THE COMPOSITION OF THE BILE FOLLOWING THE RELIEF OF BILIARY OBSTRUCTION 1

Abstract

The composition of the bile following the relief of biliary obstruction was studied in 9 cases. The total daily output of bili-rubin was more or less constant and was not related to the other factors studied. The concentration varied inversely with the volume of the bile. One or 2 patients showed some evidence of a washing out of retained pigment, but if this occurred in all it took place so slowly as not to be apparent in observations of short duration. Biliary obstruction inhibits the formation of bile acids. If the liver is not too greatly injured there is a relatively rapid return to normal; otherwise the return is greatly delayed. This was true both with regard to the concentration and total amount of bile acids. The concentration of chlorides in the bile is slightly greater than that in the blood serum. With cholerrhagia, the resultant loss of salts becomes so great as to be of clinical significance. The loss of fluids by this channel may also be so great as to cause diminution in the output of urine. The concentration of urea in the bile apparently varies directly with that in the blood. Ordinarily this pathway of elimination is not significant, but in 1 case there was considerable loss of urea through the fistula.