Diseases of the gall bladder and biliary tract - Fenyvesi

96 Pages·2017·2.08 MB·English

Diseases of the gall-bladder
and biliary tract
based on
www.harrisonsonline.com
images.MD,
Gallstones
Grant Sanders, Andrew N Kingsnorth
BMJ 2007;335:295-9
NEJM and and many others
Dr. Fenyvesi
Tamás
04/10/2017
11
„Become a doctor, no lectures required.”
Saying Goodbye to Lectures in Medical School —
Paradigm Shift or Passing Fad?
Richard M. Schwartzstein, M.D., and David H.
RRoobbeerrttss,, MM..DD
..
NEJM 2017;377:605
2
.
Secretion of the bile in the hepatic lobuli :
ductuli---interlobular ducti—right and and
left ductus hepaticus
;
Here joins the ductus cysticus,
TThhee ccoommmmoonn dduuccttuuss cchhoolleeddoocchhuuss--aammppuullllaa
Vateri-duodenum
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44
.
The bile is a pigmented isotonic fluid:
water 82%,bile acids 12%,
lecithin and other phospholipids 4%,
NNoonn eesstteerriicc cchhoolleesstteerrooll 00,,77%%,,
etc ( ions, proteins,
mucus,metabolites)
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The primary bile acids : cholic- and
chenodeoxicholic-acid
derived from cholesterole and
excreded in conjugation with glycin or
ttaauurriinn..
They are detergents in watery solution,
above 2mM concentration they form
aggregates (micellum)
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The enterohepatic circulation is a basic
phenomenon Bile acids (b.a)are reabsorbed from
the whole intestine in a passive way and actively
from the jejunum
Tha b.a.reserv is ~ 2-4g , 5-10 recirculations
daily
loss about 0.3-0.6g
synthesis is being hinderd by reabsorbed b.a.
aaaa
( 7 -hydroxylase )
77
.
[email protected]
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Function of the g.b. and of the Oddi sphincter
The O.s. controlls the excretion of bile and stops
reflux from the duodenum
The g.b. function is controlled by cholecystokinin
from duodenum mucosa (amino acids and fat…)
gg..bb.. ccoonnttrraaccttiioonn
choledochus peristaltics
O.s. resistance decrease
increase of bile flow
99
Functioning of the gall bladder and of the
Sphincter of Oddi:
In an interdigestiv period 4-8/min phasic
anterograde peristaltic contraction:
mmiinnuuttee „„ggaallll iinnjjeeccttiioonnss”” iinnttoo tthhee dduuooddeennuumm,,
cleansing the sphincter of food remnants and
small stones
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