WEBVTT - Ep 184 The Gallbladder: Humor us 0:00:00.240 --> 0:00:02.680 It started on a Sunday afternoon. I was sitting on 0:00:02.680 --> 0:00:04.920 the couch working on my laptop when I suddenly got 0:00:04.920 --> 0:00:08.440 an upset stomach. I hid cramps the nausea, but it 0:00:08.520 --> 0:00:11.880 quickly escalated. But in a few minutes, I was crouched 0:00:11.880 --> 0:00:14.200 in my bathroom floor with a sharp pain just below 0:00:14.200 --> 0:00:17.000 my rib cage. It felt like I was being repeatedly 0:00:17.000 --> 0:00:19.919 stabbed on my right side. The pain was so intense 0:00:19.960 --> 0:00:22.599 that my diaphragm wasn't contracting. It felt like it was 0:00:22.600 --> 0:00:25.520 stuck in place. I crawled into the next room, where 0:00:25.560 --> 0:00:27.800 my husband was napping, and I tried to gently call 0:00:27.840 --> 0:00:29.920 to him so as not to alarm him, but I 0:00:30.000 --> 0:00:32.400 was having trouble breathing, so I just managed to stammer, 0:00:32.840 --> 0:00:36.040 I don't feel well. He startled awake and was instantly worried. 0:00:36.440 --> 0:00:38.639 He said my lips were white. He was calling nine 0:00:38.680 --> 0:00:42.120 one one no, I croaked, I just need water, Bring 0:00:42.159 --> 0:00:45.159 me a glass of water. He hesitated, but acquiesced and 0:00:45.200 --> 0:00:46.760 went to the kitchen while I lay on the floor 0:00:46.840 --> 0:00:50.040 trying to reason through what was happening. My symptoms didn't 0:00:50.040 --> 0:00:52.760 match appendicitis or a heart attack, and since I was 0:00:52.800 --> 0:00:55.200 out of ideas, I figured it must not be anything serious. 0:00:55.520 --> 0:00:56.600 Silence from the kitchen. 0:00:57.520 --> 0:00:57.720 Now. 0:00:57.760 --> 0:00:59.800 My husband is not a whimp, but he has been 0:01:00.160 --> 0:01:02.680 to faint while having his blood drawn, and once when 0:01:02.680 --> 0:01:05.760 an acquaintance went into diabetic shock, he stepped outside to 0:01:05.800 --> 0:01:08.200 call nine one one, and then promptly passed out on 0:01:08.240 --> 0:01:11.000 the phone with a dispatcher, such that when the EMTs 0:01:11.080 --> 0:01:14.000 arrived they attended to my husband crumpled on the sidewalk, 0:01:14.200 --> 0:01:16.840 and not the man inside having a seizure. So the 0:01:16.880 --> 0:01:21.360 silence worried me. I called to him, Yes, he said, quietly. 0:01:21.760 --> 0:01:25.560 Are you passing out right now? I asked, trying not to, 0:01:26.000 --> 0:01:28.760 he said meekly. I made a mental note not to 0:01:28.800 --> 0:01:30.560 allow him in the delivery room if I ever went 0:01:30.600 --> 0:01:32.880 into labor, and tried to remind him of the task 0:01:32.920 --> 0:01:36.680 at hand. I could really use that water. I heard 0:01:36.720 --> 0:01:38.960 the faucet turn on, and then a few moments later 0:01:39.000 --> 0:01:40.920 he shuffled over and set a glass down next to me, 0:01:41.319 --> 0:01:42.959 then plopped down on the floor with his head in 0:01:43.000 --> 0:01:46.200 his hands to fight the light headlessness. I was flattered 0:01:46.240 --> 0:01:49.000 on my back. I can't drink this, I told him, 0:01:49.160 --> 0:01:51.720 I need a straw. He looked at me as if 0:01:51.760 --> 0:01:54.040 I'd asked him to climb everest, but he stood up 0:01:54.080 --> 0:01:56.480 and shuffled back into the kitchen. It was at this 0:01:56.560 --> 0:01:58.560 point that I realized I need to snap out of it, 0:01:58.720 --> 0:02:00.440 because I would need my wits about me when he 0:02:00.480 --> 0:02:02.800 inevitably fainted and hit his head on the countertop and 0:02:02.840 --> 0:02:04.880 I had to call nine on one for him. I 0:02:04.880 --> 0:02:07.240 brought myself up to sitting against the wall, and he 0:02:07.280 --> 0:02:10.239 shuffled back with a travel mug of water. I took 0:02:10.240 --> 0:02:11.959 a sip, and in a few minutes I