Pathophysiologie von Gallenblase und Gallenwegen

  • G. Paumgartner

Zusammenfassung

Während die Ausscheidung von toxischen Substanzen aus dem Blut in die Galle eine kontinuierliche Gallesekretion durch die Leber erfordert, ist für die Fettresorption im Darm die intermittierende, auf die Nahrungsaufnahme abgestimmte Abgabe von Galle ins Duodenum zweckmäßiger. Die Gallenblase hat die Aufgabe, die von der Leber sezernierte Galle zu speichern, zu konzentrieren und zum geeigneten Zeitpunkt nach den Mahlzeiten ins Duodenum abzugeben. Erstaunlicherweise führt die chirurgische Entfernung der Gallenblase jedoch kaum zu einer Beeinträchtigung der Fettresorption. Wenn auch Beobachtungen über Patienten vorliegen, bei denen nach der Cholecystektomie fettreiche Mahlzeiten zu Steatorrhoe führten [11], so konnten KRONDYL et al. [30] keine Abnahme der duodenalen Gallensäurenkonzentration oder Zunahme der fäcalen Fettausscheidung bei cholecystektomierten Personen nachweisen.

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Literatur

  1. 1.
    Begemann F, Brunner H, Caspary W, Erb W, Fromm H, Leuschner U, Möckel G, Paumgartner G, Stiehl A, Weis H, Wolpers C (1976) Hinweise für die Auflösung von Cholesteringallensteinen mit Chenodesoxycholsäure. Dtsch Med Wochenschr 101:1132–1133CrossRefGoogle Scholar
  2. 2.
    Bennion LJ, Grundy SM (1975) Effects of obesity and caloric intake on biliary lipid metabolism in man. J Clin Invest 56:996–1011PubMedCrossRefGoogle Scholar
  3. 3.
    Bennion LJ, Grundy SM (1977) Effects of diabetes mellitus on cholesterol metabolism in man. N Engl J Med 296:1365–1371PubMedCrossRefGoogle Scholar
  4. 4.
    Bennion LJ, Ginsberg RL, Garnick MB, Bennett PH (1976) Effects of oral contraceptives on the gallbladder bile of normal women. N Engl J Med 294:189–192PubMedCrossRefGoogle Scholar
  5. 5.
    Berk JE, Kaplan AA (1976) Choledocholithiasis. In:Bockus HL (ed) Gastroenterology, 3rd ed, vol III. Saunders Co, Philadelphia, pp 843–864Google Scholar
  6. 6.
    Berk JE, Monroe LS (1976) Acute cholecystitis. Part I. Medical aspects. In:Bockus HL (ed) Gastroenterology, 3rd ed, vol III. Saunders Co, Philadelphia, pp 790–807Google Scholar
  7. 7.
    Bockus HL (1976) Cholelithiasis. Part II. Clinical aspects. In:Bockus HL (ed) Gastroenterology, 3rd ed, vol III. Saunders Co, Philadelphia, pp 752–785Google Scholar
  8. 8.
    Boonyapisisit ST, Trotman BW, Ostrow JD (1978) Unconjugated bilirubin, and the hydrolysis of conjugated bilirubin, in gallbladder bile of patients with cholelithiasis. Gastroenterology 74:70–74Google Scholar
  9. 9.
    Boston Collaborative Drug Surveillance Program (1973) Lancet 1:1399–1404Google Scholar
  10. 10.
    Boston Collaborative Drug Surveillance Program (1974) N Engl J Med 290:15–19CrossRefGoogle Scholar
  11. 11.
    Brooks FP (1976) Anatomy and physiology of the gallbladder and bile ducts. In:Bockus HL (ed) Gastroenterology, 3rd ed, vol III. Saunders Co, Philadelphia, pp 611–650Google Scholar
  12. 12.
    Caroli J, Rosner D (1976) Cholangitis. In:Bockus HL (ed) Gastroenterology, 3rd ed, vol III. Saunders Co, Philadelphia, pp 865–873Google Scholar
  13. 13.
    Cooper J, Geizerova H, Oliver MF (1975) Clofibrat and gallstones. Lancet 1:1083PubMedCrossRefGoogle Scholar
  14. 14.
