The significance of the diameter of the common bile duct in cholecystectomized patients

In the cholecystectomized patients there is no correlation between the diameter of the common bile duct and the pressure in the biliary system or in the sphincter of Oddi. It is most probably due to unresolved dilatation of the common bile duct. ERCP manometry is probably a more accurate technique for establishing the diagnosis of papillary stenosis in patients who had their gallbladder removed.

Effect of short-term bile duct ligation on peripheral blood steroids, urinary PGE2 and the rate of sodium excretion in male rabbits

Short-term bile duct ligation in male rabbits resulted in a significant reduction in the rate of sodium excretion after saline challenge (10 ml/kg/hr for 4 hr, P less than 0.03). The reduction in the sodium excretory rate (14.3 +/- 7.8 to 6.3 +/- 5 mu-equiv/min, P less than 0.03) was associated with an increased urinary PGE2 excretion (200.9 +/- 174 to 731.8 +/- 1039.8 pg/min, P less than 0.01) without significant change in serum aldosterone and cortisol concentrations. Serum progesterone concentration increased (37.2 +/- 15.6 to 119.2 +/- 34.6 ng/dl, P less than 0.01) whereas serum 17-hydroxyprogesterone concentration declined after bile duct ligation suggesting the development of a 17-hydroxylase enzymatic block.

The effect of jaundiced sera and bile salts on cultured beating rat heart cells

Jaundiced serum from common bile duct ligated rats, added to cultured heart cells, decreased the beating rate, caused an early cessation of beating and production of higher levels of lactate in the media. Deoxycholate and cholate are the main bile acids in jaundiced serum; deoxycholate caused similar effects, which suggests that it is the toxic substance responsible for heart function alterations seen in patients with severe jaundice.

Manometric evaluation of sphincter of Oddi after endoscopic sphincterotomy, and in patients with previous surgical sphincterotomy

Pressures in the sphincter of Oddi and common bile duct were determined in eight patients with previous surgical sphincterotomy, and in 14 patients before and after endoscopic sphincterotomy. Motor activity in the sphincter of Oddi was seen during manometric examination in 6 out of 8 patients of the surgical group. These six patients had common bile duct stones after cholecystectomy. Endoscopic sphincterotomy equalized the choledochoduodenal gradient and reduced the sphincter pressure in all the patients except three. In two of them further extension of the length of the sphincterotomy permitted removal of the stones and substantial reduction of the motor activity of the sphincter of Oddi.

Compliance of the extramural portion of the canine common bile duct

The physiologic characteristics of the biliary tract cannot be adequately evaluated without analyzing both the resistive and compliant characteristics of the common bile duct. We studied the compliance of the common bile duct in six anesthetized dogs. Saline was infused continuously while pressure was monitored with the sphincter of Oddi intact and tied off. The mean opening pressure of the sphincter was 8.45 cm H2O. In the obstructed duct, compliance was found to decrease with increasing pressure. The mean compliance for all five dogs at low pressures (below opening pressure) was 11.0 X 10(-2) microliter/cm H2O/mm2, and at high pressures was 1.7 X 10(-2) microliters/cm H2O/mm2. Changes in flow rate did not affect the compliance of the duct. Although the compliance of the duct was found to be nonlinear overall, it was nearly linear in both the high- and low-pressure ranges.

Hepatic proline after bile duct ligation in rats

Since biliary hyperplasia of fascioliasis correlated with hepatic proline level, we examined the occurrence of a similar chemical stimulus during bile obstruction. Uptake of tritiated proline and glycine rose in both hepatocytes and a bile duct enriched cell fraction, following duct ligation in rats. The increased hepatic content of proline but not glycine suggests that proline has a role in post-obstructive biliary proliferation.

[Proteolytic processes in the small intestine of rats with the intestinal form of acute radiation sickness]

It was shown that on the 3d day after total-body irradiation of rats (12 Gy), cathepsin "D" activity was increased and the processes of autolysis and proteolysis accelerated in the small intestine under the effect of trypsin. Extracts of the small intestine tissues increased the permeability of vessels. Ligation of the common bile duct lengthened the lifespan of irradiated animals and decreased the processes of proteolysis and the vessel permeability in the small intestine wall.

