Anatomy, Physiology, Pathology

Done By: Abdullah Zuhair Alkhars Batch: 217 Contact Me At: Abdllhzk@gmail.com
Anatomy:
Hepatobiliary System Refers To Liver, Gallbladder, And Ducts Which Synthesizes & Stores Bile:
Liver Synthesizes Bile; It Collects In Hepatic Canaliculi Which Drains Into The Portal Triad Collecting
Duct, And Finally Into Left & Right Hepatic Duct, Which Unite To Form The Common Hepatic Duct >
The Gallbladder Cystic Duct Then Fuse With Common Hepatic Duct To Form Common Bile Duct > It
Finally Passes Through Pancreatic Head To Join The Main Pancreatic Duct And Enter , Via Ampulla
Of Vater, The Duodenum Where Bile Is Supposed To Be Secreted To Facilitate Fat Digestion.
Physiology:
Normally Speaking, In Accurately Calculated Proportion, Hepatocytes Secrete Water, Bile Salt/Acid,
Lecithin Phospholipid, Calcium/Bicarbonates, Cholesterol, Conjugated Bilirubin, Proteins To Make
The Bile Which Then Is Sent To Gallbladder For Storage & Later Use Whenever Fat Is Ingested.
Pathology:
Gallstones Are Assumed To Be A Consequence Of Inappropriate Proportion Of Bile Components:
(1) Cholesterol Stone "90% Of All Stones" (Large & Yellowish & Radiolucent):
(a) Obesity & Rapid Weight Loss & Dyslipidemia:
↑ Hepatic Metabolism Of Lipids > ↑ Cholesterol Secretion Into Bile > Supersaturation With Sub-
Sequent Bile Salt/Lecithin Depletion, Leading To Precipitation As Cholesterol Is Insoluble By Itself.
(b) Being Biologically Female & Pregnancy & Multiparity & OCP:
↑ Estrogen > It Act On Hepatocyte To ↑ Cholesterol Secretion Into Bile > Supersaturation With Sub
Sequent Bile Salt/Lecithin Depletion, Leading To Precipitation As Cholesterol Is Insoluble By Itself.
↑ Progesterone > It Act On Gallbladder Smooth Muscles To ↑ Relaxation > Bile Stasis; This Allows
Bile Components To Dissociate From Each Other > Cholesterol Precipitate As It's Insoluble By Itself.
(c) Malabsorption 2° To Crohn Disease & Cystic Fibrosis & Ileal Resection:
Malabsorption > Following Fatty Meal Ingestion, When Bile Is Secreted To Facilitate Fat Absorption,
Ileum Fails To Reabsorb The Bile Acids, So That They Can Be Re-Used By Liver For Further Synthesis
Of Bile > Supersaturation With Cholesterol With Consequent Precipitation As It's Insoluble By Itself.
(d) Total Parenteral Nutrition & Bowel Rest:
TPN > No Fat Ingestion With Resultant Bile Stasis > This Allows The Bile Components To Dissociate
From Each Other > Cholesterol Precipitate As It Is Insoluble By Itself; If Calcium Dissociated From
Bile Salts, It Might Bind Bicarbonates, Forming Calcium Salts Stones "Grey Stones & Radiopaque".
(e) Family History & Age > 40 YO & Fair-Skinned People "Native American & European":
Having A Family History, Being Elderly, Or Fair-Skinned Have Been Linked To ↑ Incidence Of Stones.
(2) Pigments Stone "10% Of All Stones" (Small & Black/Brown & Radiopaque/Radiolucent):
(a) Hemolysis (Sickle Disease & Spherocytosis):
Hemolysis > ↑ Circulating Unconjugated Bilirubin > ↑ Hepatic Uptake Of Bilirubin With Consequent
Conjugation & Finally Secretion Into Bile > There, The ↑ Amount Of Conjugated Bilirubin Undergoes
Spontaneous Non-Enzymatic Hydrolysis Via Water Which Yields Non-Conjugated Bilirubin > It Has ↑
Affinity To Calcium > Calcium Bilirubinate Which Is Solid In Nature "Black Stones".
(b) Alcoholic Cirrhosis & Biliary Infections:
Hepatic Infestation & Biliary Infection > β-Glucuronidase Release By Injured Hepatocyte & Microbes
> It Hydrolyzes Conjugated Bilirubin And Lecithin, Yielding Unconjugated Bilirubin & FAs > The Non-
Conjugated Bilirubin Binds Calcium To Form Calcium Bilirubinate "Brown Stones" While Depletion
Of Lecithin Allows Cholesterol To Precipitate "Yellowish Stones".