started to 0:02:12.000 --> 0:02:15.800 feel better. I returned my place on the couch. That 0:02:15.919 --> 0:02:18.720 was weird, I said. Now, let it be known that 0:02:18.760 --> 0:02:20.840 my husband wanted me to go to the hospital anyway, 0:02:21.160 --> 0:02:22.680 but I told him I didn't have time to sit 0:02:22.720 --> 0:02:25.160 in the r all night. And sure, that was pretty strange, 0:02:25.160 --> 0:02:27.520 but I felt fine now. My husband flew the South 0:02:27.560 --> 0:02:29.560 Dakota the next day and the rest of the week 0:02:29.600 --> 0:02:32.400 when as usual until Saturday afternoon, when I took her 0:02:32.480 --> 0:02:34.840 dog for a walk. I made it one block to 0:02:34.880 --> 0:02:38.560 her forest trailhead and the stabbing pain returned. I couldn't 0:02:38.560 --> 0:02:40.640 stay upright. I had to lay down on the forest floor. 0:02:40.919 --> 0:02:42.560 It was tick season and I live in a place 0:02:42.560 --> 0:02:44.960 with a very high incidence of lime disease, so this 0:02:45.040 --> 0:02:47.680 didn't seem prudent. You're gonna feel like an idiot if 0:02:47.680 --> 0:02:50.079 you get lime disease because of a stomach ache, I thought, 0:02:50.360 --> 0:02:53.200 and forced myself up. The walk was excruciating, but I 0:02:53.240 --> 0:02:55.880 managed to stumble home without vomiting in my neighbor's yards. 0:02:56.200 --> 0:02:58.200 When I got in my door, I laid down on 0:02:58.240 --> 0:03:01.519 the entryway bench. There I ride and literally moaned in 0:03:01.600 --> 0:03:04.040 agony for over an hour until I eventually made it 0:03:04.080 --> 0:03:06.280 to the couch, where I continued to writhe and moan 0:03:06.360 --> 0:03:10.320 some more. There was no position that was comfortable. After 0:03:10.400 --> 0:03:13.200 several bouts of dry heaving, I started to cough of blood. 0:03:13.760 --> 0:03:16.359 Maybe it's an ulcer, I thought, so I texted my 0:03:16.400 --> 0:03:19.800 close friend who had an ulcer and told her my symptoms. No, 0:03:20.120 --> 0:03:22.800 she said, I've never experienced any of that. You should 0:03:22.840 --> 0:03:24.920 go to the hospital. I can't drive right now, I 0:03:24.960 --> 0:03:28.079 told her, I can't even sit up. Then call a friend. 0:03:28.200 --> 0:03:31.079 She texted back, you know I don't have any of those, 0:03:31.160 --> 0:03:33.680 I replied, I had moved to a new state recently 0:03:33.800 --> 0:03:37.160 and making friends is hard. Well, then call an ambulance. 0:03:37.280 --> 0:03:40.960 She said, that seems like overkill, I told her. Plus, 0:03:40.960 --> 0:03:42.520 the dog would lose his mind and I am in 0:03:42.560 --> 0:03:44.720 no state to control him right now, and so I 0:03:44.800 --> 0:03:47.600 lay there alone, hoping the pain would subside as it 0:03:47.680 --> 0:03:51.120 had before, but it did not. My husband arrived home 0:03:51.160 --> 0:03:53.640 around eleven PM, having had to rent a car from 0:03:53.640 --> 0:03:55.520 the airport since I had texted to say I would 0:03:55.560 --> 0:03:57.960 not be there to pick him up as planned. He 0:03:58.040 --> 0:04:00.360 also wanted to take me to the hospital, but since 0:04:00.400 --> 0:04:02.880 I still couldn't sit up, I dreaded the thirty minute 0:04:02.880 --> 0:04:04.920 car ride and a long wait in the r waiting room. 0:04:05.320 --> 0:04:07.240 I promised him i'd go in the morning, when I 0:04:07.240 --> 0:04:09.840 planned to be feeling better. I spent the night on 0:04:09.880 --> 0:04:12.400 the couch without sleep, though the pain did start to 0:04:12.480 --> 0:04:15.280 lessen in the morning. He reminded me of my promise, 0:04:15.600 --> 0:04:17.960 but I still wasn't feeling up to the trip. I 0:04:18.040 --> 0:04:20.480 renegotiated the terms such that I would go to urgent 0:04:20.480 --> 0:04:22.960 care when I was capable of sitting upright, which happened 0:04:22.960 --> 