Stratification (layering) of bile in the normal gallbladder

Kaufman, Seymour A.

doi:10.1007/bf02232157

Cited by 6 publications

(9 citation statements)

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“…Approximately 30 minutes after injection of the contrast agent, films may show a dense rim of contrast around the periphery of an otherwise radiolucent gallbladder [2,5,6,8,9]. This opaque edge ring is produced as dilute contrast-laden bile enters through the cystic duct, distending the gallbladder to accommodate the increased volume, and then dissects along the path of least resistance between the gallbladder wall and the nonopacified, inspissated bile in the center.…”

Section: Discussionmentioning

confidence: 99%

“…This opaque edge ring is produced as dilute contrast-laden bile enters through the cystic duct, distending the gallbladder to accommodate the increased volume, and then dissects along the path of least resistance between the gallbladder wall and the nonopacified, inspissated bile in the center. This creates a picture which is too often misinterpreted as an opacified gallbladder containing a large, solitary calculus [2,5,6,8,9]. Progressively over the next 30 minutes, the opacified bile streams through channels in the contrast-free bile, producing a mottled appearance which may then be mistaken for multiple smaller gallstones (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Stratification or layering of contrast-laden bile in the gallbladder is a roentgenographic phenomenon which occurs during both oral cholecystography [1,2] and intravenous cholangiography [2 8]. In the past there were divergent views on the significance of stratification, some regarding it as a situation predisposing to the formation of gallstones and others regarding it as a normal phenomenon.…”

mentioning

confidence: 99%

“…In the past there were divergent views on the significance of stratification, some regarding it as a situation predisposing to the formation of gallstones and others regarding it as a normal phenomenon. It is now universally accepted that transient layering of contrast is a normal finding resulting from normal gallbladder function [2,3,5,8,9].…”

mentioning

confidence: 99%

“…Stratification is generally considered to be uncommon [2][3][4]6], and, indeed, this has been our experience with oral cholecystography. However, during intravenous cholangiography, we are able to demonstrate contrast-bile layering in the majority of studies in which the gallbladder is opacified.…”

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confidence: 99%

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Stratification in the gallbladder during intravenous cholangiography

Shaffer

Harrison

1978

Gastrointest Radiol

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The stratification (layering) phenomenon in the gallbladder is a source of errors in interpretation of intravenous cholangiography. It may mimic stones that do not exist or conceal stones that do. To avoid false-positive or false-negative interpretations, it is suggested that delayed films be taken at 4 hours in cases which demonstrate a layering phenomenon. By this time, a normal gallbladder will be homogeneously opacified and a diseased one will reveal its stones. Horizontal beam roentgenograms are mandatory for complete evaluation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Stratification in the gallbladder during intravenous cholangiography

Shaffer

Harrison

1978

Gastrointest Radiol

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Functions of the Gallbladder

Housset

Chrétien

Debray

et al. 2016

Comprehensive Physiology

129

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The gallbladder stores and concentrates bile between meals. Gallbladder motor function is regulated by bile acids via the membrane bile acid receptor, TGR5, and by neurohormonal signals linked to digestion, for example, cholecystokinin and FGF15/19 intestinal hormones, which trigger gallbladder emptying and refilling, respectively. The cycle of gallbladder filling and emptying controls the flow of bile into the intestine and thereby the enterohepatic circulation of bile acids. The gallbladder also largely contributes to the regulation of bile composition by unique absorptive and secretory capacities. The gallbladder epithelium secretes bicarbonate and mucins, which both provide cytoprotection against bile acids. The reversal of fluid transport from absorption to secretion occurs together with bicarbonate secretion after feeding, predominantly in response to an adenosine 3',5'-cyclic monophosphate (cAMP)-dependent pathway triggered by neurohormonal factors, such as vasoactive intestinal peptide. Mucin secretion in the gallbladder is stimulated predominantly by calcium-dependent pathways that are activated by ATP present in bile, and bile acids. The gallbladder epithelium has the capacity to absorb cholesterol and provides a cholecystohepatic shunt pathway for bile acids. Changes in gallbladder motor function not only can contribute to gallstone disease, but also subserve protective functions in multiple pathological settings through the sequestration of bile acids and changes in the bile acid composition. Cholecystectomy increases the enterohepatic recirculation rates of bile acids leading to metabolic effects and an increased risk of nonalcoholic fatty liver disease, cirrhosis, and small-intestine carcinoid, independently of cholelithiasis. Among subjects with gallstones, cholecystectomy remains a priority in those at risk of gallbladder cancer, while others could benefit from gallbladder-preserving strategies. © 2016 American Physiological Society. Compr Physiol 6:1549-1577, 2016.

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Layering of contrast material in oral cholecystography

Bryk

Moadel

1975

Digest Dis Sci

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Serial erect roentgenograms of the gallbladder during oral cholecystography were taken in 50 patients before and after a fatty meal. In the presence of good opacification, layering of opaque and nonopaque bile was noted in most cases 2 hours after the fatty meal. The degree of layering was related to the extent of gallbladder contraction produced by the fatty meal and the degree to which the gallbladder refilled by the inflow of nonopaque liver bile. The layering phenomenon thus appears to be a manifestation of a normally functioning gallbladder and occurs when the gallbladder refills with fresh nonopaque bile.

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Stratification (layering) of bile in the normal gallbladder

Cited by 6 publications

References 1 publication

Stratification in the gallbladder during intravenous cholangiography

Stratification in the gallbladder during intravenous cholangiography

Functions of the Gallbladder

Layering of contrast material in oral cholecystography

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