J.Jpn. Surg. Soc.. 82(6): 633-646, 1981

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Original article

HEPATIC BILE PRODUCTION AND BILE ACID METABOLISM AFTER RELIEF OF BILIARY OBSTRUCTION

Clinical study of 25 patients with extrahepatic biliary obstruction revealed that: 1) Daily bile flow, which varied independently of bile acid excretion, correlated with HCO^-₃ concentration in bile and with maximal choleretic response to exogeneous secretin. 2) Large amount of bile acids was excreted in bile during the first 24 hours after decompression and serum bile acid concentration decreased nearly to normal range within 48 hours. 3) Minimum excretion of bile acid was observed on the second day. Subsequent increase in bile acid excretion was significantly small in the cases of long-term hyperbilirubinemia either before or after decompression.
Further experiment was carried out in bile duct-ligated dogs and results: 1) Similar choleretic responses were induced by secretin either in the bile duct-ligated group or in the control. 2) Although taurocholate Tm was significantly diminished, serum bile acid concentration fell to half level within 4 hours after decompression.
Conclusion: 1) Biliary obstruction does not reduce ductular secretion which causes bile flow to vary case by case. 2) Bile acid excretion from total bile fistula, which is nearly equal to hepatic bile acid synthesis after the first 24 hours, is a usefull index of liver cell function.

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