MBBS Year 1 - Prof GE Mann L4 Bile and biliary system.pdf

Prof GE Mann, Waterloo Campus (Email: [email protected]) MBBS Year 1 Gastrointestinal Lectures L1: Overview of the digestive system L2: Digestion and absorption of nutrients L3: Salivary, gastric and pancreatic secretions L4: Bile and biliary system L5: Motility of the gut Physiology, 5th...

Prof GE Mann, Waterloo Campus (Email: [email protected]) MBBS Year 1 Gastrointestinal Lectures L1: Overview of the digestive system L2: Digestion and absorption of nutrients L3: Salivary, gastric and pancreatic secretions L4: Bile and biliary system L5: Motility of the gut Physiology, 5th Edition, eds. RM Berne, MN Levy, BM Koeppen, BA Stanton (2004) (see Chapters 31-33) [see also recent Editions] Medical Physiology, eds. WF Boron & EL Boulpaep (2003) Color Atlas of Physiology, 4th Edition, eds. A. Despopoulos & S. Silbernagl, (1991) 1 MBBS Year 1 Gastrointestinal Lectures L4: Bile and biliary system Learning Objectives Discuss relationships between structures of bile acids and their physiological function Delineate relationships between bile acids and cholesterol in man Describe functions of bile acids in human intestine Outline clinical consequences of bile acid deficiency Describe the transport of bilirubin in plasma and liver 2 3 Relationship between bile flow and liver blood flow and the role of oxygen delivery on bile flow 4 Relationship between biliary pressure and blood pressure 5 6 7  Concentration of bile acids in gallbladder Boron & Boulpaep 2003 8 Pathophysiology Biliary disease caused by abnormalities in bile composition, biliary anatomy, and function. The liver determines the chemical composition of bile, and this may be modified later by the gallbladder and biliary epithelium. Cholesterol, ordinarily insoluble in water, comes into solution by forming vesicles with phospholipids (principally lecithin) or mixed micelles with bile salts and phospholipids. Painless jaundice: Development of jaundice in the absence of abdominal pain suggestive of a malignant obstruction of the bile duct. Here, onset of jaundice is gradual and may be associated with anorexia; weight loss; and soft or loose stools. Nonbiliary causes should be considered, including increased bilirubin production (e.g., from hemolysis, blood transfusions, or ineffective erythropoiesis) and decreased bilirubin clearance due to hereditary defects http://www.emedicine.com/med/topic225.htm 9 10 11 12 13 14 Digestion and absorption of fats 15 Overview of enterohepatic circulation 16 Consequences of gallstone formation 17