GI 23

Question 1

What is the gallbladder?

Answer 1

The site of bile storage and concentration

Question 2

What are the important bil components?

Answer 2

• Bile salts
• Bilirubin
• Lipids

Question 3

What are the two types of Gallstones?

Answer 3

• Cholesterol

* Calcium bilirubinate

Question 4

When do Cholesterol stones develop?

Answer 4

When the concentration of cholesterol in the bile increases to the point where it precipitates out of a solution into crystals

Question 5

What is the solubility of cholesterol like in bile?

Answer 5

It has a low solubility but remains in solution as part of micelles

Question 6

What is increased biliary cholesterol the result of?

Answer 6

Increased hepatic secretion or too much ion and water absorption

Question 7

What is the impact of gallstone formation determined by?

Answer 7

Their size and location they become trapped

Question 8

What is the outcome with small gallstones?

Answer 8

They can easily be passed into the intestine and excreted

Question 9

What is the outcome with large bile stones leaving the gallbladder?

Answer 9

• They can get trapped leaving the gallbladder
• They can cause pain but digestion is largely unaffected because bile can be directly secreted from the liver into the small intestine

Question 10

What is the outcome with large bile stones that get trapped in the common bile duct?

Answer 10

• bile secretion is impaired

* Consequences in terms of fat digestion/absorption and fat soluble vitamins

Question 11

What might undigested fats contribute to?

Answer 11

Diarrhea

Question 12

What are the consequences of backflow of bile?

Answer 12

• Inhibits bile secretion
• Decreased bilirubin excretion
• Obstructive jaundice

Question 13

Where is the worst spot to get a gallstone?

Answer 13

Hepatopancreatic ampulla of vater

Question 14

Why is it the worst to get a gallstone at the Hepatopancreatic ampulla of vater?

Answer 14

Because it blocks bile AND pancreatic secretion

Question 15

What are the consequences of Hepatopancreatic ampulla of vater being blocked?

Answer 15

• No nutrient absorption

* Nutritional deficiency

Question 16

How is a gallstone diagnoses?

Answer 16

• Medical history and physical exam
• Ultrasound
• CT scan

Question 17

What are the treatments for gallstones?

Answer 17

• Asymptomatic - no treatment necessary
• Medication that can dissolve gallstones (ursodiol - a bile salt)
• Surgical removal of the gallbladder
• Laparoscopic cholecystectomy

Question 18

What kind of meals become harder to digest without the gallbladder?

Answer 18

Fatty meals