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Ch. 22 The Digestive System
All textbooksErin C. Amerman 2nd EditionCh. 22 The Digestive SystemProblem 22.1a
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Chapter 22, Problem 22.1a

Mr. Williams presents to your clinic with a complaint of abdominal pain in the right upper quadrant. He says that the pain worsens when he eats, particularly when he eats fatty meals. He has noticed that his stool has been an unusual clay color recently. You perform an ultrasound of his abdomen and find that gallstones are blocking his common bile duct, preventing bile from entering the duodenum.




a. Why are his symptoms worse when he consumes a high-fat meal? Would you expect his symptoms to worsen or lessen when he consumes a meal consisting only of carbohydrates? Explain.

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Step 1: Understand the role of bile in digestion. Bile is produced by the liver and stored in the gallbladder. It is released into the duodenum to help emulsify fats, making them easier to digest.
Step 2: Analyze the effect of gallstones blocking the common bile duct. When gallstones block the duct, bile cannot reach the duodenum, leading to difficulty in digesting fats.
Step 3: Connect the symptoms to the blockage. The pain in the right upper quadrant and the clay-colored stool are indicative of bile not reaching the intestine, as bile gives stool its brown color.
Step 4: Explain why symptoms worsen with fatty meals. High-fat meals require more bile for digestion. With the bile duct blocked, the body struggles to digest fats, worsening symptoms.
Step 5: Consider the effect of a carbohydrate-only meal. Carbohydrates do not require bile for digestion, so symptoms would likely lessen as the digestive process is not hindered by the lack of bile.

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Key Concepts

Here are the essential concepts you must grasp in order to answer the question correctly.

Bile Function

Bile is a digestive fluid produced by the liver and stored in the gallbladder, essential for the emulsification and digestion of fats. When fatty meals are consumed, bile is released into the duodenum to aid in fat digestion. If the common bile duct is obstructed by gallstones, bile cannot reach the intestine, leading to increased abdominal pain and digestive issues after high-fat meals.
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Gallstones and Obstruction

Gallstones are solid particles that form in the gallbladder and can obstruct the bile ducts. This obstruction prevents bile from entering the duodenum, causing symptoms such as abdominal pain, particularly after meals high in fat. The blockage can also lead to changes in stool color, such as clay-colored stools, due to the lack of bile reaching the intestines.
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Dietary Impact on Symptoms

The type of food consumed can significantly affect symptoms in patients with bile duct obstruction. High-fat meals stimulate bile release, exacerbating pain when bile flow is blocked. In contrast, meals consisting only of carbohydrates do not trigger bile release to the same extent, likely resulting in less severe symptoms, as there is no demand for bile that cannot be met due to the obstruction.
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Related Practice
Textbook Question

Which of the following statements about accessory organ secretions is not true?


a. Hepatocytes produce bile, which drains out of the liver via the common hepatic ducts.

b. Saliva contains secretory IgA and lysozyme, which play an important role in preventing the growth of pathogenic bacteria in the oral cavity.

c. Pancreatic juice contains digestive enzymes and bicarbonate ions to neutralize the acidic chyme.

d. The gallbladder produces bile, which drains out of the gallbladder via the cystic duct.

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Textbook Question

Mr. Williams presents to your clinic with a complaint of abdominal pain in the right upper quadrant. He says that the pain worsens when he eats, particularly when he eats fatty meals. He has noticed that his stool has been an unusual clay color recently. You perform an ultrasound of his abdomen and find that gallstones are blocking his common bile duct, preventing bile from entering the duodenum.



b. You test Mr. Williams's stool and find high amounts of undigested fats. Explain this finding.

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Textbook Question

Mr. Williams presents to your clinic with a complaint of abdominal pain in the right upper quadrant. He says that the pain worsens when he eats, particularly when he eats fatty meals. He has noticed that his stool has been an unusual clay color recently. You perform an ultrasound of his abdomen and find that gallstones are blocking his common bile duct, preventing bile from entering the duodenum.



c. Explain why his feces have become a clay color instead of a normal brown color.

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Textbook Question

Which of the following best describes the microscopic structure of the liver?


a. Hexagonal plates of hepatocytes surrounding a central vein with portal triads at each corner

b. Octagonal plates of hepatocytes surrounding a central artery with portal triads at each corner

c. Irregular groups of hepatocytes surrounding a central vein with bile ducts at each corner

d. Hexagonal plates of hepatocytes surrounding a portal vein with bile ducts at each corner

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