A new catheter for endoscopic manometry of Oddi's sphincter

With a newly designed manometry catheter and a modified pull-through maneuver a high presure zone can reproducibly be recorded between the duodenum and the pancreato-biliary tree corresponding to Oddi's sphincter. Catheter marking allows in addition calculation of the length of this zone. Since the sealed end of the catheter remains during pressure recording within the ductal system repeated push-and-pull maneuvres can be performed through the sphincter area.

Effects of adrenergic stimulation on the choledochoduodenal sphincter mechanism

The object of this study was to access the effects of systemic bolus injections of epinephrine and of norepinephrine upon the sphincter at the choledochoduodenal junction in the cat and the dog. The bile duct was transected and the downstream segment was cannulated. Two methods were used to assess sphincteric activity. In method I the bile duct was perfused with Ringer's solution at a constant pressure and the flow rate of the solution was recorded. In method II the bile duct was perfused at a constant rate of flow and the terminal intraductal pressure was recorded. Intraduodenal pressure and respiratory movements were also recorded. There was a significant decrease in sphincteric activity following both epinephrine and norepinephrine administration in both cats and dogs, using both constant pressure and constant flow methods.

Intestinal absorption and biliary excretion kinetics of 14C-labeled methadone in the rat

Intestinal abosrption, biliary excretion and enterohepatic circulation of d,l-methadone were studied in male, female, fasted and fed rats by monitoring the appearance of radioactivity in the portal vein, the inferior vena cava, and the bile following intraduodenal administration of 2-14C-d,l-methadone. An early peak in portal concentration was not reflected in the peripheral blood or in the bile. An enterohepatic circulation exists, but is minimal, accounting for less than 1% of the dose in the first hr. Experimental diversion of the bile flow from the lumen of the duodenum has little effect on the relative percentage of methadone vs. metabolites circulating in the blood. However, bile diversion was associated with a 2 to 3 fold increase in the concentration of methadone and its metabolites in portal and peripheral blood 30 min following administration. Eighty to 90% of the 14C in the portal blood is present as methadone and 60 to 70% of the 14C in peripheral blood is methadone while less than 10% of the radioactive materials in the bile is methadone. The amount of metabolite No. 1, metabolite No. 2 and water soluble metabolites vary with over 60% of the radioactive compounds in recirculated bile in the form of water soluble materials.

[A photo-optical observation of gallbladder motility in dogs (author's transl)]

A photo-optical observation on gallbladder motility was made with the 16 mm cine-cholangiography. The subjects studied were thirty two mongrel dogs. The gallbladder was exposed by a short upper midline abdominal incision under pentothal anesthesia. Gallbladder bile was aspirated and contrast medium was given into the bladder, through a transhepatic route. The cine-cholangiography was done by an image intensifier at a speed of one frame every 2 to 4 seconds. The cinefilms taken were observed repeatedly by the screen projection at various speeds. The drawings were made by tracing the outline of the image of the gallbladder on each frame and were overlapped. Moreover, a contraction curve was made by the cholecystometry using of film motion analyzer in every case. At the same time bile flow into the duodenum was recorded to study a relationship between the gallbladder contraction and motility of the terminal common bile duct. The results obtained are as follows: 1. In a resting state any contraction of the gallbladder was not seen during 30 minutes, and a peristalsis-like movements of the neck portion was observed. However, there was not a relationship between the contraction curve of the gallbladder and the bile flow into the duodenum. 2. Immediately after giving Caerulein, the contrast medium injected into the gallbladder was rapidly discharged into the common bile duct by a peristalsis-like movement of the neck. The size of the gallbladder was markedly decreased into three fifths of the initial state three minutes after administration. At the same time contrast medium was continuously discharged into the duodenum. 3. After giving pilocarpine a marked contraction with forceful movement of the neck and body was observed, and the size of the gallbladder was decreased into three quarters ot the initial state. Bile discharge into the duodenum was markedly increased with an active open- and closing movement of the terminal common bile duct.

A functional description of the canine choledochoduodenal flutter valve

Forward- and reverse-opening pressures of the choledochoduodenal junction were measured in anesthetized, vagotomized dogs. Mean reverse-opening pressures were found to be significantly greater in most cases including those following the intraductal administration of vasoactive agents which are known to significantly influence mean forward-opening pressures. The polypeptides CCK-PZ and CCK-C8 were ineffective in reducing mean forward-opening pressures regardless of the route of administration. Previously published observations have indicated that mean forward-opening pressures are also unaffected by nervous activity. It is concluded that the canine choledochoduodenal junction possesses the physical and functional properties of a passive flutter valve during duodenal relaxation.

