Studies on Cholelithiasis, particularly on the Relations between Bile Acids in Bile and the Infection of the Bile Ducts

Abstract

Some etiological studies of gall stones and of cholecystitis have ever been made and discussed from various angles and now it is apparent that the infection of the bile ducts plays important roles etiologically for them, aside from the problem whether it is concerned with them primarily or secondarily. But the infection theory contains some contradiction which is pointed out by various researchers in the fact that even many ba-cteria instillated into the gall bladder do not cause the formation of gall stones or cholelithiasis so easily.
On the other, Prof. Matsukura has ever noticed the fact that in cholelithiasis and cholecystitis the concentration of bile acids, particularly of dihydroxycholanic acid, is conspicuously lowered in comparison with that of normal cases and advocated the significance of the low concentration of dihydroxycholanic acid in the infection of the bile ducts, based upon various clinical and experimental studies made in his laboratory.
The author made some serial clinical and experimental studies on bile acids in bile, particularly the significance of the substance “Dihydroxycholanic Acid” in the infection of bile ducts, as one part of the etiological studies of cholecystitis and gall stones undertaken in the laboratory and obtained some results as follows.
1) The concentration of dihydroxycholanic acid in bile of healthy person or of patients with gastroduodenal ulcers is high, ranging from 30 to 60 mg/cc, while in cholelithiasis and cholecystitis, the levels are mostly in a range less than 20 mg/cc.
2) No bacteria were detected in the bile of healthy person or of the patients with gastroduodenal ulcer. But in bile of cholelithiasis or of cholecystitis, showing the level of dihydroxycholanic acid in a range less than 20 mg/cc, bacteria were found and isolated.
3) Coli-bacilli occupied the majority among the microorganisms isolated from the bile of cholelithiasis and of cholecystitis.
According to these clinical and experimental studies, it can be presumed that in cholecystitis and in cholelithiasis, the colibacilli played the cardinal role and the infection of the bile ducts with coli-bacilli is closely related with the lowering of the concentration of dihydroxycholanic acid in bile.
The author made a experimental study regarding the relation between the lowering of the concentration of the acid and the infection of the bile ducts in rabbit and following results were obtained.
4) The level of the dihydroxycholanic acid in the normal rabbit ranged from 70 to 110 mg/cc but if the occlusion of the bile ducts was artificially made at the Vater's ampullae where the choledochus joins the duodenun, the level increased slightly on the 2nd postoperative day but then decreased gradually up to the levels of 12 to 32 mg/cc on the 8th day, showing apparently the lowering tendency.
5) In normal rabbits which accepted colibacilli through the portal vein and in the group of rabbits of which liver function was damaged with carbon tetrachloride and 2, 4-diaminotoluene, coli-bacilli were detected in both of the groups but the numbers of the bacilli were markedly small and the slight increase of the bacilli was observed only in one case out of those with damage of the liver function. But in all of ten cases with the occlusion of the bile ducts, a great number of bacilli were observed. Moreover, in 8 cases, gall stones were constituted and in 2 cases bile sands were seen.
6) 1. In liver of normal rabbits which were instillated coli-bacilli through the portal vein, very slight inflammatory changes were seen, but at the gall bladder no inflammatory changes were seen grossly as well as histologically.
2. In livers of rabbits as well as in the gall bladder, with the damaged liver function and instillation of coli-bacilli through the portal vein, almost no inflammatory change was observed in the gall bladder.