Lecture 18 - 18/02/2013
Shouldn't be able to touch liver from under the ribs unless you have hepatitis.
Common bile duct and pancreatic duct fuse and spill into the 2nd stage of duodenum through the
ampulla of vater (controlled by sphincter of Oddi)
Case Study: Gallstone disease
Pain after meal in upper R epigastric region. Urine became darker, stool floated. Jaundice
1. How could the findings in the ultrasound explain the patient's pain?
After you eat food, CCK release is stimulated by fatty acids in the duodenum (APUD
cells, specifically I cells). CCK causes gall bladder contraction and bile is secreted.
Stones block the duct, causing an increase in pressure. Pain receptors in wall of gall
bladder you get gall bladder distension and pain.
Gall stones can be made of cholesterol, bile pigments, and Ca2+.
Stones are calcified and easily seen on the US.
2. How can you explain the yellowing of the sclera? Expand on the metabolism of the
pigment causing the jaundice in this patient
Backflow in liver because of obstruction of common hepatic duct. Bilirubin enters the
blood stream instead. The catabolism of heme makes biliverdin (greenish) via heme
oxygenase. After a reduction you get bilirubin.
Bilirubin binds to glucoronic acid in 1:2 ratio.
Jaundice occurs when plasma bilirubin reaches 34μmoles/L.
Bilirubin glucoronide is deconjugated by bacteria.
Urobilinogen gives urine the yellow colour, and stercobilinogen gives colour to feces.
o If secretion of stercobilinogen drops, feces