Stimulation of bile output by gastrointestinal hormones following portoenterostomy for biliary atresia.
For biliary atresia portoenterostomy with externally draining conduit provides a model for quantitation of hepatic excretory function and for assessment of the physiologic response of the intrahepatic biliary system to gastrointestinal hormones in a human hepatopathologic condition. Four patients with biliary atresia were serially evaluated from 2 weeks to 43 months following total bile diverting portoenterostomy. A fifth patient with no bile flow provided a control for these studies. The pattern of Rose Bengal excretion for three patients with a satisfactory clinical course was different from that of a fourth patient with highly variable flow and persistent cholestasis. Marked volume and bicarbonate concentration increases in bile were noted 30 to 45 minutes after secretin infusion but only in the four patients with bile flow. The volume response to glucagon was more diffuse. Bilirubin and bile acid concentrations decreased in the stimulated bile flow periods and hourly outputs of these cholephils were not increased above basal. During two intervals of low bile output, secretin markedly increased bile flow in the patient with persistent cholestasis establishing the patency of the hepatoenteric anastomosis (functional obstruction) in contrast to the lack of secretin response in the control (structural obstruction).
D001646:Bile / Q000378:metabolism*; D001652:Bile Ducts / Q000002:abnormalities*; D004386:Duodenum / Q000601:surgery*; D005260:Female; D005934:Glucagon / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007583:Jejunum / Q000601:surgery*; D008099:Liver / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy; D012395:Rose Bengal; D012633:Secretin / Q000627:therapeutic use
D012633:Secretin; D012395:Rose Bengal; D005934:Glucagon