Term
| The gallbladder is beneath which segments of the liver? |
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Definition
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Term
| What does the Cystic Artery branch off of? |
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Definition
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Term
| Describe the Triangle of Calot |
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Definition
Lateral: Cystic Duct
Medial: CBD
Superior: Liver |
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Term
| What is the blood supply to the hepatic duct and CBD? |
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Definition
Lateral: Right hepatic Artery
Medial: Retroduodenal branches of the GDA
[Considered longitudinal blood supply] |
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Term
| On ERCP, where are the blood vessels that supply the hepatic duct and CBD located? |
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Definition
| 9-o'clock and 3-o'clock positions |
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Term
| Where does the cystic vein drain into? |
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Definition
| Right branch of the portal vein |
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Term
| On which side of the CBD are the lymphatics located? |
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Definition
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Term
| What is the parasympathetic and sympathetic innervation to the biliary system? |
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Definition
Parasympathetic: Left (anterior) trunk of vagus.
Sympathetic: T7-T10 (splanchnic and celiac ganglions) |
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Term
Which tissue layer is the gall bladder missing?
Mucosa, submucosa, muscularis propria or serosa? |
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Definition
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Term
| Histologically, what type of cells is the gallbladder mucosa made of? |
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Definition
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Term
| Describe the peristalsis in the CBD and common hepatic duct. |
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Definition
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Term
| Contraction of which sphincter is required for gallbladder contraction? |
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Definition
| Sphincter of Oddi (at the ampulla of vater) |
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Term
| Which drugs/hormones contract and relax the sphincter of oddi? |
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Definition
Contract: Morphine
Relax: Glucagon |
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Term
What is the normal size of each of the following:
-CBD before cholecystectomy?
-CBD after cholecystectomy?
-Gallbladder wall?
-Pancreatic duct? |
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Definition
CBD before chole: <8mm
CBD after chole: <10mm
Gallbladder wall: <4mm
Pancreatic duct: <4mm |
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Term
| After cholecystectomy, do total bile salt pools increase or decrease? |
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Definition
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Term
| Where in the GI tract is the highest concentration of CCK and secretin cells found? |
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Definition
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Term
| What is the name of the epithelial invaginations in the gallbladder wall? |
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Definition
| Rokitansky-Aschoff sinuses |
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Term
| How are Rokitansky-Aschoff sinuses formed? |
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Definition
| From increased gallbladder pressure |
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Term
| Which biliary ducts can leak after a cholecystectomy? |
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Definition
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Term
| Where are the ducts of Luschka found? |
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Definition
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Term
| Which hormones/input cause increased bile excretion? |
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Definition
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Term
| Which hormones/input cause decreased bile excretion? |
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Definition
Somatostatin
Sympathetic stimulation |
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Term
| Which hormone causes gallbladder contraction? |
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Definition
CCK
-Causes constant, steady, tonic contraction |
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Term
| What are the 3 essential functions of bile? |
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Definition
1- Fat-soluble vitamin absorption
2- Essential fat absorption
3- Bilirubin and cholesterol excretion |
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Term
| How does the gallbladder form concentrated bile? |
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Definition
| Via active resorption of NaCl and water |
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Term
| What is the Na+ concentration (mEq/L) in the hepatic bile vs GB bile? |
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Definition
Hepatic: 140-170
GB: 225-350 |
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Term
| What is the Cl- concentration (mEq/L) in the hepatic bile vs GB bile? |
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Definition
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Term
| What is the Bile Salt concentration (mEq/dL) in the hepatic bile vs GB bile? |
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Definition
Hepatic: 1-50
GB: 250-350
[obviously...] |
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Term
| What is the Cholesterol concentration (mEq/dL) in the hepatic bile vs GB bile? |
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Definition
Hepatic: 50-150
GB: 300-700 |
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Term
| Where in the GI tract does ACTIVE resorption of CONJUGATED bile salts occur? |
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Definition
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Term
| Where in the GI tract does PASSIVE resorption of UNCONJUGATED bile salts occur? |
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Definition
Small intestine (45%)
Colon (5%) |
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Term
| After how many hours postprandial does maximal gallbladder emptying occur? |
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Definition
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Term
|
Definition
-Hepatocytes (80%)
-Bile canalicular cells (20%) |
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Term
| Is the color of bile due to conjugated or unconjugated bilirubin? |
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Definition
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Term
| What is stercobilin? Color? |
|
Definition
-Breakdown product of conjugated bilirubin in gut.
-Gives stool brown color |
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Term
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Definition
| Conjugated bilirubin (in gut) is broken down and resorbed --> Urobilinogen --> Urobilin |
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Term
| Where is urobilin excreted? Color? |
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Definition
| Urine, creating the yellow color |
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Term
| What substrates/enzymes are involved in the synthesis of bile salts (acids)? |
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Definition
1. HMG-CoA --> Cholesterol
Enzyme: HMG-CoA Reductase
2. Cholesterol --> Bile Salts (acids)
Enzyme: 7-alpha-hydroxylase |
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Term
| What is the rate limiting step in cholesterol synthesis? |
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Definition
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