Changes In Gallbladder Volume Research Articles

Population-Based PBPK Model for the Prediction of Time-Variant Bile Salt Disposition within GI Luminal Fluids.

In vivo studies have shown cyclic bile salt (BS) outputs during fasting whereas higher amounts have been observed in fed states. This leads to fluctuations of intestinal BS concentrations ([BS]) that can affect the rate and extent of absorption of lipophilic drugs in particular. However, most PBPK models use fixed values of [BS] in fasted and fed states albeit with different values in different regions of the GI tract. During fasting, there is a relationship between gallbladder volume (GBV) and the phase of the Interdigestive Migrating Motor Complex cycle (IMMCc), showing cyclic GBV changes with periodic filling and emptying. This relationship is also affected by the origin of the IMMCc (antral or duodenal). In fed states, meta-analysis indicated that GB residual volume (% of fasting maximum) was 46.4 ± 27%CV and 30.7 ± 48%CV for low- and high-fat meals, respectively. The corresponding values for the duration of the emptying phase were for low fat meals 0.72h ± 1%CV and for high fat meals 1.17h ± 37%CV. The model, the Advanced Dynamic Bile Salt Model (ADBSM), was built bottom-up and its parameters were not fitted against in vivo measurements of [BS]. It involved update of the dynamic luminal fluid volumes model based on meta-analysis of available imaging data. The ADBSM is incorporated into the Simcyp (v18r2) PBPK simulator. The model predictivity was good (within 1.25-fold error for 11/20 of the clinical studies) and was assessed against clinical studies of luminal [BS] that provide only the type of meal (i.e., low- or high-fat), the timing of the meal and/or water intake events, and the number and age range of the study participants. The model is also an important component of models capturing enterohepatic recirculation of drug and metabolite. Further work is required to validate the current model and compare to simpler models with respect to drug absorption, especially of the lipophilic compounds.

Prospective study on changes in the donor gallbladder contraction function after left lateral lobe hepatectomy.

This study aimed to evaluate the feasibility of donor gallbladder preservation in liver transplantation. Conventional removal of the donor gallbladder is applied in a majority of pediatric liver transplantation. A total of 42 donors who underwent gallbladder preservation in liver transplantation from October 2013 to December 2015 at the Beijing Friendship Hospital, China, were enrolled for the study. The changes in gallbladder volume and the gallbladder EF of donors before and after surgery were measured through ultrasound, and the changes in the donor gallbladder contraction function before and after surgery were evaluated to help verify the feasibility of gallbladder preservation in living donor left lateral lobe hepatectomy. The gallbladder emptying index dropped to 42.67% in 2weeks after surgery and gradually increased with the length of recovery time, which could reach 69.14% in 3months after surgery. At that time, 97.6% of the donors were considered to have recovered their gallbladder contraction function. The gallbladder contraction function at an early stage after gallbladder preservation in liver transplantation is not obviously improved, but it can recover to a normal level in 1month after surgery, indicating that the gallbladder preservation in hepatectomy of living donor can effectively guarantee the gallbladder contraction function.

Sonographic Evaluation of Effect of Smoking and Fatty Meals on Gallbladder

Background: It is well established that fatty food causes gallbladder contraction by releasing cholecystokinin (CCK). Smoking also causes contraction of gallbladder. There are a limited number of studies evaluating the effect of smoking and fatty meals on gallbladder motility by ultrasonography.Objective: The aim of this study is to see the effect of smoking on gallbladder contraction in comparison with fatty meals.Materials and Methods: This cross sectional study was conducted on thirty young adult male volunteers having age between 18−40 years in the department of Radiology and Imaging of Bangabandhu Sheikh Mujib Medical University. Unbiased gallbladder volume measurement of each volunteer was taken on two separate days before and after taking fatty food and as well as before and after smoking at 5,15, 30 and 60 minutes interval. All information were meticulously recorded in structured data collection sheet and analyzed statistically. Then mean gallbladder volume changes against time were presented graphically for two groups using the pre and post smoking values.Results: The result shows that smoking has contractile effect on gallbladder like fatty food. The mean comparison of net change of gallbladder volume before and after smoking and before and after fatty food intake in both smoker and non-smoker groups has been statistically significant (p<0.05).Conclusion: Fatty food and smoking should be strictly prohibited before ultrasonography of hepatobiliary system for better evaluation.J Enam Med Col 2018; 8(1): 29-34

Angioarchitecture of gallbladder in pig: LM and SEM study on vascular microcorrosion casts.