Evaluation of biliary pressure by perfusion method and its significance

The present authors have made it a rule to use a modified Mellet-Guy's method for measuring pressure in the bile duct. The determined manometric pressure expressed in curve has been classified into (a) basal pressure, (b) rising time, (c) perfusion pressure, (d) dumping time and (e) residual pressure. The basal pressure (a) represents a static pressure free from any load in the bile duct. The rising time (b) varies with factors including the measuring apparatus, ductal elasticity and capacity, resistance at the choledochal terminal, and the volume of physiological saline infused. The perfusion pressure (c) is likely to undergo interference of a variety of factors such as the ductal diameter, mural elasticity and thickness, resistance at the choledochal terminal, along with the measuring apparatus. The dumping time (d), free from the influence of the measuring apparatus, is considered to be an important guide for us to guess the condition of choledochal terminal. The residual pressure (e) and the trend of manometric pressure curve help us to surmise the choledochal terminal resistance and the presence of ductal abnormalities. After all, among the above factors, the dumping time and the residual pressure are apparently available for objective evaluation of bile duct pressure.

By-passing the sphincter of Oddi does not affect gallbladder emptying in the pig

A study of the relationship between bile secretion and nutrition in the pig requires a complete and continuous collection of the bile and its reinfusion to the animal. In most of the studies performed in different species, bile has been directly reinfused into the duodenum, leading to the exclusion of the sphincter of Oddi from the biliary pathway. It has been postulated that such an exclusion could inhibit gallbladder emptying. The aim of the present work was to study postprandial gallbladder emptying in the pig, depending on the site of bile reinfusion, i.e. the duodenum or the lower bile duct. The gallbladder bile was coloured with indocyanine green (ICG) and marker secretion was recorded after a test-meal. The results showed that after meal intake, the gallbladder emptied over a similar period of time and according to similar kinetics, whatever the site of bile reinfusion.

Immunoglobulins in rabbit hepatic bile: selective secretion of IgA and IgM and active plasma-to-bile transfer of polymeric IgA

Proteins in hepatic bile from cannulated rabbits were analysed by gel filtration, electrophoresis, density gradient ultracentrifugation, and immunochemical methods. Bile-to-serum concentration ratios (no. = 8) demonstrated that IgA and free secretory component (SC) were major constituents of rabbit bile. Relative concentration ratios, obtained by dividing the bile to serum level ratio for each protein by the corresponding ratio for albumin, were 310, 1.6, 1.0, 0.82, and 0.54 for IgA, IgM, albumin, transferrin, and IgG respectively, suggesting that both IgA and IgM are selectively secreted into bile. Ligation of the bile duct (no. = 5) led to a selective increase of the serum levels of IgA and SC, the latter as secretory IgA. After intravenous injection (no. = 4) of human polymeric IgA, 37-69% of the injected dose was recovered in bile after 3 h, in contrast to 4-5% for human monomeric IgA. The active transfer of both rabbit and human polymeric IgA into rabbit bile occurs via the same hepatic SC-mediated transport process as that described for the rat.

Action of cholecystokinin-octapeptide on sphincter of Oddi basal pressure and phasic wave activity in humans

The human sphincter of Oddi (SO) exhibits phasic wave activity over a 4 to 6 mm segment. Approximately 60% of these waves occur in an antegrade direction, 14% are retrograde, and 26% occur simultaneously. Because cholecystokinin-octapeptide (CCK-OP) stimulates the flow of bile into the duodenum, its effect on SO phasic wave contractions and contraction sequences was evaluated at ERCP manometry. An infused triple-lumen catheter of 1.7 mm outer diameter with side orifices spaced 2 mm apart was stationed in the SO segment so that all three orifices recorded phasic pressure waves. We studied 31 patients with normal ductal anatomy and normal SO pressures. In 21 of these patients CCK-OP (20 ng/kg) was given intravenously after a 2- to 3-minute baseline recording was obtained. Pressure recordings were continued for up to 10 minutes following CCK-OP administration. CCK-OP caused a significant inhibition in the frequency and amplitude of SO phasic waves as well as a significant decrease in basal SO pressure. Before CCK-OP most phasic contractions were antegrade, and after CCK-OP the sequence pattern remained unchanged. We conclude that CCK-OP reduces or transiently abolishes SO phasic contractions but that it does not change their temporal sequence. In addition, CCK-OP produces a decrease in basal SO pressure. These findings suggest that the action of CCK-OP in humans is to inhibit SO phasic activity and reduce SO basal pressure to allow increased flow of bile.

