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26 Cards in this Set
- Front
- Back
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Functions of bile.
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Lipid digestion
Disposal of hphobic materials Aids in absorption of fat soluble vits |
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Synthesis of bile acid. Begin with cholesterol, end with a bile salt.
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Cholesterol-->CholylCoA-->Cholic Acid/Chenodeoxycholic acid (primary bile acids)
Cholic acid-->deoxycholic acid (secondary bile acid; via bacteria) Chenodeoxycholic acid-->lithocholic acid (secondary bile acid; via bacteria) -->within liver, conjugated to glycine or taurine before being re-secreted (in gut, glycine/taurine removed)-->glychocholic/taurocholic acid |
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Why must bile acids be conjugated before their secretion?
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Conjugation to glycine/taurine improves hydrophilicity (lose less bile acid this way)
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Describe location of bile during:
Fasting state Beginning of meal After a meal |
Fasting: bile acid moves down biliary tract and concentrated in gallbladder (low levels of bile acids in small intestine, portal vein, liver)
Meal-->CCK released from intestinal mucosa-->relax sphincter of Oddi, stimulates gallbladder. Bile acids flow into intestines. GB remains contracted, bile acids secreted by liver bypass gallbladder and go directly to duodenum. After meal: SOD contracts, gallbladder relaxes and begins to fill. |
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Gall stones are highly prevalent in this population.
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Pima Indians
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How are stones formed?
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Motility: gall bladder not contracting well-->gall bladder stasis-->stone formation
Nucleation Factors(...) Supersaturation of Bile w/cholesterol: supersaturation of cholesterol-->more potential for crystal formation |
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Risk factors for gallstones.
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Sex (women!)
Race, weight, age PREGNANCY OCPs (estrogen!) Rapid weight loss (gastric bypass) Cirrhosis TPN (gallbladder stasis) |
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Why is pregnancy a risk for gallstones?
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Supersaturation due to E2-induced increase in cholesterol secretion and Progest-induced reduction in BA secretion
Overproduction of hphobic bile acids-->reduced ability to solubilize cholesterol Progesterone-induced slowing of gall bladder emptying. |
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Cholesterol gallstones:
Composition Color Location |
50-100% cholesterol
Yellow-brown Location: gallbladder +/- common duct |
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Cholodocolithiasis:
What is it? |
Gall stone stuck in common bile duct
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Black Pigment Stones:
Composition Color Location |
Calcium bilirubinate polymer
Black Gallbladder +/- common duct Seen with anyone who has RBC destruction |
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Brown Pigment Stones:
Composition Color Location |
Unconj'd bilirubin, calcium soaps
Brown Bile ducts Seen in pts with infection/inflammn |
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This stone is seen in patients with increased RBC destruction.
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Black pigment
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This stone is seen in patients with metabolic derangement.
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Cholesterol gallstone
Metabolic derangement = obestiy, +famhx, aging (excessive chol secretion), women |
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This stone is seen in patients with infections.
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Brown pigment
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Biliary colic:
Presentation Cause Labs Dx Tx |
Severe, localized RUQ pain
Due to intermittent obstruction of cystic duct Note: 30% asyx Labs: nl Dx: Ultrasound along w/clinical hx Tx: Cholecystectomy |
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Ursodeoxycholic acid:
Effects Indication |
Mech unknown but:
-inhibits biliary secretion of cholesterol -increases hepatic bile secreiton -inhibits deposition of cholesterol into stones -improves gallbladder emptying -improves gallbladder muscle contractility -reduces gallbladder inflammn Indication: Pts w/small gallstones sans calcification |
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Acute Cholecystitis:
Presentation Cause Labs Dx Tx |
Severe, localized pain in RUQ with n/v/f
Causes: impacted stone in cystic duct, acute inflammn of gallbladder mucosa, secondary bacterial infection Labs: Elevated WBCs, bilirubin, ALT/AST Dx: U/S, hepatobiliary scintigraphy (HIDA)--gallbladder doesn't light up! Tx: Abx, sx |
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Murphy's Sign:
What is it? Indicative of? |
Upon palpation, right subcostal tenderness and inspiratory arrest (can't inspire when palpate!)
Indicates acute cholecystitis |
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Choledocholithiasis:
Presentation Cause Labs Dx Tx |
Often asyx, but can present ~biliary colic; can see painless jaundice or RUQ tenderness
Due to obstruction of common bile duct Labs: elevated bilirubin, ALP Dx: U/S, MRCP (specialized MRI) Tx: ERCP (snip common bile duct and remove stones) |
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Cholangitis:
Presentation Cause Tx |
Pain, jaundice, fever;
mental confusion, lethargy, delirium Cause: impacted stone in common bile duct-->bile stasis-->bacterial superinfection of stagnant bile Tx: Bile duct decompression (ERCP) |
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Risk factors for developing gallbladder cancer.
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Porcelain gallbladder (intramural calcification of gallbladder wall)
Gallbladder polyps Salmonella infection Biliary cysts |
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Medical term for gallstone.
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Cholelithiasis
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Cholangiocarcinoma:
What is it? Risks of developing it |
Cancer of bile ducts
Risks: Primary sclerosing cholangitis Parasitic infection |
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Primary Sclerosing Cholangitis:
What is it? Associated with? |
Progressive inflammation, stricturing, and fibrosis of bile ducts.
Associated with IBD, esp UC. Appears as beading. |
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