Conduction of activity between muscles in the terminal region of the common bile duct and in the neighboring duodenum

The relationship between muscle activity at the terminal region of the common bile duct and the duodenal muscle was examined in rabbits. The rhythmic muscle activity in the terminal region was synchronous with duodenal muscle activity. The activity of the latter muscle preceded the former. The activity at the terminal region synchronous with the rhythmic activity of the duodenal muscle sometimes disappeared spontaneously. The muscle activity of the ampulla and the spincter at the terminal region was sometimes independently lost. The conduction of excitation from the duodenal muscle to the terminal region appeared to be performed at several sites. The existence of a "conduction-shunt path" between the terminal region and the duodenum, as well as between the ampulla and the sphincter appeared probably. Some quantitative differences were found between the spincter, ampulla and duodenum in inhibitory effects to stimulation of splanchnic nerves and reflex effects and to excitatory effects of cholecystokinin-pancreoxymin and caerulein. These results seem to indicate that the sympathetic nerves and the intramural cholinergic neurones controlling these region carry out activities quantitatively different from each other.

Enzyme histochemical studies of rabbit bile ducts with and without bile flow

The histochemical enzyme pattern in normal, extra-hepatic bile ducts from rabbits was studied. A difference between the duct epithelium and the crypt epithelium was noted mainly in the activity of gamma-glutamyl-transpeptidase and alkaline phosphatase which only stained positively in the crypts. No difference from the normal enzyme pattern was noted after diversion of the bile flow for up to 30 days.

Pseudocalculus of the common bile duct. A dynamic radiographic differentiation from true retained stone

Static T-tube cholangiographic evidence of distal common duct calculi may in fact be only "pseudocalculi," which might be elucidated by a dynamic fluoroscopic study. We have seen five such cases. X-ray evidence for this phenomenon is presented. Pertinent anatomy, physiology, and clinical considerations are discussed.

Continuous positive-pressure ventilation and choledochoduodenal flow resistance

Resistance to flow through the choledochoduodenal junction was measured during constant perfusion (0.8 ml saline/min). In eight dogs, intermittent positive-pressure ventilation (IPPV) and continuous positive-pressure ventilation (CPPV) were compared. Pressure in the common bile duct was always higher during JPPV than IPPV. With the first application of CPPV the rate of intravenous fluid was adjusted to maintain constant Hct. Mean hepatic venous pressure (Phv) increased from 6.6 to 11.5 cmH2O (P less than 0.001). Mean pressure in the common bile duct increased (P less than 0.001) from 11.6 to 14.1 cmH2O. The average increase in resistance was 21%. Changes reversed with return to IPPV. During the second application of CPPV, intravenous fluid was increased to maintain constant arterial pressure. Phv increased to 12.8 cmH2O and pressure in the common bile duct increased to 15.0 cmH2O (30% increase). In four additional dogs, choledochoduodenal resistance during continuous CPPV was reduced by intravenous vasopressin, intravenous norepinephrine and intraducta phenylephrine. CPPV increases resistance to flow through the choledochoduodenal junction, probably by vascular engorgement.

Synthetic capacity and cell metabolites of bile duct obstructed rat livers. Effect of free and conjugated dihydroxy bile acids

Morphologic alterations in liver cells after bile duct ligation are well known and documented in numerous reports. Biochemical studies concerning metabolic changes in cholestatic liver are rare. Therefore, in this study, liver cell metabolites and the capacity of the perfused cholestatic rat liver to produce glucose, urea and ketone bodies were measured. In addition the influence of dihydroxy bile acids on normal and bile duct ligated rat livers was studied. Concentrations of adenine nucleotides, lactate, pyruvate, 3-hydroxybutyrate, acetoacetate, glucose and UDP-glucose were found to be identical in cholestatic and normal livers. Glycogen content, however, was significantly lowered in cholestatic livers. Gluconeogenesis from lactate and urea production from ammonium chloride were only slightly reduced in bile duct obstructed rat livers. Dihydroxy bile acids did not affect the metabolism of normal or cholestatic livers. Ketone body production from oleate was reduced to 66% in bile duct obstructed livers, taurochenodeoxycholate further reduced this value to the normal value. In contrast to earlier reports (Fisher and co-workers, 1971 Lab. Invest. 21; 88-91; Gastroenterology 60: 742) chenodeoxycholate induced neither cholestasis nor a marked fall in ATP content or rat liver in our experiments with female Wistar rats. In conclusion, dihydroxy bile salts did exert toxic short term effects on rat livers.

