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The Hunger Project Bolen Report
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Bile and Biliary Conditions Print E-mail

Dr. Kennedy Bile is a yellow-green fluid made by the liver, stored in the gallbladder and passes through the common bile duct into the duodenum where it emulsifies fat making it available to be digested by an enzyme (lipase) from the pancreas. The principal components of bile are cholesterol, bile salts, and the pigment bilirubin. An imbalance between these components of bile -- cholesterol, bile salts, and bilirubin -- leads to the formation of gallstones. Cholesterol is normally kept in liquid form by the dissolving action of the bile salts; an increased amount of cholesterol in the bile overwhelms the dissolving capacity of the bile salts and leads to the formation of cholesterol gallstones. Similarly, a deficiency of bile salts promotes cholesterol gallstone formation. Bile acid is made by the liver and works with bile to break down fats. Bile acids are derived from cholesterol.

Bile Acid Resin

Bile acid resins are substances (used as mdicines) which bind in the intestines with bile acids that contain cholesterol and are then eliminated in the stool. The major effect of bile acid resins is to lower LDL cholesterol by about 10 to 20 percent. Small doses of resins can produce useful reductions in LDL cholesterol. Bile acid resins are sometimes prescribed with a statin for patients with heart disease to increase cholesterol reduction. When these two drugs are combined, their effects are added together to lower LDL cholesterol by over 40 percent. Cholestyramine (brand name: Questran) and colestipol (Colestid) are the two main bile acid resins currently available. This is a primitive way of dealing with an imaginary problem; nevertheless it is used. The relationship between cholesterol levels and vascular disease is tenuous at best and may be non-existant. It has been refered to by some doctors as The Great Cholesterol Hoax.

Biliary Sand

Biliary sand is a term mostly used by surgeons when they remove the gallbladder to describe uncountable, small particles in bile that are visible to the naked eye. Biliary sand may be looked upon as a stage in the growth of the particles that comprise sludge (which are microscopic and not visible to the naked eye) and gallstones, which are large enough to be counted easily. The composition of biliary sand varies but is similar to the composition of gallstones. The most common components of biliary sand are cholesterol crystals and calcium salts. Biliary sand may cause no symptoms or cause intermittent symptoms.

Biliary Sludge

Bile sludge is a mixture of microscopic particulate matter in bile that occurs when particles of material precipitate from bile. The most common particulate components of biliary sludge are cholesterol crystals and calcium salts. Biliary sludge has been associated with certain conditions including rapid weight loss, fasting, pregnancy, medications (ceftriaxone, octreotide), and bone marrow or solid organ transplantation although it most commonly occurs in individuals with no identifiable condition. Biliary sludge can be looked upon as a condition of microscopic gallstones, although it is not clear at what size the particles in biliary sludge should be considered gallstones.

Gallstones

Gallstones form when substances in the bile harden. Gallstones can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. Gallstones can block the normal flow of bile if they lodge in any of the ducts that carry bile from the liver to the small intestine. That includes the hepatic ducts, which carry bile out of the liver; the cystic duct, which takes bile to and from the gallbladder; and the common bile duct, which takes bile from the cystic and hepatic ducts to the small intestine. Bile trapped in these ducts can cause inflammation in the gallbladder, the ducts, or, rarely, the liver. Other ducts open into the common bile duct, including the pancreatic duct, which carries digestive enzymes out of the pancreas. If a gallstone blocks the opening to that duct, digestive enzymes can become trapped in the pancreas and cause an extremely painful inflammation called gallstone pancreatitis. If any of these ducts remain blocked for a significant period of time, severe damage or infections can occur, affecting the gallbladder, liver, or pancreas. Gallstone attacks often occur after eating a meal, especially a fatty one. Symptoms can include pain for up to several hours in the upper, back, or under the right shoulder together with nausea, vomiting, abdominal bloating or indigestion. These symptoms can mimic those of other problems, including heart attack, so accurate diagnosis is important.

Biliary Atresia

Biliary atresia is congenital absence or closure of the major bile ducts, the ducts that drain bile from the liver. Biliary atresia results in a progressive inflammatory process which may lead to cirrhosis of the liver. The infant looks normal at birth but develops jaundice after the age of 2 to 3 weeks with yellowing of the eyes and skin, light-colored stools and dark urine caused by the build up of the pigment called bilirubin in the blood. The abdomen may be swollen with a firm, enlarged liver. Weight loss and irritability develop as the jaundice increases. There is one case of biliary atresia out of every 15,000 live births. Females are affected slightly more often than males.



The information in this article is not meant to be medical advice.�Treatment for a medical condition should come at the recommendation of your personal physician.

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