Bile Salt Cholecystitis. ∗

Abstract

Pancreatic juice, in the case of obstruction at the ampulla of Vater may become activated by some unknown factor and develop a marked proteolytic activity in the pancreatic tissues. In the same manner the digestive power of gastric juice may become so enhanced that a gastric ulcer will be produced. Whatever other factors are active, it is clear that pure gastric juice per se may have the power to erode the gastric mucosa. It has been suggested recently by one of us 1 that similar respect may be due the bile and that it may under certain circumstances acquire a destructive power in the same manner as the gastric juice. The most obvious constituent of the bile which has a toxic and destructive power on body tissues is of course the bile salts, which may exist in solution in the bile in concentrations higher than any other material in the body fluids. As the bile is concentrated in the gall bladder the bile salt content frequently rises to 7 or 8%. While our own studies have indicated that these figures are seldom exceeded, the analyses given in two textbooks of physiological chemistry, Hawk's 2 and Hammarsten's, 3 give the normal concentration of bile salts at about 10%.

Protocols. Two forms of bile salts were used: (1) so-called Purified Bile Salts (Armour and Company); (2) the same material freed by alcohol extraction from the very large percentage of non-alcohol-soluble material which it contains. The injections were all made by the non-traumatic technique discussed above. Twenty-two dogs were operated upon, six of these serving as controls. Sixteen dogs received 20-35 cc. of 10-15 or 20% bile salts. The controls consisted of the introduction of the catheter alone (4 dogs) and the introduction of a catheter plus a washing of the gall bladder with normal salt solution (2 dogs). All the controls showed normal gall bladders with the exception of one which revealed a little bleeding on the serosa.