Gallstone formation and gallbladder bile composition after colectomy in dogs

Abstract

A high prevalence of gallstones has been described in patients following colectomy. The aim of this study was to examine whether lithogenicity is attributed to colectomy. In the present study, changes in gallbladder bile composition and the mechanism of gallstone formation after colectomy were examined in dogs. Ten mongrel dogs underwent restorative proctocolectomy. Seven dogs which received sham operations served as controls. Over a 12-week postoperative period, samples of gallbladder bile, formed gallstones and serum were collected and analyzed. In 7 of the 10 (70%) colectomized dogs, gallstones were found in the gallbladder, while the control dogs had no stones. Macroscopically the gallstones were similar to black pigment stones observed in humans. Chemical analysis and Fourier transform-infrared spectroscopy examination revealed that the stones were composed mainly of sodium bilirubinate and proteins, with minor amounts of calcium salts and cholesterol. Significant increases in biliary pH and concentrations of ionized calcium and unconjugated bilirubin were observed in the gallbladder bile of the colectomy group compared with that of the control group. The total bile acid and total bilirubin concentrations were significantly decreased in the colectomy group. Cholesterol crystal nucleation did not occur. The inhibitory effect of gallbladder bile on calcium carbonate precipitation in an in vitro assay system was preserved even after colectomy. In conclusion, proctocolectomy increases the concentration of unconjugated bilirubin in gallbladder bile and induces pigment gallstones which are composed mainly of sodium bilirubinate and proteins since calcium ions and cholesterol are stabilized in dogs.

Effect of Terminal Ileal Transposition on Gallbladder Bile Composition Following Proctocolectomy

“…Chemical analysis and Fourier transform-infrared had 40 to 50 cm of stalked terminal ileal segment, with a distal end 1 cm proximal to the ileocecal junction, that was transposed between spectroscopy examination of the gallstones are dethe proximal colon and the anus. In the IAA group, seromuscular scribed elsewhere by Noshiro et al [28].…”

940 Loss of Keratin 19 Predisposes to the Development of Cholestatic Liver Disease

“…Therefore, future studies should analyse the impact of K19 on bile flow under stress conditions. Another factor that is known to affect the stone formation in general is the biliary pH [186][187]. Although the importance of biliary pH in porphyrin stone formation is poorly understood, previous studies revealed that increased biliary pH induced the hydrolysis of conjugated bilirubin to insoluble indirect bilirubin and precipitated the aggregate formation [186][187].…”

“…Another factor that is known to affect the stone formation in general is the biliary pH [186][187]. Although the importance of biliary pH in porphyrin stone formation is poorly understood, previous studies revealed that increased biliary pH induced the hydrolysis of conjugated bilirubin to insoluble indirect bilirubin and precipitated the aggregate formation [186][187]. However, this clinical finding does not seem to explain our observation given that DDC-fed K19-KOs showed decreased biliary bicarbonate concentration and therefore will most likely have a decreased biliary pH.…”