Observations on the distensibility of the common bile duct

This series describes 9 patients in whom a rapid change in bile duct caliber was documented by ultrasonography, intravenous or direct cholangiography, or endoscopic retrograde cholangiopancreatography. Two major observations were made: (a) the capacity of the common duct to distend and collapse over a short period, and (b) discordant measurements of bile duct diameter on successive examinations with different modalities (i.e., ultrasonography followed by cholangiography). It is thought that these discrepant measurements can be explained by the ability of the common duct to distend rapidly in response to pathologic and physiologic fluctuations in biliary pressure.

Studies on the mechanism of the increase in serum alkaline phosphatase activity in cholestasis: significance of the hepatic bile acid concentration for the leakage of alkaline phosphatase from rat liver

In experimental bile obstruction the serum activities of the membrane-bound liver enzymes, alkaline phosphatase, 5'-nucleotidase and gamma-glutamyltransferase are greatly increased, whereas in the liver only the alkaline phosphatase activity is elevated. After partial hepatectomy or tetrachloride poisoning the alkaline phosphatase activity in the regenerating live is increased to the same extent as in cholestasis without an accompanying elevation in serum activity. The following results support the hypothesis of a bile salt-mediated solubilization of membrane-bound enzymes in cholestatic liver: (1) 30 min after bile duct ligation the total bile acids in the liver were increased 5-fold, 2 h later as much as 10-fold. After 1 day, the bile acid concentration was still 4 times above normal. (2) Isolated plasma membranes from normal and obstructed livers were incubated in vitro with increasing amounts of tri- and dihydroxycholanic acids. At a final concentration of 1 mmol/l taurochenodeoxycholate significant amounts of membrane-bound enzymes were released into the 12,000-g supernatant. (3) In the regenerating liver, where tissue phsophatase activity was high and serum phosphatase activity unchanged, the bile salt concentration was not increased.

[Is the duodenal papilla an autonomic sphincter? A contribution to the functional morphology (author's transl)]

A morphologic study of the duodenal papilla was performed by laminations in three planes. The muscle system reveals that there are no autonomic sphincters, but muscle bundles deriving from duodenal longitudinal and circular muscle layers, interdigitating and acting for opening of the papillary mouth. Activity results from myogenous rhythmic contractions of smooth muscle cells, stimulated by the ductal hydrostatic pressure, and from the duodenal peristalsis. The closure of the papilla is weak, incomplete and achieved by the oblique entrance of the duct. Interpretation of functional analysis and procedures of treatment should be based upon the knowledge of normal morphology of the papilla.

The effect of buprenorphine and oxycodone on the intracholedochal passage pressure

The effect of i.v. buprenorphine (0.3 mg) and oxycodone (10mg) on intracholedochal passage pressure were studied in 20 patients who had undergone surgery of the common biliary tract, prior to the extraction of an indwelling T tube. Informed consent was obtained from all patients, each of who was given buprenorphine or oxycodone in random order. The intracholedochal passage pressure was measured from the T tube perfused with continuous saline infusion (55 ml/h). Both analgesics significantly (P less than 0.01) increased the intracholedochal passage pressure after 5 min, with an equal peak increase of about 1.5 kPa at about 7 min. The pressure decline was rapid and similar in both groups: 20 min after administration of the test drug only about 40% of the maximum elevation caused by either drug remained. Thereafter, a slower fall towards the baseline was recorded after both drugs during the remaining 45 min of the study period. The results indicate that buprenorphine can be used with the same indications and precautions as other narcotics for postoperative pain relief in patients who have undergone surgery of the biliary tract.