0:04:26.120 around noon. At this point, I was actually feeling almost normal, 0:04:26.360 --> 0:04:28.960 so I insisted on taking myself and I told the 0:04:29.000 --> 0:04:31.280 check and staff my symptoms. I was told they could 0:04:31.279 --> 0:04:33.320 not see me at urgent care, I'd have to go 0:04:33.360 --> 0:04:36.000 to the er. I called my husband from the parking 0:04:36.040 --> 0:04:38.160 lot and bated whether to wait until Monday morning to 0:04:38.160 --> 0:04:40.760 see a doctor rather than going to the er, where 0:04:40.760 --> 0:04:44.080 I truly waste time. But he was sufficiently worried that 0:04:44.160 --> 0:04:47.320 I relented and drove over to the ar. To my surprise, 0:04:47.560 --> 0:04:49.160 if you tell the check and nurse that you are 0:04:49.200 --> 0:04:52.359 experiencing sharp stabbing pain just under your ribs, there is 0:04:52.400 --> 0:04:55.360 basically no weight. I was called back to a little 0:04:55.360 --> 0:04:58.679 curtained room almost immediately and blood and urintests were taken, 0:04:58.760 --> 0:05:01.159 as well as an X ray. The doctor came to 0:05:01.160 --> 0:05:04.120 tell me my results a couple hours later. My liver 0:05:04.200 --> 0:05:07.120 function tests were off the charts. He suspected my gall 0:05:07.200 --> 0:05:09.560 buttter had to come out. They kept me in the 0:05:09.560 --> 0:05:13.440 hospital overnight. I had an MRI to confirm Coli societis 0:05:13.440 --> 0:05:16.560 the next morning, and then laparoscopic surgery the next and 0:05:16.640 --> 0:05:19.960 I went home that same day. After three days of recovery. 0:05:20.080 --> 0:05:22.560 I felt great, and I promised everyone in my life 0:05:22.600 --> 0:05:24.680 that the next time my gall butter goes, I'll go 0:05:24.720 --> 0:05:25.640 straight to the hospital. 0:06:12.160 --> 0:06:20.560 Oh my gosh, Maria, Maria, Maria, I mean disclosure. I 0:06:20.600 --> 0:06:25.080 have heard this story a couple times now, and every 0:06:25.160 --> 0:06:30.480 time I'm just like I am enthralled and horror spired 0:06:30.600 --> 0:06:33.719 at the right parts and believed at the right parts 0:06:33.839 --> 0:06:37.320 and laugh at the right parts. It's just yeah, it's 0:06:37.360 --> 0:06:41.800 a great story. It's a great story. And I'm glad 0:06:42.000 --> 0:06:42.679 you're okay. 0:06:43.120 --> 0:06:44.440 Set of circumstances. 0:06:44.800 --> 0:06:49.360 Yeah, yeah, thank you, Maria, Yeah. 0:06:48.880 --> 0:06:51.680 Thank you for thank you reliving that yet again for 0:06:51.800 --> 0:06:54.599 us and everyone who's listening. 0:06:55.080 --> 0:06:58.760 Yeah. Hi, I'm Aaron Welsh and I'm erin on an 0:06:58.839 --> 0:07:01.839 Updike and this this podcast will kill you. 0:07:01.880 --> 0:07:03.360 Today we're talking about the gallbladder. 0:07:03.920 --> 0:07:07.280 Just the gallbladder, the gallbladder, the golfbladder. 0:07:07.880 --> 0:07:10.040 I almost texted you multiple times to be like, it's 0:07:10.080 --> 0:07:12.800 just gallbladder, right, We're not doing like a specific part. 0:07:12.880 --> 0:07:15.880 It just it's gallbladder, a specific part of the gallbladder. 0:07:16.120 --> 0:07:19.160 Like we're not just doing like golf gullstos or like. 0:07:19.280 --> 0:07:21.320 Or like gallbladder cancer or like. 0:07:21.640 --> 0:07:24.880 This didus Holy, Yeah, we're doing gallbladder. 0:07:25.560 --> 0:07:25.800 Yeah. 0:07:26.560 --> 0:07:27.120 I can't wait. 0:07:27.480 --> 0:07:30.520 I mean, And and the reason that if you had 0:07:30.600 --> 0:07:33.160 texted me that my answer would have been like, I 0:07:33.160 --> 0:07:36.840 don't know, I don't know what these things are so whatever, 0:07:36.960 --> 0:07:40.280 we could do anything you want to do our podcast. 0:07:40.920 --> 0:07:45.240 We've promised this for a while now we have. I'm 0:07:45.280 --> 0:07:46.800 really excited to finally be doing it. 0:07:47.280 --> 0:07:51.240 I mean, of all of the organs to start with. 0:07:52.600 --> 0:07:55.080 Is this the first like organ episode? 