Studies on Gallbladder Function. Ix. The Anion-Cation Content of Bile From the Normal and Infected Gallbladder

Abstract

In an earlier paper (1) we discussed the anion-cation concentration of normal hepatic bile when subjected to the activity of the dog's normal gallbladder. Under these conditions the chloride and bicarbonate concentrations and the pH of hepatic bile decrease, while the base, bile salt and calcium concentrations increase. In every instance fluid is absorbed. In a very limited number of observations we have found the depression of the freezing point of hepatic and gallbladder bile approximately the same, although the total anion-cation concentration was increased considerably in the latter.As a prelude to the anion-cation studies we had studied the effect of gallbladder activity on certain of the individual constituents of hepatic bile when placed in the normal bile-free gallbladder of the unanaesthetized dog (2) (3) (4). It was observed that when the gallbladder became infected the activity of the membrane on the constituents studied was altered considerably. In such instances, water was only slowly absorbed; or, in the more severely damaged organ, fluid actually poured into its lumen, the latter action being a complete reversal of the normal mechanism. Under these circumstances chloride and bicarbonate entered the gallbladder lumen with the inflowing fluid, the chloride concentration of the secreted fluid being about plasma level while the total CO2 concentration was often several times the normal plasma level. Calcium, introduced as calcium lactate, was precipitated, partly in the gallbladder lumen, and partly in the gallbladder wall. Cholesterol in either a colloidal suspension, or in hepatic bile, increased in concentration, but not in total amount when placed in the normal gallbladder. The same was true of bile pigment. When, however, the gallbladder was infected the total amount of cholesterol increased, while the total amount of bile pigment decreased (5).These isolated observations made at a time when we were chiefly concerned with normal function convinced us that a study of the anioncation changes in hepatic bile subjected to the activity of an abnormal 1 Harriet M. Frazier Fellow in Research Surgery. 67

The Composition of Human Gallbladder Bile and Its Relationship to Cholelithiasis

“…The relatively low chloride figures may be contrasted with the high values observed in pathological material described in the next section. Similar differences have been observed by Johnston et al (10). The concentration of chloride varies inversely with that of bile acid and compensates changes in the latter.…”

“…It must be conceded, however, that crystals could not be found in the abundance that is ordinarily characteristic of bile from pathological gallbladders. The importance of the ratio between bile acid and cholesterol as a factor governing the solubility of cholesterol has been stressed by Newman (30), Andrews, Schoenheimer and Hrdina (31), and Johnston et al (10). Such a relationship between cholate and cholesterol may be seen in the present series.…”

“…However, in the presence of moderate cholecystitis the relatively high concentration of chloride present in hepatic bile not only remains undiminished, but, as bile acid diffuses from severely damaged gallbladders bicarbonate is more often decreased. It appears that the abundant secretion of bicarbonate in the dog described by Ravdin, Johnston, Austin and Riegel (34) (21), and Johnston et al (10) have shown that injury to the mucosa of the gallbladder causes the pH and bicarbonate of dog's gallbladder bile to increase. Again, the differences in the chemical properties of the predominating bile acids in human and dog bile aid in explaining the inconsistency.…”

“…Riegel, Ravdin, Johnston and Morrison (33) have reported high chloride concentration in hydrops fluid. The importance of increased chloride as an indicator of gallbladder dysfunction has been stressed by these workers (10).…”