The study focused on the description of pig gallbladder angioarchitecture, with particular emphasis on the specifics of the course of blood vessels in individual layers of the gallbladder wall. Furthermore, the vascular systems of the pig gallbladder were analyzed in terms of the adaptation of this organ to changes in its volume during cyclical bile storage and discharge. The gallbladder is supplied by the cystic artery, which in the pig represents a mixed pinnate and bipinnate pattern of branching. The light microscopic and scanning electron microscopic observations of three-dimensional vascular corrosion casts showed the presence of two main complex vascular networks in the wall of the gallbladder, one located in the subserosal and the other in the mucosa. The unique features in the pig, connected with the size of the gallbladder, is the well-developed horizontal venous plexus under folds of the mucosa, which is a voluminous reservoir of fluids absorbed from bile and vascular networks around mucous glands. Superficial blood vessels of the gallbladder run in vascular pairs or triads, where a single artery runs between two veins. The structures of blood flow control, that is, venous valves, were observed only in venules of the subserosal plexus. Spatial arrangement of the vascular network in the pig gallbladder shows functional plasticity during changes in gallbladder volume. The course of superficial blood vessels in the well-filled gallbladder is arcuate, while in the empty gallbladder it is undulated or spiral. In the mucosal and intramural vessels the direction of blood vessels may change from perpendicular to oblique.

Visualization of Bile Movement Using MRI Spin-Labeling Technique: Preliminary Results

The purpose of this article is to noninvasively visualize intrabiliary bile movement using an MRI spin-labeling technique and administration of water, full-fat milk, and negative contrast agent as stimuli for bile excretion. Six healthy volunteers underwent three studies with each of three oral liquid agents (water, full-fat milk, and manganese chloride solution) for a total of 18 MRI studies. Oblique-coronal T2-weighted images of the common bile duct were acquired at an inversion time of 1500 milliseconds after pulse labeling using a spin-labeling technique with an inversion pulse, repeated at intervals of 22 seconds. Bile flow rate was measured before and for 50 minutes after administration of the oral liquid agents, and its correlation with the change in gallbladder volume was assessed. Both anterograde and retrograde intermittent bile movements were successfully visualized in the common bile duct. The summation of excreted bile volume calculated from spin-labeled images correlated significantly with a decrease in gallbladder volume (p = 0.011). Milk stimulated significantly prolonged bile flow; flow was momentary with manganese chloride and mild with water; however, gallbladder volume decreased only in milk studies (p = 0.003). Biliary flow early after oral intake correlated significantly with gallbladder contractility at 50 minutes after oral intake (p = 0.049). A new method for visualizing intrabiliary bile movement in semi-real time (22-second time resolution) using an MRI spin-labeling technique was proposed. Bile was shown to be excreted in a to-and-fro type of movement. Administration of water and negative contrast agent may induce temporary bile excretion.

Ultrasonographic evaluation of preprandial and postprandial gallbladder volume in healthy cats

To noninvasively assess the influence of ingestion of a standard meal on gallbladder volume (GBV) in healthy cats. 10 healthy adult domestic shorthair cats (4 neutered females, 5 neutered males, and 1 sexually intact male). Nonsedated cats were positioned in dorsal and left lateral recumbency to obtain ultrasonographic measurements of the gallbladder via the subcostal and right intercostal acoustic windows, respectively. Gallbladder volume was calculated from linear measurements by use of an ellipsoid formula (volume [mL] = length [mm] × height [mm] × width [mm] × 0.52). Measurements were recorded after food was withheld for 12 hours (0 minutes) and at 5, 15, 30, 45, 60, and 120 minutes after cats were fed 50 g of a standard commercial diet (protein, 44.3%; fat, 30.3%; and carbohydrate, 15.6% [dry matter percentage]). Agreement between gallbladder linear measurements or GBV obtained from the subcostal and right intercostal windows was good. Feeding resulted in linear decreases in gallbladder linear measurements and GBV. Via the subcostal and intercostal windows, mean ± SD GBV was 2.47 ± 1.16 mL and 2.36 ± 0.96 mL, respectively, at 0 minutes and 0.88 ± 0.13 mL and 0.94 ± 0.25 mL, respectively, at 120 minutes. Gallbladder width most closely reflected postprandial modification of GBV. Results indicated that ultrasonographic assessment (via the subcostal or right intercostal acoustic window) of postprandial changes in GBV can be used to evaluate gallbladder contractility in cats. These data may help identify cats with abnormal gallbladder emptying.