[Renewal time, proliferative pool and duration of the mitotic cycle of the epithelial cells of the common bile duct]

Using cholchicine and H3-thymidine the following parameters of the mitotic cycle (in hours) were calculated: T=56.6; tm=0.9; tg2=1.2; ts=6; tg1=48.5 The proliferative pool was 7.5% and the time of epithelium renewal--754.5 hours. The common bile duct epithelium should be referred to the tissue systems with slow renewal.

The mucosal lining of the intramural common bile duct as a determinant of ductal opening pressure

Microanatomical evidence is presented which shows that the lumen of the intraduodenal portion of the common bile duct is almost completely filled by folds of a highly vascularized mucosa in the dog, cat, rabbit, and human. These folds are most apparent near the intraduodenal ductal orifice, where they almost completely occlude the lumen. Physiological data are presented which indicate that changes in systemic arterial blood pressure are associated with changes in the opening pressures of the choledochoduodenal junction of the cat and dog, which vary in the same direction. Experimental results indicate that bile duct opening pressures of these two species are increased by the intraductal administration of histamine and reduced by the intraductal administration of norepinephrine. A histological examination of the intraductal mucosal folds in this area, subsequent to the administration of the elevating agent, revealed a marked presence of vascular engorgement. It is concluded that the most significant determinant of changes in ductal opening pressures in the cat and dog is probably the state of the mucosal vasculature of the terminal portion of the common bile duct.

Technique for assessment of local effects of substances found in bile upon opening pressure of choledochoduodenal junction

An assessment of the localized influences of various chemicals found in bile was made by applying them to the interior of the canine choledochoduodenal junction. Test agents were isolated by air bubbles and introduced into the terminal lumen of the intramural portion of the common bile duct via the pressure measurement catheter; they remained in the duct for approximately 1.5 min. The system was flushed and opening pressures were then measured. Responses were measured in terms of alterations in ductal opening pressures generated by a linear pressure ramp. Histamine, serotonin, and bethanechol markedly increased ductal opening pressures, whereas epinephrine and norepinephrine decreased opening pressures. None of the agents affected either cardiovascular or small intestinal motor activity in the vicinity of the sphincter when administered in the manner. The results suggest that the presence in bile of certain neurohumoral transmitters and neurohumoral-like agents may directly affect the canine choledochoduodenal sphincter function.

Sphincter patency and hepatic BSP uptake after biliary sphincterotomy

An attempt has been made to assess the patency and function of the choledochoduodenal junction after biliary sphincterotomy by estimating the first arrival time of injected bromsulphalein (BSP) in duodenal aspirate and the effect of morphine on this. Studies on 49 patients 1--12 years after this operation showed the arrival time to be normal in 47, but in 2 cases there was delay, which suggests that stenosis may develop in time in abot 4 per cent of cases. This had not been detected clinically, radiologically, or by liver function testing. Although it did not effect the BSP arrival time in T-tube bile, morphine was found to prolong the duodenal arrival time in control patients and also after sphincterotomy of the type used, indicating that the protective mechanism of the sphincter region may not have been destroyed by this operation. Abnormal BSP retention in plasma has been reported up to 5 years afte supraduodenal exploration of the bile ducts in 30 per cent of cases. Similarly, in the present study after biliary sphincterotomy plasma BSP levels were above normal in 14 of 49 patients, suggesting that this abnormality reflects the original pathological condition rather than the type of operation used to deal with it.

A proposed mechanism of zinc absorption in the rat

Studies were conducted at the cellular level in an attempt to describe the processes involved in zinc absorption from the intestine. A low-molecular-weight zinc-binding ligand was identified in the pancreas of rats and pancreatic secretions from a dog. The whole-body absorption of 65Zn in rats in which the common bile duct was ligated was significantly less than the absorption of 65Zn in rats in which the hepatic bile duct was ligated. The uptake of 65Zn by epithelial cells from everted intestinal segments was markedly increased in the presence of the zinc-binding ligand fraction from pancreatic secretions. Following in vivo labeling, 30% of the 65Zn in the epithelial cell was associated with the partially purified basolateral plasma membrane. When labeled basolateral plasma membranes were incubated in a medium that contained zinc-free albumin, approximately 96% of the 65Zn was transferred to the medium while less than 30% of the isotope was released to media that contained either no albumin or a 3:1 zinc: albumin complex. In rats fed a zinc-deficient diet, 65Zn absorption was inversely proportional to the serum zinc concentration, and both zinc and copper injections produced a marked decrease in 65Zn absorption. These results suggest that zinc absorption consists of interactions among a low-molecular-weight ligand, recpetor sites on the basolateral membrane, and metal-free albumin.