alpha-Naphthylisothiocyanate induced alterations in hepatic drug metabolizing enzymes and liver morphology: implications concerning anticarcinogenesis

Alpha-naphthylisothiocyanate (ANIT) is a biliary toxin with anticarcinogenic properties. The studies described were designed to investigate the effects of continuous ANIT feeding on liver function. Male F-344 rats were fed ANIT at 0.01%, 0.022%, 0.047%, and 0.1% of the diet for 2, 4, and 6 weeks. Microscopic evaluation of liver sections revealed time- and dose- dependent bile duct proliferation, bile duct cell hypertrophy, and focal hepatocytic necrosis. Liver derived serum enzyme activity and serum bilirubin concentrations were increased in a fashion which correlated closely with the histological observations. A dose dependent decrease in hepatic cytochrome P-450 content, ethoxycoumarin-O-deethylase activity, and benzphetamine-N-demethylase activity was observed after 2 and 4 weeks of feeding ANIT. However, these enzyme activities returned to control values at 6 weeks in all except the 0.1% group. ANIT increased microsomal epoxide hydrolase and cytosolic DT-diaphorase activity (200-6005 of control). The enhancement was dose related and peaked at 2 and 4 weeks for epoxide hydrolase and DT-diaphorase, respectively. Both epoxide hydrolase and DT-diaphorase activity remained elevated at 6 weeks. These results suggest that ANIT mediated anticarcinogenesis, previously hypothesized to be the result of reduced mixed function oxidase activity, also may be accounted for by enhanced epoxide hydrolase and DT-diaphorase activity.

Biliary iodipamide and iodoxamate excretion as function of basal bile flow in normal, common bile duct obstructed and liver-damaged dogs

The investigation was performed in 6 cholecystectomized chronic bile fistula dogs in which, except in complete common bile duct obstruction, the bile was diverted and replaced with a constant taurocholate infusion of 0.3 mumoles per min. per kg. Iodipamide and iodoxamate were i.v. infused at a rate of 6.7 mumoles per minute per kg for 30 minutes. Different degrees of extrahepatic obstruction were simulated by producing different intrabiliary pressure conditions. Progressive hepatic parenchymal disease was induced by oral administration of dimethylnitrosamine. In both conditions basal (precontrast) bile flow, maximum biliary excretion rate and bile concentration of the contrast agents decreased with increasing hepatic dysfunction. This investigation suggests that, regardless of the underlying mechanism, the bile iodine concentration required for radiographic visualization of the biliary system is no longer attained in intravenous cholangiography when the basal bile flow decreases below 2 microliter per min per kg in the presence of a physiologic bile salt plasma pool. In hepatic dysfunction alkaline phosphatase correlated better with the maximum biliary excretion rate and concentration of the contrast agents than SGPT, SGOT, and serum bilirubin and therefore seems to be the best parameter to predict the chance of a successful intravenous cholangiography.

[Experimental results after acute and chronic ligation of bile duct (author's transl)]

The bile duct was ligated in 14 bastard dogs. Bilirubine, alcaline phosphatase, GOT, GPT, GLDH, and gamma GT were measured pre- and postoperatively. On the 8th postoperative day stenosis of the choledochus was eliminated using a patch plasty for dilatation in 7 dogs, whereas the occlusion remained in the other 7 dogs. Laboratory and histological results were characteristic for cholestasis 8 days after occlusion; these changes disappeared within 4 weeks after patch plastic surgery. In the controls these parameters normalized as well within 8 weeks, in spite of the persisting occlusion. These results show, that pathological changes after short term cholestasis are fully reversible; they demonstrate as well, that there are compensatory mechanisms operating in dogs with permanent occlusion of the bile duct.

[Jaundice-dependent hepatic failure and stress ulcer - an animal experiment]

Experimental studies confirm the clinical results of a correlation between jaundice-dependent hepatic failure and an incidence of stress ulcers: stress ulcers appeared much more frequently in stress-exposed rats with ligation of the choledochus and in animals with operative restitution of the bile flow after ligation of the choledochus than they appeared in controls.