Gallbladder disease in pregnancy

Objective To assess the prevalence & incidence of biliary sludge and stones during pregnancy and to measure the changes in gallbladder volume.

Pathophysiological significance of gallbladder volume changes in gallstone diseases

To study the pathophysiological significance of gallbladder volume (GBV) and ejection fraction changes in gallstone patients. The fasting GBV of gallstone patients with acute cholecystitis (n = 99), chronic cholecystitis (n = 85) and non-gallstone disease (n = 240) were measured by preoperative computed tomography. Direct saline injection measurements of GBV after cholecystectomy were also performed. The fasting and postprandial GBV of 65 patients with gallstones and chronic cholecystitis and 53 healthy subjects who received health examinations were measured by abdominal ultrasonography. Proper adjustments were made after the correction factors were calculated by comparing the preoperative and postoperative measurements. Pathological correlations between gallbladder changes in patients with acute calculous cholecystitis and the stages defined by the Tokyo International Consensus Meeting in 2007 were made. Unpaired Student's t tests were used. P < 0.05 was deemed statistically significant. The fasting GBV was larger in late stage than in early/second stage acute cholecystitis gallbladders (84.66 +/- 26.32 cm(3), n = 12, vs 53.19 +/- 33.80 cm(3), n = 87, P = 0.002). The fasting volume/ejection fraction of gallbladders in chronic cholecystitis were larger/lower than those of normal subjects (28.77 +/- 15.00 cm(3) vs 6.77 +/- 15.75 cm(3), P < 0.0001)/(34.6% +/- 10.6%, n = 65, vs 53.3% +/- 24.9%, n = 53, P < 0.0001). GBV increases as acute cholecystitis progresses to gangrene and/or empyema. Gallstone formation is associated with poorer contractility and larger volume in gallbladders that contain stones.

The effects of paramagnetic contrast agents on the gallbladder volume

Iodinated contrast agents lead to contraction of the gallbladder. The purpose of this prospective study was to investigate whether the paramagnetic contrast agents used for magnetic resonance imaging (MRI) cause volume changes in gallbladder or not. The gallbladder volume changes were evaluated by ultrasound just before and 15 minutes after the imaging procedure in 10 patients without any paramagnetic contrast agent administration and 36 patients in whom paramagnetic contrast agents were administered during MRI. Gallbladder volume measurements before and 15 minutes after MRI were compared with each other. The mean pre- and post-procedural gallbladder volumes in patients on paramagnetic contrast agents were 30.2 +/- 19.3 cm(3) and 27.8 +/- 13.5 cm(3), respectively. They were 31.8 +/- 15.0 cm(3) and 29.5 +/- 9.3 cm(3), respectively, in patients who were not administered any paramagnetic contrast agent. There were no statistically significant difference between groups, regarding pre- and post-MRI gallbladder volumes. MRI, with or without paramagnetic contrast agents, does not lead to gallbladder volume contraction. In that regard, there appears to be no need to avoid ultrasound aimed to evaluate the gallbladder after MRI examinations.

The G protein-coupled receptor G2A: Involvement in hepatic lipid metabolism and gallstone formation in mice

The G2A receptor is a member of the ovarian cancer G protein-coupled receptor 1 family of stress-inducible G protein-coupled receptors. In this study, we examined the hepatobiliary effects of loss of function of G2A in mice fed either a chow or lithogenic diet. G2A-deficient (G2A(-/-)) mice fed chow had a 25% reduction in biliary phosphatidylcholine content, reduced hepatic gene expression of the phosphatidylcholine transporter adenosine triphosphate-binding cassette B4, and an 8-fold increase in expression of the nuclear receptor liver X receptor (LXR). Despite the increased expression of LXR, transcription of several LXR target genes was reduced. G2A(-/-) mice fed a lithogenic diet had rapid gallstone formation, an increased cholesterol saturation index, a 2.5-fold increase in farnesoid X receptor expression, a 5-fold increase in LXR expression, and a 90% reduction in cholesterol 7alpha-hydroxylase expression in comparison with wild-type mice. There were no changes in gallbladder volume. These data demonstrate that the G2A receptor is important for hepatobiliary bile salt, cholesterol, and phospholipid homeostasis and for the pathogenesis of cholesterol gallstone formation.