0:07:56.160 --> 0:07:56.440 Yeah? 0:07:57.040 --> 0:08:00.560 Isn't it? Yeah? Yeah? Is that right? I feel like 0:08:00.600 --> 0:08:03.280 we've talked about doing like the heart, We've talked about 0:08:03.280 --> 0:08:06.440 doing other organs. 0:08:06.480 --> 0:08:09.200 I can can you think of other organs? 0:08:09.200 --> 0:08:11.200 I mean, the uterus is the first one I think 0:08:11.240 --> 0:08:14.840 of it. We've done a lot of like uterus right, 0:08:15.040 --> 0:08:17.440 the discussions, but we've not just like done a whole 0:08:17.480 --> 0:08:18.600 episode on the uterus. 0:08:19.080 --> 0:08:22.280 Nope, not yet. Well, gallbladder here we are here. We 0:08:22.320 --> 0:08:25.600 are celebrate the gallbladder and also chastise it for the 0:08:25.640 --> 0:08:26.840 things that it does poorly. 0:08:29.120 --> 0:08:31.520 I can't wait. I'm really really excited. I have no 0:08:31.600 --> 0:08:33.200 idea what you have in store for me, Aaron, but 0:08:33.360 --> 0:08:34.800 I it's gonna be fun. 0:08:34.920 --> 0:08:40.920 I know that we'll see before we get into all 0:08:40.960 --> 0:08:44.440 of that thought quarantine any time, quarantin any time. What 0:08:44.480 --> 0:08:45.640 are we drinking this week? 0:08:45.720 --> 0:08:49.480 We're drinking on the stones, like on the rocks. 0:08:50.040 --> 0:08:52.040 We're going to do gall of stone. 0:08:52.280 --> 0:08:55.400 Oh I thought we said Oh no, you're right. 0:08:55.480 --> 0:08:57.240 We did do on the Stones. 0:08:57.480 --> 0:08:59.640 Okay, we have a lot of ideas. 0:09:00.160 --> 0:09:03.920 We did well, we had two at least so and 0:09:04.200 --> 0:09:08.400 in on the Stones we're actually doing a classic cocktail 0:09:08.880 --> 0:09:11.000 which I've always heard of but never knew what was in. 0:09:11.240 --> 0:09:12.160 It's a Harvey. 0:09:11.880 --> 0:09:15.839 Wallbanger, not to be confused with Wait wait wait, Harvey 0:09:15.880 --> 0:09:17.400 Wahlberg isn't a person, is it. 0:09:19.120 --> 0:09:23.520 There's Mark Wahlberg, right, and then there's Donnie Wahlberg and 0:09:23.600 --> 0:09:24.880 I assume other Wahlberg's. 0:09:25.559 --> 0:09:27.360 I don't know why that was the first thing I 0:09:27.400 --> 0:09:31.160 thought of when you said Harvey Wallbanger, you did? 0:09:31.200 --> 0:09:33.040 You were like, what's in the what's in the the 0:09:33.080 --> 0:09:35.200 Harvey Wahlberg, I'm like, excuse me? 0:09:37.280 --> 0:09:37.360 What? 0:09:37.720 --> 0:09:42.480 Yeah, okay, in the Harvey Wallbanger or on the Stones 0:09:42.720 --> 0:09:48.320 is orange juice vodka a like a yellow kind of 0:09:48.400 --> 0:09:53.520 vanilla e liqueur called galliano or guyano Guyiano I'm not 0:09:53.520 --> 0:09:58.800 sure how you pronounce it, and a marishino cherry delish. Yeah, 0:09:58.960 --> 0:10:02.640 it's delish. The reason we chose this too is because 0:10:02.760 --> 0:10:05.599 I when I was like thinking of the quarantine, I 0:10:05.720 --> 0:10:08.800 was like, Okay, well it's got to be yellow, because 0:10:08.800 --> 0:10:11.960 that's what bile is, and then I told you and 0:10:12.000 --> 0:10:14.240 you were like, yeah, but bile's not yellow. I mean 0:10:14.480 --> 0:10:16.120 what we're going with it anyway. 0:10:15.960 --> 0:10:19.360 It's yellow. It can be yellow. It ranges from like 0:10:19.520 --> 0:10:22.880 yellow to green or black is not a good color 0:10:22.920 --> 0:10:27.280 for bile, but sometimes so it's a spectrum. I think 0:10:27.280 --> 0:10:29.200 we think of it in our minds as more bright 0:10:29.320 --> 0:10:32.760 yet like more on the light yellow spectrum than it. 0:10:32.760 --> 0:10:35.600 It's closer usually to the darker side of the spectrum. 0:10:35.679 --> 0:10:39.400 But you know what, already learning things, already learning things. 