Gall Bladder Versus Sphincter Papillae.

Abstract

An analysis of the contraction curves of the human gall bladder, constructed from cholecystograms taken at short intervals after a meal of egg yolk and cream, indicates that the average gall bladder discharges approximately ¾ of its volume in the first half hour after each meal. The first phase of contraction in which this is accomplished, is usually divided into three parts: the “initial response” (usually of 2 minutes duration), the “2-minute pause”, and the “principal period of discharge”. On the basis of Elman and McMaster's work on the sphincter of the dog, 1 the sudden discharge of the first 2 minutes is interpreted as being due to the opening of the sphincter; the interruption of emptying during the next 2 minutes to the initial increase in resistance offered by the sphincter to the flow of bile (as described by these authors); and the subsequent “principal discharge” to the contractile force of the gall bladder which, after slowly getting under way, is able for a time to overcome the growing resistance at the outlet of the common duct. That even the “initial response” (after ingestion of fatty foods) is partly due to contraction and not wholly to elastic recoil, is indicated by the change in shape which the human gall bladder undergoes during these first 2 minutes—that shape being then assumed which is characteristic of the rest of the first phase of contraction. (See also Ivy's demonstration 2 of the contraction and evacuation of the gall bladder caused by the intravenous injection of highly purified “secretin” preparations.)

Experiments designed to verify this action of the sphincter, show that stimuli other than the ingestion of food may provoke this “initial response”. When a patient, for instance, is suddenly subjected to the odor of fried bacon, there ensues a momentry discharge of bladder bile (1 to 3 cc.)—cornparable in duration to the initial drop in resistance of the sphincter described by Elman and McMaster, for in 2 minutes the gall bladder begins to fill again, in spite of the fact that the patient continues to smell food.