INTRA-OPERATIVE AND POST-OPERATIVE OBSERVATIONS ON BILE ACIDS IN THE BILE IN PATIENTS WITH BILIRUBINATE GALLSTONE

Several methods are now available to quantitate the amount of bile acids in the bile. The assessment by Gas-Liquid-Chromatographic determination has the advantages of measuring each bile acid individually and being accurate as mentioned in this paper. 30 bile samples were obtained from five patients with bilirubinate gallstones. Four major bile acids in the bile were studied
It was found that the average total amount of bile acids in the bile of 5 intraoperative samples was reduced, and that the ratios between four major bile acids and their amount were changed. The ratio between primary bile acids CA/CDCA equaled to 1.34, the amount of secondary tile acid LCA was increased, white that of DCA was decreased. The reduction in the total amount makes the unconjugated bilirubin precipitate easier, and the increase of LCA makes the bile more viscous. These factors may result in the formation of calcium bilirubinate particles and bilirubinate polymers, leading to bitirubinate gallstone
The bile obtained from T-tube was also studied, showing that the amount of the bileacids on the second day after operation was markedly decreased. The average amountwas only 43% of the bite obtained during the operation, but the bilirubin in the same sample was increased about 3-4 folds. It is reasonable to think that this change is an important factor for bilirubinate gallstone formation.