Analysis of bile acids using thin-layer chromatography was conducted to evaluatepathological changes in diseases of the biliary tract system.
Studies were performed on 108 patients with cholelithiasis and/or cholecystitis, 22cases with cancer of the biliary tract, 2 cases with stricture of the common bile duct and 10 control patients.
Hepatic bile or gall-bladder bile were obtained at the time of percutaneous transhepatic cholangiography or operation, or from T-tube drainage.
Glycocholic, glycodihydroxycholic, taurocholic and taurodihydroxycholic acids were determined separetely by Gänshirt's method.(Dihydroxycholic acid was calculated as deoxycholic acid).
The following results were obtained.
1) In biliary tract diseases there were some cases with lower ratio of glycine conjugated bile acids to taurine conjugated bile acids (G/T ratio) than control; i. e. the G/T ratio was slightly diminished in cholelithiasis, while remarkable decrease was noted in cancer of the biliary tract and benign stricture of the bile duct.
2) In cholelithiasis, the decrease of G/T ratio corresponded with the severity of inflammatory changes of the gall-bladder wall.
3) The G/T ratio decreased when there were abnormalities in serum transaminase and alkaline phosphatase or liver histology. These findings suggest that the lower G/T ratio indicates abnormality of function and structure of the liver.
4) In a study of the biliary excretion of bile acids in 35 patients with choledochotomy drainage, it was found that the mode of postoperative change of the G/T ratio could be classified into 3 types as follows:
i) Type I: In this group, the G/T ratio increased and reached a plateau (G/T>4) after the fourth to fifth postoperative day. Prognosis for this group was excellent.
ii) Type II: In this group, the G/T ratio increased very slowly and remained low.
iii) Type III: In this group, the G/T ratio increased very slowly and was not more than 1.5 after the 14th postoperative day.
5) It is concluded that morphological and functional disturbance of the liver is not seen in Type I, whereas structural and functional derangement of the liver is seen in Type II and noted remarkably in Type III.
These findings can be applied to ascertain the course of recovery of liver function and to aid in determining when to withdraw drainage after operation of the biliary tract.
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