Changes in gallbladder volume in healthy dogs after food was withheld for 12 hours followed by ingestion of a meal or a meal containing erythromycin

To assess the influence of meal ingestion and orally administered erythromycin on gallbladder volume in dogs. 22 healthy dogs. Ultrasonographically determined gallbladder dimensions in unsedated dogs were used to calculate volume. Measurements were recorded after food was withheld for 12 hours (time 0) and 15, 30, 45, 60, 90, and 120 minutes after a 100-g meal without (n = 22) or with erythromycin (1.0 mg/kg [7], 2.5 mg/kg [7], and both dosages [8]). Gallbladder ejection fraction represented the percentage of volume change from time 0. Intraday and interday coefficients of variation determined operator repeatability and physiologic variation. We did not detect significant differences in gallbladder volume per unit of body weight between treatments at time 0 or in ejection fraction percentage within or between treatments. Median time 0 gallbladder volume was 0.6 mL/kg (range, 0.4 to 1.9) but was > 1.0 mL/kg in 3 of 22 (14%) dogs and <or= 1.0 mL/kg in 19 of 22 (86%) dogs. Twenty dogs achieved an ejection fraction >or= 25% with at least 1 treatment, but 2 dogs with a gallbladder volume <or= 1.0 mL/kg at time 0 did not. Intraday and interday coefficients of variation were 18% and 25%, respectively. Gallbladder volume <or= 1.0 mL/kg at time 0 and ejection fraction >or= 25% were typical. No treatment consistently induced greater gallbladder contraction. Dogs with a gallbladder volume > 1.0 mL/kg and ejection fraction < 25% may require a combined meal and erythromycin protocol.

The effect of moderate alcohol intake on gallblader motility a milk ultrasonographic study.

ObjectivesTo assess the effect of periodic and moderate alcohol intake on gallbladder motility.MethodsThe ultrasonographic ellipsoid method was used in 21 healthy male subjects: 12 non-alcohol and 9 alcohol drinkers. The stimulus for gallbladder contraction was 165 ml of half cream milk. Gallbladder dynamics were studied for 20 minutes following the ingestion of the milk. The mean percentage change in gallbladder volume after 10 and 20 minutes gave indications of gallbladder motility.ResultsModerate and periodic alcohol intake did not stimulate rapid postprandial gallbladder emptying.ConclusionThe protective effect of alcohol against biliary cholesterol cholelithiasis could not be due to stimulation of gallbladder emptying.

The Effect of Moderate Alcohol Intake on Gallblader Motility A Milk Ultrasonographic Study

Objectives: To assess the effect of periodic and moderate alcohol intake on gallbladder motility. Methods: The ultrasonographic ellipsoid method was used in 21 healthy male subjects: 12 non-alcohol and 9 alcohol drinkers. The stimulus for gallbladder contraction was 165 ml of half cream milk. Gallbladder dynamics were studied for 20 minutes following the ingestion of the milk. The mean percentage change in gallbladder volume after 10 and 20 minutes gave indications of gallbladder motility. Results: Moderate and periodic alcohol intake did not stimulate rapid postprandial gallbladder emptying. Conclusion: The protective effect of alcohol against biliary cholesterol cholelithiasis could not be due to stimulation of gallbladder emptying.

Correlation of Mechanical Factors and Gallbladder Pain

Acalculous biliary pain occurs in patients with no gallstones, but is similar to that experienced by patients with gallstones. Surgical removal of the gallbladder (GB) in these patients is only successful in providing relief of symptoms to about half of those operated on, so a reliable pain‐prediction model is needed. In this paper, a mechanical model is developed for the human biliary system during the emptying phase, based on a clinical test in which GB volume changes are measured in response to a standard stimulus and a recorded pain profile. The model can describe the bile emptying behaviour, the flow resistance in the biliary ducts, the peak total stress, including the passive and active stresses experienced by the GB during emptying. This model is used to explore the potential link between GB pain and mechanical factors. It is found that the peak total normal stress may be used as an effective pain indicator for GB pain. When this model is applied to clinical data of volume changes due to Cholecystokinin stimulation and pain from 37 patients, it shows a promising success rate of 88.2% in positive pain prediction.