    Den Besten L, Connor WE, Bell S (1973) The effect of dietary cholesterol on the composition of human bile. Surgery 73:266–273Google Scholar
  15. 15.
    Domschke W, Domschke S (1977) Bilirubin metabolism and bile secretion:Hormonal regulation. In:Bianchi L, Gerok W, Sickinger K (eds) Liver and bile. MTP Press Ltd, Lancaster, pp 45–53Google Scholar
  16. 16.
    Dowling RH (1977) Chenodeoxycholic acid therapy of gallstones. Clin Gastroenterol 6:141–163PubMedGoogle Scholar
  17. 17.
    Dowling RH, Bell GD, White J (1972) Lithogenic bile in patients with ileal dysfunction. Gut 13:415–420PubMedCrossRefGoogle Scholar
  18. 18.
    Golden GT, Sears HF II, Wangensteen SL (1973) Posttraumatic cholecystitis. Am Surg 39:275–278PubMedGoogle Scholar
  19. 19.
    Goldstein F (1976) Cystic duct syndrome. In:Bockus HL, (ed) Gastroenterology, 3rd ed, vol III. Saunders Co, Philadelphia, pp 734–739Google Scholar
  20. 20.
    Gottfries A (1968) Studies on acute cholecystitis. Acta Chir Scand 393 (Suppl)Google Scholar
  21. 21.
    Gottfries A (1969) Lysolecithin:A factor in the pathogenesis of acute cholecystitis? Acta Chir Scand 135:213–217PubMedGoogle Scholar
  22. 22.
    Grodzki M, Mazurkiewicz-Rozynska E, Czyzyk A (1968) Diabetic cholecystopathy. Diabetologia 4:345–348PubMedCrossRefGoogle Scholar
  23. 23.
    Hallenbeck GA (1967) Biliary and pancreatic intraductal pressures. In:Handbook of physiology, vol 11/6. American Physiological Society, Washington, pp 1007–1025Google Scholar
  24. 24.
    Heaton KW (1973) The epidemiology of gallstones and suggested aetiology. Clin Gastroenterol 2:67–83PubMedGoogle Scholar
  25. 25.
    Hill GL, Mair WSJ, Goligher JC (1975) Gallstones after ileostomy and ileal resection. Gut 16:932–936PubMedCrossRefGoogle Scholar
  26. 26.
    Hoerr ST, Hazard JB (1966) Acute cholecystitis without gallbladder stones. Am J Surg 111:47–55PubMedCrossRefGoogle Scholar
  27. 27.
    Hofmann AF, Paumgartner G (eds) Chenodeoxycholic acid therapy of gallstones. Progress report 1975. FK Schattauer, StuttgartGoogle Scholar
  28. 28.
    Imamoglu K, Perry JF Jr, Wangensteen OH (1957) Cholehthiasis due to stricture of bile duct. Surgery 42:623–628PubMedGoogle Scholar
  29. 29.
    Iser JH, Murphy GM, Dowling RH (1977) Speed of change in biliary lipids and bile acids with chenodeoxycholic acid — is intermittent therapy feasible? Gut 18:7–15PubMedCrossRefGoogle Scholar
  30. 30.
    Krondyl A, Vavrinkova H, Michalec C (1964) Effect of cholecystectomy on the role of the gallbladder in fat absorption. Gut 5:607–610CrossRefGoogle Scholar
  31. 31.
    Lansford Ch, Mehta S. Kern F Jr (1974) The treatment of retained stones in the common bile duct with sodium cholate infusion. Gut 15:48–51PubMedCrossRefGoogle Scholar
  32. 32.
    Lieber MM (1952) The incidence of gallstones and their correlation with other diseases. Ann Surg 135:394–405PubMedCrossRefGoogle Scholar
  33. 33.
    Lin TM (1975) Actions of gastrointestinal hormones and related peptides on the motor function of the biliary tract. Gastroenterology 69:1006–1022PubMedGoogle Scholar
  34. 34.
    Lindström CG (1977) Frequency of gallstone disease in a well defined Swedish population. Scand J Gastroenterol 12:341–346PubMedCrossRefGoogle Scholar
  35. 35.