Susceptibility of the liver and biliary tract to anaerobic infection in extrahepatic biliary tract obstruction. Bacteriological investigations - an experimental study in rabbits

The influence of common duct occlusion on susceptibility to infection with anaerobic gram-negative rods was investigated in rabbits. Intravenous inoculation was performed with three B. fragilis strains isolated from human infections and with a stock culture of Fusobacterium mortiferum. Liver tissue, gallbladder, bile, and blood were investigated. Anaerobic culture procedures were based on the use of a 'glove-box' with an oxygen-free atmosphere and pre-reduced, anaerobically sterilized media. Anaerobic transport was based on flushing of samples with oxygen-free carbon dioxide and transport-time less than 30 minutes. In regard to two B. fragilis strains (ss. fragilis) and in regard to Fusobacterium mortiferum, common duct occlusion significantly increased the number of infected animals compared to a control group of inoculated animals without common duct occlusion. Spontaneous infection did not arise in a control group of animals with common duct ligation. It is concluded that: 1) in biliary tract occlusion, anaerobic bacteria are able to invade the biliary tract from the blood stream, and 2) biliary tract occlusion produces sufficient anaerobic conditions for obligate anaerobic bacteria to multiply in the bile.

Plasma concentration of lipoprotein-X (LP-X) in experimental bile duct obstruction

Sequential quantitative determinations of lipoprotein-X (LP-X), measurements of plasma lipids, initial rate of cholesterol esterification, and liver function tests were performed after experimental cholestasis in 6 dogs. In 3 animals ligation and transsection of the common bile duct were combined with cholecystectomy. In 2 other dogs a similar operation, but without removal of the gallbladder, was carried out. In the bile-duct-obstructed and cholecystectomized dogs, LP-X appeared 11-21 hours after operation, and in dogs with preserved gallbladder 32 hours after operation. During the observation periods (6-41 days), the LP-X levels were much higher in the cholecystectomized dogs than in the ones with preserved gallbladders. In most of the bile-duct-obstructed dogs the curves of LP-X concentrations in plasma were bi-phasic. The first peak after 1 to 5 days was followed by a fall, and 10 to 14 days after operation another rise was observed. Concomitant with the changes in the level of LP-X, fluctuations in the levels of phospholipids and free cholesterol occurred. An inverse relationship between LP-X and the activity of lechithin: cholesterol acyltransferase was found.

[Adrenoceptors and autonomic nerve control mechanisms in the biliary tract]

Effects of sympathomimetics and sympatholitics were studied on the biliary system of guinea-pigs (in vitro) and rabbits (in vitro and in vivo). Contractions and relaxations produced by sympathomimetic amines are mediated by alpha-excitatory and beta-inhibitoray adrenoceptors in the biliary system (gallbladder, common bile duct and sphinctor of oddi) of guinea-pigs. Sympathomimetic amines caused relaxations in the sphincter of oddi in rabbits (in vitro and in vivo) and responses were antagonized by alpha- and beta-blockade or a combination of both. Sympathomimetic amines caused contraction and relaxation on the common bile duct of rabbits. Transmural stimulation to guinea-pig gallbladder and rabbit common bile duct is mediated by cholinergic and adrenergic nerves, alpha-inhibitory adrenoceptor would thus be involved in the postanglionic cholinergic nerve endings in the gallbladder of guinea-pig. No difference was observed in mechanical responses to transmural stimulation in either the isolated sphincter of oddi or the duodenum of rabbits. It is concluded that the guinea-pig biliary system is functionally independent of the gastro-intestinal system and that the rabbit sphincter of oddi is functionally similar to the duodenal wall.

Secretin-induced bile secretion, bile acid output and blood supply to the liver in the dog

Bile secretion and blood flow in the portal vein and the hepatic artery were determined in cholecystectomized anesthetized dogs before and during continuous infusion of varying doses of secretin. Secretin increases bile volume without alteration of bile acid output. Hepatic arterial flow was not altered by any dose. However, high doses of secretin increased portal venous blood flow significantly. It is concluded that secretin action on liver blood flow mirrors mainly superior mesenteric arterial vasodilation and seems to be a rather pharmacologic than a physiologic response. Bile secretion is not influenced by changes of hepatic blood flow in the physiologic range.