Enhancement of intragastric acid stability of a fat emulsion meal delays gastric emptying and increases cholecystokinin release and gallbladder contraction

Preprocessed fatty foods often contain calories added as a fat emulsion stabilized by emulsifiers. Emulsion stability in the acidic gastric environment can readily be manipulated by altering emulsifier chemistry. We tested the hypothesis that it would be possible to control gastric emptying, CCK release, and satiety by varying intragastric fat emulsion stability. Nine healthy volunteers received a test meal on two occasions, comprising a 500-ml 15% oil emulsion with 2.5% of one of two emulsifiers that produced emulsions that were either stable (meal A) or unstable (meal B) in the acid gastric environment. Gastric emptying and gallbladder volume changes were assessed by MRI. CCK plasma levels were measured and satiety scores were recorded. Meal B layered rapidly owing to fat emulsion breakdown. The gastric half-emptying time of the aqueous phase was faster for meal B (72 +/- 13 min) than for meal A (171 +/- 35 min, P < 0.008). Meal A released more CCK than meal B (integrated areas, respectively 1,095 +/- 244 and 531 +/- 111 pmol.min.l(-1), P < 0.02), induced a greater gallbladder contraction (P < 0.02), and decreased postprandial appetite (P < 0.05), although no significant differences were observed in fullness and hunger. We conclude that acid-stable emulsions delayed gastric emptying and increased postprandial CCK levels and gallbladder contraction, whereas acid-instability led to rapid layering of fat in the gastric lumen with accelerated gastric emptying, lower CCK levels, and reduced gallbladder contraction. Manipulation of the acid stability of fat emulsion added to preprocessed foods could maximize satiety signaling and, in turn, help to reduce overconsumption of calories.

THE EFFECT OF MAGNESIUM SULFATE ON THE HUMAN GALLBLADDER

Purpose: Magnesium Sulfate has been used to treat many diseases, such as eclampsia, status asthmaticus. Mg SO4 may increase bile secretion and relax the sphincter Of Oddi, resulting in emptying and consequently a reduction of Gallbladder volume. The aim of the study is to determine the effect of magnesium on human Gallbladder by measuring the gallbladder volume. Methods: A double-blinded prospective study with 6 healthy volunteers. Each volunteer was randomly assigned three different meals on three different days: a fatty meal (positive control), normal saline (negative control) and 2 grams of oral magnesium sulfate. All volunteers fasted overnight and underwent an ultrasound to check the measurements of the gallbladder prior to the administration of a meal and thereafter at intervals of 30 min, 1 hour, 2 hours, and 4 hours After meal (total of 5 ultrasounds each day). The ultrasound operator was blinded to the designated meal during the entire study. The mean post-meal Gallbladder volumes and post-meal percentage change in Gallbladder volume were calculated. Paired T test was used to compare the pre-meal and post-meal Gallbladder volumes, as well as the post-meal Gallbladder volumes between normal saline, fatty meal and MgSO4. Results: The mean pre-meal Gallbladder volumes for fatty meal, MgSO4, and normal saline were 14.22 cc, 14.42cc and 12.52cc respectively. The mean post-meal Gallbladder volumes for the fatty meal, MgSO4, and normal saline groups were, 9.4cc, 11.3cc, 11.6cc respectively, while the mean percentage change post-meal were 32.8%, 24.1%, 5.1%, respectively. There was a significant change in Gallbladder volume post-meal after administration of fatty meal (p = 0.005) and MgSO4 (p = 0.01) compared to pre-meal volume There was a significant difference between mean percentage change in Gallbladder volume between normal saline and fat (p = 0.01) and between normal saline and MgSO4 (p = 0.03). The mean post-meal Gallbladder volumes for the MgSO4 at 30minutes, 1 hours, 2 hours and 4 hours were 11.79, 10.94, 10.65, and 11.98 respectively. The maximal effect occurred at 1 to 2 hours post its administration with p values of 0.0092 and 0.0074 respectively. The mean post-meal Gallbladder volume for normal saline at 30 minutes, 1 hour, 2 hours and 4 hours were 11.92, 11.41, 11.44, and 12 respectively. Conclusions: Our study shows that oral administration of MgSO4 has a significant effect on Gallbladder volume with maximum effect at 1 and 2 hours after medication.

