Relative Toxicity of Different Bile Salts on the Normal Gall Bladder.

Abstract

In a previous publication we have shown that an experimental increase of the bile-salt concentration in the bile produces changes in the gall bladder wall similar to “human cholecystitis” Sixteen experiments had been performed, using “commercial bile-salts” (Armour and Company), and so-called “purified bile-salts”, i. e., the commercial variety freed from non-alcohol soluble impurities by alcohol precipitation. The latter proved the more effective preparation of the two. The technique employed consisted of the retrograde introduction of a fine ureter catheter into dog's gall bladders through an opening in the common duct and introduction of the bile-salt solution through this catheter. To elucidate this action further, we have made a more thorough investigation using different bile-salt fractions. The following results were obtained from 55 additional experiments: The process of hydrolyzing increases rather than decreases the effectiveness of the bile salts. While a 20% solution causes a tremendous reaction on the gall bladder wall, a concentration as low as 8.7% still produces a marked effect. Two cases of bile peritonitis occurred in this group. In a series of 13 experiments, a special study was made of Na desoxycholate. This proved to be the most powerful fraction, a concentration of 15% causing gangrene of the gall bladder wall, bile peritonitis, or even death, while even a concentration of 7.5% gave a marked reaction. Cholic and apocholic acid are slightly weaker in their actions than desoxycholic acid, apocholic being the stronger of the two. Positive reactions were obtained with 7% apocholic acid, while higher concentrations of cholic acid were necessary to produce similar changes. Glycocholic acid, on the other hand, has much less effect on the gall bladder wall than the fractions described above. An 8% solution yielded a normal gall bladder regularly, a reaction being obtained only with a 13% solution. Injection of taurocholic acid, obtained by evaporation of dog bile to about one-third of its volume, however, gave strongly positive results, i. e., bile peritonitis and death accompanied by a marked change in the gall bladder wall. For the sake of completeness, we examined the action of Decholin (Dehydrocholic acid), which is used in the medical management of human cholecystitis. A 20% solution can be injected into the dog's gall bladder without producing a marked reaction in the gall bladder wall.