0:10:39.480 --> 0:10:42.400 We will post the full recipe for on the Stones 0:10:42.800 --> 0:10:45.040 on our website this podcast will Kill You dot com, 0:10:45.080 --> 0:10:47.240 as well as on all of our social media channels, 0:10:47.240 --> 0:10:48.120 so check it out. 0:10:48.600 --> 0:10:51.920 Check it out. Also check out on our website, our 0:10:52.040 --> 0:10:55.559 merch our bookshop, dot org affiliate account, and our good 0:10:55.600 --> 0:10:59.160 Reads list our music by Bloodmobile, who's also on Instagram, 0:11:00.120 --> 0:11:04.560 Treon page, transcripts, sources from all of our episodes, and 0:11:04.840 --> 0:11:05.719 so much. 0:11:05.480 --> 0:11:09.720 More, so much more. We're on YouTube. 0:11:10.000 --> 0:11:14.360 We're on YouTube, follow you exactly right network, subscribe to 0:11:14.480 --> 0:11:19.320 it all. We're on what do you call It? iHeart podcasts, 0:11:19.559 --> 0:11:22.760 Now and Apple Podcasts and all of the other ones. 0:11:23.400 --> 0:11:24.480 Thanks for listening. 0:11:24.760 --> 0:11:28.840 At the end and now over to the beginning. 0:11:30.559 --> 0:11:32.880 I'm going to talk us through what the heck is 0:11:32.880 --> 0:11:49.600 the gall bladder right after this break Aaron. You know 0:11:49.640 --> 0:11:53.400 those like old timey water skins, like I think they're 0:11:53.400 --> 0:11:55.400 probably made out of like animal organs, but you see 0:11:55.400 --> 0:11:57.560 them in like old movies, like old westerns, like you 0:11:57.760 --> 0:11:59.880 put it on a saddle bag and then you drink 0:12:00.120 --> 0:12:04.160 water out of this. Yeah, okay, So your gallbladder. 0:12:04.320 --> 0:12:07.160 Oh oh af to an unusual start. 0:12:07.800 --> 0:12:14.360 Is kind of like a little water skin kind of okay, okay, 0:12:14.360 --> 0:12:16.640 it's like it shaped a little bit like that, like 0:12:16.640 --> 0:12:18.559 what I what I think of it as those little 0:12:18.600 --> 0:12:21.280 water skins. It's like this seven to ten centimeter so 0:12:21.320 --> 0:12:23.440 it's quite a bit smaller than those water skins. So 0:12:23.480 --> 0:12:24.920 two and a half to four inches long. 0:12:25.080 --> 0:12:27.240 I'm a little so little pouch. 0:12:27.800 --> 0:12:31.839 Yeah, And it sits just on the underside of your liver, 0:12:32.280 --> 0:12:34.880 and your liver hangs out in the right upper quadrant 0:12:34.960 --> 0:12:38.000 of your abdomen. It just like a butts against your diaphragm, 0:12:38.080 --> 0:12:41.079 which is what separates your abdomen from your thorax or 0:12:41.120 --> 0:12:41.559 your chest. 0:12:41.960 --> 0:12:44.520 The liver is always so much higher than I think 0:12:44.559 --> 0:12:46.560 of like for some reason, I just think of the 0:12:46.640 --> 0:12:49.800 chest cavity as empty, and all my organs are somehow crowded. 0:12:49.800 --> 0:12:53.640 At the very bottom, your chest cavity is empty, not 0:12:53.760 --> 0:12:55.880 like your well, my heart. 0:12:55.760 --> 0:12:58.880 That's okay, loves you heart, and then well there's anything 0:12:58.920 --> 0:13:01.040 else until like my until the bottom. 0:13:01.200 --> 0:13:05.520 Yeah, the liveries weigh the heck up there, way up there. 0:13:06.040 --> 0:13:09.280 And this little pouch sits just there's like a little 0:13:10.120 --> 0:13:12.720 a little groove, a little divot that it basically sits in. 0:13:13.240 --> 0:13:17.040 And it is part of what's called our biliary system, 0:13:17.240 --> 0:13:20.840 which is basically a series of tubes like a I 0:13:20.880 --> 0:13:23.320 think of it as like the branching plumbing system that 0:13:23.400 --> 0:13:27.440 the super Mario brothers travel through. Some of these tubes 0:13:27.760 --> 0:13:31.200 come from the liver they're called the hipatic ducts, and 0:13:31.240 --> 0:13:35.640 then they join together with the tube