Gallbladder contractility and volume characteristics in gallstone dyspepsia.

It is difficult to differentiate gallstone dyspepsia and functional dyspepsia by clinical symptoms and signs. We hypothesized that gallstone dyspepsia was related to abnormal gallbladder motility. We aimed to differentiate gallstone dyspepsia from functional dyspepsia by measuring gallbladder motility. We measured gallbladder volume changes in response to gastric distension (saline 500 mL) and fatty meal in 10 normal volunteers (controls) and 62 patients with gallstones and dyspepsia before cholecystectomy. Forty cholecystectomized patients were symptom free or had improvement (group I), while the remaining 22 patients had persistent dyspepsia (group II). Gallbladder volume change and ejection fraction were analyzed and compared among the three groups. In group I, there were significant decreases in gallbladder volumes 5-25 min after gastric distension, compared to fasting volumes. Compared to normal volunteers and group II, group I had significantly decreased gallbladder volumes 10-20 min after drinking 500 mL of normal saline and 10 to 50 min after eating fatty meal. Our results support the hypothesis that increased gallbladder contraction after gastric distension or fatty meal may be related to dyspeptic symptoms in uncomplicated gallstone disease. These findings may be useful in differentiating functional dyspepsia from gallstone dyspepsia, patients with the latter disease may benefit from laparoscopic cholecystectomy.

The effect of khat chewing on gallbladder motility in a group of volunteers

An increase in the prevalence of gallstones has been reported from the Middle East and the Republic of Yemen. Changing dietary habits and obesity are thought to be responsible but other local factors may contribute such as chewing the leaves of the khat plant ( Catha edulis Forsk.) which is a widespread social custom in Yemen. We have studied the effects of khat chewing on gallbladder motility in a group of 10 healthy volunteers. All subjects underwent ultrasound measurements of gallbladder volume after chewing khat leaves or lettuce, which was used as the control. Results were compared after chewing for up to 2 h in the fasting state and in response to a fatty meal. There was no significant change in gallbladder volume after chewing khat compared with lettuce in the fasting state ( P=0.7) or in gallbladder emptying after a fatty meal ( P=0.4) and we conclude that khat chewing has no clinically significant effect on gallbladder motility.

Contrast material and gallbladder kinetics: implications for same day sonography after intravenous pyelography or CT scanning.

Sonographic examination of the gallbladder has allowed us to study the effects of various substances on this organ. A prospective study involving 77 patients was undertaken to evaluate the effects of intravenous or oral contrast agents on gallbladder volume changes in patients without known gallbladder disease. A mean volume after contraction of 24.8% was observed after administration of intravenous contrast agent (P < 0.01) and of 31.9% after oral administration (P < 0.01). This phenomenon of contraction of the gallbladder should therefore be recognized when sonographic or computed tomographic evaluation of the gallbladder is undertaken after imaging procedures that use radiographic contrast agents either intravenously or orally.

Stimulation of gallbladder emptying by intravenous lipids.

Few studies have dealt with the effect of i.v. administration of lipids on gallbladder emptying, and the results have been conflicting. Five healthy volunteers, three women and two men, aged 26 to 54 years, (mean, 29 years) were studied. Gallbladder emptying was assessed by means of real-time ultrasonography. In all subjects, the infusion of a 10% fat emulsion (Intralipid; Kabivitrum, Stockholm) over 3 hours caused a reduction in gallbladder volume. This effect was statistically significant at about 80 minutes of lipid infusion and became progressively more marked as the infusion progressed, reaching a reduction of approximately 30% during the third hour of infusion. A significant relationship (p < .001) was found between the concentration of serum triglycerides and the degree of gallbladder volume decrease. In control studies, infusion of physiologic saline containing glycerol, the excipient of intralipid, caused no significant changes in gallbladder volume. The results indicate that i.v. infusion of lipids is able to stimulate significantly contraction of human gallbladder.