Question #4aaa8

1 Answer
Feb 11, 2016

It is usually a symptom of Primary biliary cirrhosis or Bile acid malabsorption.

Explanation:

Bile is used in the digestive system to emulsify fats and neutralize hydrochloric acid in the intestine. It is produced in the liver and stored in the gall bladder.

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Bile acid malabsorbtion (BAM)
After a meal that contains fat or protein (or even drinking a cup of coffee) the gallbladder to contracts, releasing bile acids into the upper intestine that travel with the food, aiding it's digestion, before being absorbed back into the body at the end of the small intestine to be stored until next needed. This is done in the ileum (the bottom section of the small intestine - see this answer for more on the parts of the intestine).

If the ileum gets diseased or damaged (perhaps during surgery, in radiotherapy or due to inflammation such as that caused by Crohn's disease) it can prevent the bile salts from being reabsorbed. This leads to the Bile salts entering the large intestine (colon) and then being passed out in the faeces. However, it also causes diarrhoea.

The second type of BAM is caused, not by damage to the ileum, but by overproduction of bile in the first place - sometimes associated with a lack of the hormone FGF19 (fibroblast growth factor) which regulates bile production in the liver.

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Primary Biliary Cirrhosis
Bile is produced in the liver and usually passes out through the bile duct. However, in PBC, the immune system mistakenly attacks this.
The duct gradually swells and scars, obstructing the flow of bile. As it can't leave the liver, it builds up and can even lead to cirrhosis.

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Bile Reflux
Another bile related condition worth mentioning is Bile Reflux - even if it doesn't necessarily involve an excess. Bile and food usually enter the small intestine through the Pyloric valve (a heavy ring of muscle at the outlet of the stomach). If the lower oesophageal (the tube that food travels through) sphincter malfunctions, then it can cause bile and stomach acid to reflux into the oesophagus. This leads to bile in the vomit.

I hope this helps; let me know if I can do anything else:)