from the gall bladder, 0:13:35.640 --> 0:13:38.520 which is called the cystic duct, and those all joined 0:13:38.559 --> 0:13:42.600 together into what's called the common bile duct. And then 0:13:42.640 --> 0:13:46.040 another branch comes over from the pancreas. I don't know 0:13:46.080 --> 0:13:47.760 why I went this way, because it's coming from your 0:13:47.800 --> 0:13:52.160 left side, and these all together empty out into our duadnum, 0:13:52.240 --> 0:13:54.760 which is the first part of our small intestine. So 0:13:54.800 --> 0:13:58.400 you have this series of duct work that connects our liver, 0:13:58.640 --> 0:14:02.280 our pancreas, and then there's this one branch that ends 0:14:02.320 --> 0:14:05.280 in a blind pouch, and that blind pouch is the 0:14:05.320 --> 0:14:07.840 gall bladder. To better illustrate this. 0:14:07.920 --> 0:14:09.160 Oh, do we have props? 0:14:09.360 --> 0:14:13.400 We have props today. I made a billiary tree, Oh 0:14:13.440 --> 0:14:17.959 my gosh, out of some pipe cleaners and a balloon. 0:14:18.040 --> 0:14:21.680 So if you're just listening, imagine thank you. I tried 0:14:21.680 --> 0:14:23.880 to get my kids to help, and they were like, nah, 0:14:24.000 --> 0:14:25.480 I'm good. 0:14:25.720 --> 0:14:27.840 But minecraft to watch exactly. 0:14:30.160 --> 0:14:33.400 So I made this. Imagine if you're just listening, I'm 0:14:33.400 --> 0:14:35.160 going to talk you through it. Basically, we've got two 0:14:35.200 --> 0:14:38.800 pipe cleaners that come together in like a y shape. 0:14:39.200 --> 0:14:42.960 These are our two hepadict like left and right hepadic ducts. 0:14:43.440 --> 0:14:45.640 These are what are bringing the bile which is made 0:14:46.120 --> 0:14:52.800 in the liver down into the common hepatic duct. This pouch, 0:14:52.880 --> 0:14:56.200 which is a balloon, a squeezy balloon, is the gall bladder. 0:14:56.520 --> 0:15:00.680 It's connected to this whole system by the cystic duct here. Okay, 0:15:01.560 --> 0:15:05.280 then we have the common bial duct. This branch coming 0:15:05.360 --> 0:15:08.680 out towards the left, which is really quite skinny, connects 0:15:08.760 --> 0:15:11.520 really close to the bottom of the common bial duct, 0:15:11.600 --> 0:15:14.360 and that is what connects the pancreas. That's the pancreatic duct. 0:15:14.440 --> 0:15:16.240 Okay, the blues the pancreas, got it. 0:15:16.800 --> 0:15:19.960 And then it lets out in a sphincter. So there's 0:15:19.960 --> 0:15:24.520 a muscular sphincter here called the sphincter of odie, and 0:15:24.960 --> 0:15:31.720 it is what allows flow out into the duadnum or testin. 0:15:32.320 --> 0:15:33.800 Hold on, where's the liver again? 0:15:34.080 --> 0:15:37.000 The liver here is up there, okay, Okay, So the 0:15:37.040 --> 0:15:39.320 liver is what's covering the top part of this, and 0:15:39.360 --> 0:15:42.600 then your gall bladder sits just underneath the liver just 0:15:42.680 --> 0:15:46.000 kind of poking out. Got a day, okay, And so 0:15:46.320 --> 0:15:50.600 the gall bladder it's essentially a storage unit or really 0:15:50.640 --> 0:15:54.600 like a storage and handling unit. Okay. Our liver is 0:15:54.720 --> 0:15:58.520 producing bile, and it produces something like a leader a day, 0:15:58.680 --> 0:16:02.360 which is more than I realized. But it produces this 0:16:02.520 --> 0:16:05.880 bile I know, right. It produces this bio at different 0:16:06.000 --> 0:16:09.800 rates depending on whether we are eating or whether we're fasting, right, 0:16:09.880 --> 0:16:13.560 in response to hormone signals that it gets when we're eating. 