Which would lead to an increase in hepatocyte synthesis of primary bile acids?
Correct Answer: An ileal resection
Description: The rate of synthesis of primary bile acids from cholesterol is inversely related to the rate at which bile acids are extracted from the hepatic poal blood and resecreted into the bile canaliculi. Therefore, an increase in the rate of synthesis occurs following ileal resection. Ileal resection decreases the ability to absorb bile acids from the small intestine and causes a decrease in enterohepatic recirculation of the bile acids. Therefore, secretion of new bile acids is increased.Injection of cholecystokinin or stimulation of the vagus nerve contract the gallbladder and relax the sphincter of Oddi, causing increased delivery of bile acids to the duodenum. These bile acids are absorbed in the ileum and returned to the liver in the hepatic poal blood. Therefore, synthesis of new bile acids is decreased. Lovastatin, which decreases the activity of 3 hydroxy-3-methyl glutaryl coenzyme A (HMG-CoA) reductase, decreases synthesis of cholesterol and, therefore, decreases the synthesis of bile acids. A decrease in dietary cholesterol would decrease the synthesis of primary bile acids.
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