00:00
Now, what signals bile release?
What makes my body say,
"Hey, it's time to squish that out."
Well, look at that deliciousness
in those three circles.
00:11
Cheeseburger, pizza,
these are all fatty foods.
00:17
And when stomach contents,
especially fats and protein,
which is why we selected
today's menu specifically for you.
00:25
Fats and proteins when they enter the
duodenum, and cholecystokinin is released
from the duodenal mucosal cells.
00:34
Okay, "Whoa,
that's a lot of words.""
Let's swim back
through it, right?
Look at our person there.
00:41
Don't get distracted by the
deliciousness, especially if you're hungry.
00:44
But look at that picture, we got the lungs,
the rib cage, the liver, the stomach.
00:50
So when I take a bite of
that giant cheeseburger
in my mouth down
into my stomach,
once it makes it through
my stomach to the duodenum
at the end of the stomach - duodenum
is where it's entering the intestines,
cholecystokinin is released from
the mucosal cells in the duodenum.
01:13
Eat fat and protein, down to
your stomach, into your duodenum,
then the duodenum is stimulated
to release cholecystokinin.
01:21
So why do you care?
Well, this can become kind of problematic
in patients with gallbladder disease.
01:28
Cholecystokinin stimulates
the contraction of the gallbladder
and the relaxation of
the sphincter of Oddi.
01:36
Okay, think that through.
01:38
So when I eat something
particularly fatty and with protein,
food moves through my system,
when it hits my small intestine,
cholecystokinin is released.
01:49
Well, that causes my gallbladder
to - so my gallbladder is going to
to release all the bile
that's been stored there.
01:58
It's concentrated or less concentrated
depending on how long it was there.
02:02
So the bile is
being squirted out.
02:05
Now, how do I get the bile
from the common bile duct
into the small intestine
to mix with the food?
Well, the sphincter
of Oddi needs to relax.
02:16
So cholecystokinin does two
things: stimulates the gallbladder dip
and it stimulates the
sphincter of Oddi to open.
02:25
Take a look at the picture.
02:27
Now you see that we have
that sphincter of Oddi right there.
02:30
You see, that's the relief valve to
let that bile drain into the duodenum.
02:36
So the sphincter of Oddi
surrounds the ampulla of Vater.
02:39
Have you heard those? No,
it's not a Star Wars movie.
02:42
But the ampulla of Vater
is just this little projection.
02:46
It sticks into the duodenum.
02:48
The sphincter of oddi is the gatekeeper
that releases it or opens that opening.
02:53
That's where bile and
pancreatic secretions,
we will get into those
later, but that's where bile
and the juices from the pancreas
flow when the sphincter relaxes
and bile can actually
enter the small intestine.
03:06
So think of it as like
a muscular valve.
03:10
Before we move on, what do you
need to take away from this slide?
You probably already knew
that food goes in your mouth,
to your stomach and then enters
the intestine through the duodenum.
03:21
But did you know that that's
what stimulates cholecystokinin.
03:25
And cholecystokinin does two things:
it tells your gallbladder to push it out,
and it tells the release
valve, the gate keeper,
the sphincter of Oddi, to open up and
to drain the bile and the pancreatic juices
into the intestine to start
ripping apart that food.
03:45
So cholecystokinin stimulates the secretion
of bile salts into the biliary system.
03:51
It stimulates the secretion
of pancreatic enzymes.
03:55
It induces satiety.
03:57
That means that
tells me, I am full.
04:00
I should no longer be hungry.
04:02
Now, that makes sense because when
I eat food, I need to not just keep eating.
04:06
I just need to eat
what my body needs.
04:09
Cholecystokinin is
part of that process.
04:12
It also helps me modulate
hormones and neuropeptides.
04:16
That's pretty impressive and
look where it comes from: your gut.
04:21
But I want to go back to that
pancreas for just a minute.
04:25
Start at the top of the picture.
04:26
Liver, then you see the hepatic ducts, the
common duct connecting to the gallbladder.
04:33
Now, there you just
have the duodenum.
04:35
We've left the stomach off of
this drawing just so you can see it.
04:38
It comes down and it is going to
stop right there at the pancreas, right?
So where the pancreas
connect to the biliary system
the pancreas is going to
drain those digestive enzymes
- the pancreatic
enzymes right there.
04:54
So what actually goes into your
duodenum is a combination of bile
from the liver and pancreatic
juices from the pancreas.
05:03
Cholecystokinin stimulates
that release by the pancreas too.
05:08
So it's pretty complex result
when cholecystokinin is stimulated.