Digestion 4

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4/7/2013 1 Gallbladder Gallbladder resides in liver Contains bile Empties into duodenum by the same spigot as pancreas Common bile duct Spastic gallbladder Shoots bile not only into the duodenum but also the neck of pancreas destroying pancreas Doctors want to remove gallbladder in order to protect pancreas Not worried about bile, there’s a pill for that Cholecystectomy – removal of the gallbladder. Bile Role Breaks down huge fats into chylomicrons Real small fatty molecules that can be broken down by a lipase enzyme Pigments come from metabolism of hemoglobin  fat metabolism   fat digestion fat absorptionfat solvent (vitamins) Vitamins ADEK

Fat Digestion & Absorption:

4/7/2013 2 Fat Digestion & Absorption

Fat Digestion & Absorption:

4/7/2013 3 Fat Digestion & Absorption

Fat Digestion & Absorption:

4/7/2013 4 Fat Digestion & Absorption

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5 Gallstones (mostly cholesterol) Gallbladder is made up of smooth muscle If gallbladder loses tone Does not empty regularly Chemically imbalanced or cholesterol-laden bile remains in gallbladder for long periods of time. Surgical techniques for weight loss cause gallstones in one third of patients Lap band adjustable gastric banding system Vertical-banded gastroplasty Bypass surgery (RGB or Roux-en-Y gastric bypass) Sodeoxycholic acid (Actigall), a normal bile constituent, can be given orally for those experiencing rapid weight loss. Removing Gallstones As long as gallstones stay in gallbladder your fine silent gallstones . When they move up into the bile duct there’s a problem They can dissolve them by making the pH less alkaline Surgically remove them using laparoscopic techniques. Sonic surgery ( Lithotripsy ) using a ultrasound generator called a lithotriptor. Pulverizes stones

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4/7/2013 6 Bile salts (acids) Cholic acid Chenodeoxycholic acid 80% of the bile acids are reabsorbed in the ileum. Bile Pigments Give color to feces Good diagnostic tool Brown black or red means blood Complete yellow almost white Steatorrhea Fat in feces Impaired fat absorption Fat retention coefficient lower than 95% (ingested fat-fecal fat) Especially useful in monitoring cystic fibrosis. Bilirubin converted by bacteria  urobilinogen Reddish brown Biliverdin Greenish brown Other metabolites Cholesterol Neutral fats Phospholipids

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