lipids cholesterol IgA bilirubin metabolic wastes
what is cholelithiasis
pathology of the bile duct due to concentration of bile in gallbladder that causes cholesterol to crystallise into gall stone
how is symptomatic cholelithiasis treated
laparoscopic cholecystomy
how is cholelithiasis treated if liver does work
ursodeoxycholic acid
what should you give to help Biliary colic pain
Buprenorphone or pethidine
NOT MORPHINE
what can relieve biliary spasm
atropine
glycerytitrate
what happens to bile salts
some is lost in faeces
majority is reabsorbed by active transport in the terminal ileum where it undergoes enterohepatic recycling
what happens to primary acids
dehydroxylated by gut bacteria to form secondary bile acids which are returned to the ileum and conjugated with glycine/taurine and recycled as bile salts
when are bile acid sequestrants used
hyperlipidaemia
cholestatic jaundice
bile acid diarrhoea
examples of bile acid sequestrants
colveselam
colestipol
colestyramine
side effects of bile acid sequestrants
diarrhoea
reduced absorption of fat soluble vitamins and thiazide diuretics
unpalatable
what do xenobiotics facilitate
excretion
main organ of drug metabolism
liver
phase 1 metabolism reactions
oxidation, reduction, hydrolysis
phase 2 metabolism reactions
add endogenous substance
conjugation
where do phase 2 reactions usually occur
liver
what happens in hepatic encephalopathy
severe hepatic failure where detoxification of ammonia to urea fails causing a toxic effect on CNS
what can be used in severe hepatic failure
lactulose to convert NH3 to NH4+ which is not absorbed
antibiotics to inhibit NH3 generation
which antibiotics are used to inhibit NH3 generation in hepatic encephalopathy
neomycin
rifamixin
