GI 02: Gallbladder, Pancreas, Small + Large Intestine

Common Bile Duct:

1) Formed from ___ duct and ___ duct of ___. Enters the duodenum via sphincter of ___

1) Hepatic duct and cystic duct of gallbladder. Enters duodenum via sphincter of Oddi

Functions of the Gallbladder + Common Bile Duct

1) Gallbladder ____ hepatic bile by reabsorbing ___, ____, and ____

2) Fats and amino acids in the intestinal lumen promote release of ___ from the ____ mucosa

3) ___ promotes ___ of the gallbladder which results in the release of ___ __

1) Gallbladder concentrates hepatic bile by reabsorbing chloride, bicarbonate, and water

2) CCK; Duodenal mucosa

3) CCK; promotes contraction of the gallbladder; releases bile acids

Function of Bile Acid

1) Stimulates release of ____

2) (#1___) ___ release of bile

3) Bile acids are ____ along the length of the GI tract, including by ___ transport in the ___ ileum

1) FGF-19 (Fibroblast growth factor 19)

2) FGF-19 suppresses release of bile 

3) Reabsorbed; Active Transport, DISTAL

Contents of Bile

1) 80% ___ acid and chenodeoxycholic acid which forms ___ like soap to facilitate ___ and ___ dissolution into aqueous solution

2) 16%

3) 4%

1) Cholic acid; forms micelles like soaps; facilitates fat and cholesterol dissolution into aqueous solutions

2) Lecithin

3) Unesterified cholesterol

Diseases of the Gallbladder (Gallstones / Cholethiasis)

1) Formation of stones from ____ or ____ bilirubinate in bile crystallizing

2) Gallstones can increase in size until they block the release of ___ from ___ causing severe pain during food consumption (biliary colic)

3) Causes:

A) Increased ___ secretion of ___ (diet, certain drugs, etc)

B) Pregnancy ( __ trimester)

C) Rapid weight ___

1) Stones from cholesterol or calcium bilirubinate in bile crystallizing

2) Block release of bile from gallbladder

3) Causes:

• A = Increased biliary secretion of cholesterol

• B = Pregnancy in THIRD trimester

• C = Rapid weight loss

Pancreas stimulation

1) Pancreas secretes ___ iso-osmotic fluid containing 20 ___

2) Pancreas secretion is promoted by what nerve activation

3) Pancrease secretion if also promoted by

• pH?

• What type of acids (2)

• Release of ___

1) Alkaline; 20 enzymes

2) Vagus nerve activation

3) Secretion:

• Low pH

• Fatty acids and Amino acids

• Release of CCK

Pancreatic Duct

1) Secretes ___ and ___ in exchange for ___.

2) ___ Cl- is maintained by cystic fibrosis transmembrane regulator (___) chloride channel

3) Pancreatic ___ cell secretions adjust the ___ to permit digestive activity in the small intestine

4) Gastric acid (__ pH) contracts duodenal mucosa causing cells to release _ which stimulates pancreatic ductal secretion

1) Secretes water and bicarbonate in exchange for lumen

2) Lumen; (CFTR)

3) Pancreatic duct cell secretions adjust the pH to permit digestive activity in the small intestine

4) Gastric acid low pH contacts duodenal mucosa causing S cells to release secretin whcih stimulates pancreatic ductal secretion

Pancreatic acinus secretions

1) ____ enzymes such as amylase break down starches

2) ___enzymes such as lipase break down lipids

3) ___ enzymes such as trypsin/chymotrypsin break down proteins

4) ____ break down nucleic acids

1) Amylolytic

2) Lipolytic

3) Proteolytic

4) Ribonucleases

Cystic Fibrosis

Mutation leading to abnormal cystic fibrosis transmembrane conductance regulator chloride channel

2) Duct cells unable to exchange bicarbonate and water with ___ which prevents ___ of enzymes out of the pancreas

3) Lack of ___ to neutralize gastric pH results in inactivation of ___ in the duodenum

4) Severe disease can result in destruction of ___ pancreas during fetal development

5) Patients require enzyme supplementation with ___ to allow for appropriate digestion

2) Chlorine; prevents flushing of enzymes

3) Lack of bicarbonate to neutralize gastric pH; results in inactivation of enzymes in duodenum

4) Severe disease can result in destruction o EXOCRINE pancreas during fetal development

5) Patients require supplementation with ANTACIDS

Acute Pancreatitis

1) Pancreatic inflammation most commonly due to ___ or chronic ___ ___

2) Possible for elevated serum ____ to also precipitate an attack

3) Symptoms include: ____ pain, low grade fever, increased HR, lowered BP

1) Gallstones or chronic alcohol intake

2) Elevated serum TRIGLYCERIDES

3) ABDOMINAL pain

Chronic Pancreatitis

1) ___ damage to the pancreas

2) Common causes include ___ and ___ but up to 25% are idiopathic

3) results in ___ pain, impaired ___ tolerance, malabsorption/digestion, delayed food transit

1) Irreversible

2) Alcoholism + smoking

3) Chronic pain, impaired glucose tolerance