1. Liver and Gallbladder (Part II) - Alcon

• biliary bile acid are composed of?

  • cholic acid
  • chenodeoxycholic acid
  • deoxycholic acid
• Fecal bile are unconjugated due to the bacterial enzyme in the colon
• increase bile secretion will increase rate of bile acid returning to the liver = negative feedback
• there is increase secretion of bile during digestive period which will decrease synthesis
• bile acid malabsorption after ileal resection

  • bile acid diarrhea
  • fatty acid diarrhea
• short ileal resection - compensatory increase in hepatic synthesis of bile acid

  • so there is sufficient to restore their secretion
  • increase passage of bile acid will cause diarrhea
• long ileal resection - increase in bile acid synthesis will cause insufficient to restore secretion

  • result in impaired micellar dispersion of lipolytic product --> malabsorption of fat
• Biliary excretion is one of the major mechanisms of cholesterol excretion in humans.
• Hepatic synthesis is the most important endogenous source of cholesterol
• 1)The liver is also the primary organ for cholesterol excretion
• Brown and block gallstone is due to inflammation of gallbladder due to chronic infection
• Endoscopic retrograde cholangiopancreatography (ERCP) - combined endoscopic and fluoroscopic procedure

  
• Cholestasis - Marked reduction or stagnation in bile secretion and flow
• Cholestasis will cause

  • functional impairment of the hepatocytes
  • obstruction at any level of the excretory pathway of bile
• Cholestasis can be measured by elevation of serum alkaline phosphatase
• Bile duct stones are the most common cause of postcholecystectomy symptoms
• Charcot triad is the classic picture of acute cholangitis:

  • jaundice
  • abdominal pain (RUQ)
  • fever (with rigors)
• Reynolds pentad: Charcot triad + mental status changes and sepsis
• The liver converts insoluble bilirubin to soluble (conjugated) bilirubin
• Jaundice (Icterus) - yellow discoloration

  • serum bilirubin concentration exceeds 3 mg/dL