0:16:14.480 --> 0:16:18.440 And then this bile is traveling ultimately to the duadnum. Right, 0:16:18.440 --> 0:16:21.360 It has to get into our intestine because it's going 0:16:21.400 --> 0:16:24.920 to help us digest our foods. But because there is 0:16:24.960 --> 0:16:29.360 this muscular sphincter at the bottom, it's regulating the flow 0:16:29.440 --> 0:16:32.000 of bile, So the bio is not just free flowing, 0:16:32.040 --> 0:16:36.080 gushing all the time into our duadnum. So depending on 0:16:36.200 --> 0:16:39.440 the timing pre meal, after a meal, if you're snacking 0:16:40.120 --> 0:16:45.240 and the pressure of this sphincter, bio will either flow 0:16:45.320 --> 0:16:50.600 outwards into the small intestine or it gets diverted into 0:16:51.080 --> 0:16:51.800 the gallbladder. 0:16:52.920 --> 0:16:55.640 Okay, so if you're like, we don't need to digest 0:16:55.720 --> 0:17:00.040 right now, just hold on to this until for a little. 0:16:59.760 --> 0:17:04.000 Bit, then boop the pressure Like that sphincter's closed, so 0:17:04.040 --> 0:17:06.399 the pressure builds up here and then bloop, that fluid 0:17:06.440 --> 0:17:10.040 gets diverted into our gallbladder. Something like ninety percent of 0:17:10.080 --> 0:17:12.760 the bile that's produced during times that we're not actively 0:17:12.800 --> 0:17:15.159 eating or digesting our food ends up going into the 0:17:15.200 --> 0:17:19.240 gallbladder for storage. But while it's there, it's not just 0:17:19.800 --> 0:17:23.760 sitting there. Our gallbladder is doing a job, and that 0:17:23.880 --> 0:17:27.159 job is concentrating this bile. You can think of it 0:17:27.280 --> 0:17:30.080 kind of like a barrel that's aging your fine wine, 0:17:30.480 --> 0:17:35.520 right yeah, some of I'm really going hard on the 0:17:36.119 --> 0:17:37.120 analogies here today. 0:17:37.200 --> 0:17:38.120 I like it. 0:17:38.760 --> 0:17:41.119 So, if you have wine in a barrel, like some 0:17:41.200 --> 0:17:43.280 of that wine soaks into the barrel, right, so the 0:17:43.320 --> 0:17:45.240 wine that comes out after a certain amount of time 0:17:45.280 --> 0:17:46.880 is a little bit different than what went in. It's 0:17:46.920 --> 0:17:50.520 the same thing here. So the bile that exists in 0:17:50.560 --> 0:17:54.920 the gall bladder is more concentrated because there's all these crypts. 0:17:54.960 --> 0:17:57.000 It's not like a smooth wall on the inside of 0:17:57.000 --> 0:17:59.399 the gall bladder. It's got like folds and layers and 0:17:59.440 --> 0:18:02.240 these cryps. So you actually even end up having like 0:18:02.520 --> 0:18:06.280 layers within the gallbladder of this fluid, this bile where 0:18:06.320 --> 0:18:09.560 the most concentrated stuff is deep down in the crypts, 0:18:09.640 --> 0:18:13.359 this inner lining, and then there's less concentrated stuff on top. 0:18:13.840 --> 0:18:17.840 So after a meal, and depending on how big that 0:18:17.920 --> 0:18:20.679 meal was, how much fat was in that meal, like 0:18:20.720 --> 0:18:23.200 a lot of different components, how much hormones are being 0:18:23.200 --> 0:18:26.200 secreted out, how well your gallbladder squeeze is to begin with, 0:18:26.600 --> 0:18:30.560 our gallbladder will get to work squeezing and pushing that 0:18:30.760 --> 0:18:35.119 concentrated bile out the cystic duct, which will mix with 0:18:35.280 --> 0:18:39.080 stuff coming from the liver. That's free flowing still, and 0:18:39.119 --> 0:18:42.720 then we'll eventually travel while mixing also with enzymes from 0:18:42.720 --> 0:18:47.440 the pancreatic duct out through that sphincter into our duodenum 0:18:47.720 --> 0:18:49.320 so that we can digest our fat burger. 0:18:50.119 --> 0:18:55.080 Two questions give it to me? How is it concentrating? 