Regulation and responses of gallbladder muscle activity in health and disease

Abstract

A complex relationship links biliary symptoms with the mechanisms of gallbladder emptying and the presence of gallstones. This relationship has been investigated by clinical studies of symptoms associated with gallstones, by investigation of gallbladder emptying and cholecystokinin (CCK) release in patients with gallstones, and after cholecystectomy, or truncal vagotomy, and in the irritable bowel syndrome (IBS). Laboratory studies examined receptor density on bovine gallbladder, and contractility of human gallbladder in response to a variety of stimuli was studied in vitro . A set of six symptoms associated with the presence of gallstones was identified; IBS appeared to be present in two-fifths of patients before cholecystectomy but only one-third of these patients had persistent IBS symptoms one year after operation. Gallbladder emptying studies confirmed the poor contraction of stone-bearing gallbladders; abnormal patterns of emptying were also found in patients with IBS. Gallbladder emptying and filling appear to be largely neurally regulated. CCK receptor density was very low in gallbladder tissue, suggesting that receptors on nerve cells might mediate the action of CCK. Relaxation of gallbladder muscle was mediated by adrenergic and nitrergic nerves. The inflammatory mediator bradykinin, however, had a strong direct action on muscle cells to cause gallbladder contraction. The work reported here gives an overview of the symptoms and mechanisms of disease associated with the presence of stones in the gallbladder.

Simultaneous/Incidental Cholecystectomy During Gastric/Esophageal Resection: Systematic Analysis of Risks and Benefits

“…Since then, a number of pathophysiological studies have been performed to determine the mechanisms behind this possible effect, suggesting that resection of the anterior hepatic branch of the vagal nerve interrupts the innervation of the gallbladder [6]. Vagotomy has been shown to reduce gallbladder emptying in some but not all studies, and gallbladder emptying also is related to cholecystokinin release, which is increased after vagotomy [7][8][9][10][11][12][13][14][15]. Although the exact pathophysiological mechanisms are not clear, upper gastrointestinal (GI) surgery may potentially impact gallstone formation by altered gallbladder filling and emptying and/or response to and secretion of cholecystokinin [16][17][18].…”

Assessment of Bio-social Aspect with Cholelithiasis Patients in Baghdad City

“…The majority of the groups were not in use of contraceptive drugs were accounted (65%), and the duration of use contraceptive from (1-5) years accounted (13%) for the cases. This table indicated that the mean of scores for items of the signs and symptoms, it indicated that, highly mean of score on items (3,4,5,6,8), and the remaining items were medium mean of score on items (1, 2, 7), and no mean of score on items 9. This table revealed that the mean of scores for items of the dietary pattern, is highly mean of score on items (4, 7, 9, 10, 11, 13, 15); and the remaining items were medium mean of score on items (1, 2, 5, 6, 12, 14 16); and no mean of score on items (3,8).…”

“…Another researcher noted that an increase in serum cholesterol and lipid levels in pregnancy, along with biliary stasis lead to a higher incidence of cholelithiasis (3) .…”

“…In the USA. (20%) of persons aged, (40) years, have gallstones and each year, (500,000) undergo cholecystectomy (3) . Research interest during the last two decades has been focused on the metabolism of biliary lipids and its relationship to gallstone formation, It has become evident that a disturbed metabolism of cholesterol or bile salt constitutes a major factor in gallstone formation (4) A clinical picture emerges that relies on the five ''F''s.…”

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“…As to the involvement of gallbladder in IBS, the reports have been conflicting. A small percentage of patients with IBS may have gallbladder disease[ 2 ], and some studies have shown normal[ 3 , 4 ], others enhanced[ 5 ], or impaired [ 6 ]gallbladder emptying in IBS. Despite these contradictions there is a higher rate of cholecystectomy in patients with IBS than that predicted in the general population[ 5 , 7 ].…”