Gall Bladder

Question 1

What kinds of disorders result in the gallbladder?

2 common examples?

Answer 1

• Disorders involve inflm, infection, stones & tumors

* Cholecystitis (inflm) & cholelithiasis (stones) common

Question 2

Fx of gallbladder?

Answer 2

To store and concentrate bile

Question 3

Components of bile?

Answer 3

• Bilirubin
• Bile salts
• Lecithin
• Fatty acids
• Water + electrolytes normally found in plasma

Question 4

What constitutes the hepatobiliary sytem?

Answer 4

• Gallbladder
• Left + right hepatic ducts - which come together to form the…
• Common hepatic duct
• Cystic duct (extends to the gallbladder)
• Common bile duct (which if formed by the union of the common hepatic duct and the cystic duct
  –> common bile duct extends to the duodenum, right before which it joins with the main pancreatic duct
  (See p. 935 for picture)

Question 5

What sphincters does bile pass through before entering duodenum?

Answer 5

Sphincter on bile duct allows bile to enter into pacreatic duct (which becomes hepatopancreatic ampulla)
Sphincter of Oddi allows flow from hepatopancreatic ampulla into duodenum

Question 6

Cholelithiasis =

Answer 6

Gallstones

Question 7

Et of Cholelithiasis

How does the stone form?

Answer 7

1) Abn bile composition
(eg: inc in cholesterol, dec bile salts)
AND/OR
2) Bile stasis → precipitation

• Inflm debris → nuclei for stone formation (particles collect around it)
• E. Coli and Strep faecalis infections
• Genetic susceptibility?

Question 8

Explain hypothesized reason for E. Coli and Strep faecalis infections and gallstones?

Answer 8

= suggested that those two experience infection from either of these are more susceptible to stone formation

suggested that when you have these infections, they tend to counter the composition of bile (mechanism unknown)

Question 9

Do all those who have gallstones experience symptoms?

Answer 9

No, many have them and they go undetected

Question 10

Types of gallstones?

Answer 10

• Cholestrol stones (80%) – d/t bile + elevated cholesterol content
• Pigment stones (20%)
* In both above circumstances, problem is change in bile composition, not stasis
• Mixed stones – inc overall solute concentration in the bile, variety of components (not d/t either just cholesterol or bilirubin, etc)

Question 11

What are the main components of pigment stones?

Answer 11

bilirubin + Ca salts

Question 12

Symptoms of gallstones?

Answer 12

• Colic pain (intermittent, radiating) - can radiate to chest, back, often confused with MI
• Nausea, vomiting? (pain, GI symptom)

Question 13

Dx of gallstones?

Answer 13

• Physical exam, Hx
• Ultrasound (US) – will show stones
• Scans

Question 14

Tx of gallstones?

Answer 14

• Pain meds
• Drugs for nausea + Vom
• Dissolving agents (eg: actigall)
• Sx (eg: retrograde endoscopy – insert wire from GI tract and then into bile duct) in some cases
• Tx complications

Question 15

How do dissolving agents work?

Answer 15

these drugs contain bile acid, the acid dissolves the stones

Question 16

What are possible complications of gallstones?

Answer 16

eg: cholecystitis, pancreatitis

perforation of duct or ball bladder..leading to possible chemical peritonitis