0:18:55.520 --> 0:18:55.639 Like? 0:18:56.520 --> 0:18:59.639 And number two, what is bile? 0:19:00.880 --> 0:19:02.560 I knew you were gonna ask that question, So my 0:19:02.680 --> 0:19:08.400 literal next part is what the heck is bile? So God, 0:19:08.440 --> 0:19:12.040 when we work together, Well, the way that it's concentrating 0:19:12.119 --> 0:19:15.280 is basically there's like, you know, a bunch of transporters, 0:19:15.280 --> 0:19:18.239 like ion transporters and different things in the wall of 0:19:18.359 --> 0:19:21.280 the gall bladder itself, like in that intestinal lumin or 0:19:21.359 --> 0:19:24.920 not intestinal, but in that bile lumine. And so it's 0:19:24.960 --> 0:19:28.240 going to be like soaking up like basically taking back 0:19:28.280 --> 0:19:31.080 some of that water and maybe other parts of what's 0:19:31.119 --> 0:19:35.160 in the bile and leaving a more concentrated bile behind. 0:19:35.320 --> 0:19:39.240 If that makes it. Yeah, So bile, great question. So 0:19:39.280 --> 0:19:44.520 glad you asked. Is this yellowish greenish liquid that's made 0:19:44.600 --> 0:19:47.359 in our liver and it's made up of a bunch 0:19:47.359 --> 0:19:51.120 of different things. It's a combination of bile acids, which 0:19:51.160 --> 0:19:53.639 is the most kind of active part and probably one 0:19:53.640 --> 0:19:57.320 of the more important parts of bile and bile acids 0:19:57.520 --> 0:19:59.920 are We've talked about them in one of our pregn 0:20:00.160 --> 0:20:03.639 the episodes when we talked about cholestasis of pregnancy. But 0:20:04.240 --> 0:20:08.639 these are made from cholesterol. So our liver is making 0:20:08.720 --> 0:20:12.320 cholesterol and then through a process of a whole bunch 0:20:12.320 --> 0:20:17.760 of enzymes converting that cholesterol into bile acids. And then 0:20:18.359 --> 0:20:20.440 what it also does on top of that, there's another 0:20:20.480 --> 0:20:23.200 thing called biol salts, and that's just a fancy name 0:20:23.280 --> 0:20:26.640 for the liver will take these bio acids, combine them 0:20:26.640 --> 0:20:31.199 with other amino acids to make them more hydrophilic so 0:20:31.240 --> 0:20:35.439 that they're more soluble in water, because cholesterol is fat 0:20:35.520 --> 0:20:39.040 and fats don't mix well with water. So our liver 0:20:39.280 --> 0:20:42.680 makes these cholesterol products called bio acids, then makes them 0:20:42.680 --> 0:20:45.600 into something that's more hydrophilic that we call a bio salt, 0:20:46.200 --> 0:20:50.119 and that's a big, huge component of our biole It 0:20:50.240 --> 0:20:53.800 also contains bilirubin, which is a byproduct of like red 0:20:53.840 --> 0:20:58.840 cell breakdown. It also has other phospholipids. There's probably just 0:20:58.880 --> 0:21:03.560 some like plain processed cholesterol in there. There's water, and 0:21:03.600 --> 0:21:08.960 then there's other salts and minerals. What bile does, especially 0:21:09.000 --> 0:21:12.720 these bile acids or bile salts, our help in the 0:21:12.840 --> 0:21:17.760 digestion of lipids or fats in our gi tract. They 0:21:17.800 --> 0:21:22.480 are helping to emulsify and facilitate the absorption of our 0:21:22.520 --> 0:21:28.000 fats and things like fat soluble vitamins. Okay, they also 0:21:28.119 --> 0:21:31.840 are going to grab onto and help eliminate cholesterol from 0:21:31.880 --> 0:21:35.840 our body by grabbing onto it and then essentially like 0:21:35.880 --> 0:21:38.480 we'll poop it out, so they'll like block some absorption 0:21:38.600 --> 0:21:43.760 of cholesterol. And because these are made in the liver 0:21:44.400 --> 0:21:48.359 and then traveling via this biliary system maybe pit stopping 0:21:48.359 --> 0:21:51.720 in the gallbladder, and then being re secreted after they're 0:21:51.840 --> 0:21:55.280 in our digestive tract and they're doing their jobs, they 0:21:55.400 --> 0:22:00.359 actually get reabsorbed through our intestinal wall later on in 0:22:00.400 --> 0:22:04.080 our small intestine, then re enter what's called our entero 0:22:04.160 --> 0:22:07.719 hepatic circulation, go back into our liver where they can 0:22:07.760 --> 0:22:11.639 be reprocessed, re secreted and used again. 0:22:12.320 --> 0:22:15.800