    Malagelada JR, Go VLW, DiMagno EP, Summerskill WHJ (1973) Interaction between intraluminal bile acids and digestive products on pancreatic and gallbladder function. J Clin Invest 52:2160–2165PubMedCrossRefGoogle Scholar
  36. 36.
    Malagelada JR, Go VL, Summerskill WHJ (1974) Altered pancreatic and bihary function after vagotomy and pyloroplasty. Gastroenterology 66:22–27PubMedGoogle Scholar
  37. 37.
    Maton PN, Murphy GM, Dowling RH (1977) Ursodeoxycholic acid treatment of gallstones. Lancet 2:1297–1301PubMedCrossRefGoogle Scholar
  38. 38.
    Munster AM, Goodwin MN, Pruitt BA Jr (1971) Acalculous cholecystitis in burned patients. Am J Surg 122:591–593PubMedCrossRefGoogle Scholar
  39. 39.
    Nakagawa S, Makino I, Ishizaki T (1977) Dissolution of cholesterol gallstones by ursodeoxycholic acid. Lancet 2:367–369PubMedCrossRefGoogle Scholar
  40. 40.
    Newman HF, Northup JD (1959) The autopsy incidence of gallstones. Int Abstr Surg 109:1–13Google Scholar
  41. 41.
    Nicholas P. Rinando PA, Conn HO (1972) Increased incidence of cholelithiasis in Laennec’s cirrhosis. A postmortem evaluation of pathogenesis. Gastroenterology 63:112–121PubMedGoogle Scholar
  42. 42.
    O’Brien JJ, Shaffer EA, Williams LF Jr, Small DM, Lynn J, Wittenberg J (1974) A physiological model to study gallbladder function in primates. Gastroenterology 67:119–125PubMedGoogle Scholar
  43. 43.
    Oviedo MA, Ho KJ, Biss K, Soong SJ, Mikkelson B, Taylor CB (1977) Gallbladder composition in different ethnic groups. Arch Pathol Lab Med 101:208–212PubMedGoogle Scholar
  44. 44.
    Paumgartner G (1975) Was ist gesichert in der internistischen Therapie des Gallensteinleidens? Internist (Berlin) 16:566–570Google Scholar
  45. 45.
    Paumgartner G (1977) Die Gallensteinauflösung mit Chenodesoxycholsäure in der Praxis. Ther Umschau 34:767–771Google Scholar
  46. 46.
    Pertsemlidis D, Panveliwalla D, Ahrens EH Jr (1974) Effect of clofibrate and of an estrogenprogestin combination on fasting biliary lipids and cholic acid kinetics in man. Gastroenterology 66:565–573PubMedGoogle Scholar
  47. 47.
    Pridgen JE, Aust JB, McInnis WD (1977) Primary intrahepatic gallstones. Arch Surg 112:1037–1044PubMedCrossRefGoogle Scholar
  48. 48.
    Robertson RD (1970) Noncalculous acute cholecystitis following surgery, trauma and illness. Am Surg 36:610–614PubMedGoogle Scholar
  49. 49.
    Ryan J, Cohen S (1976) Interaction of gastrin I, secretin, and cholecystokinin on gallbladder smooth muscle. Am J Physiol 230:553–556PubMedGoogle Scholar
  50. 50.
    Salzer GM, Olbrich E, Kutschera H (1970) Zur Epidemiologie der Cholelithiasis. Acta Hepato-Splenol 17:65–74Google Scholar
  51. 51.
    Sarles H, Hauton J, Planche NE (1970) Diet, cholesterol gallstones, and composition of bile. Am J Dig Dis 15:251–260PubMedCrossRefGoogle Scholar
  52. 52.
    Schein CJ (1972) Acute cholecystitis. Harper and Row, New YorkGoogle Scholar
  53. 53.
    Scherstén T, Nilsson SV, Cahlin E (1970) Current concepts on the pathogenesis of human gallstones. Scand J Gastroenterol 5:473–478PubMedGoogle Scholar
  54. 54.
    Schreibman PH, Pertsemlidis D, Liu GCK, Ahrens EH Jr (1974) Lithogenic bile:A consequence of weight reduction. J Clin Invest 53:72aGoogle Scholar
  55. 55.
    Shaffer EA, Small DM (1977) Biliary lipid secretion in cholesterol gallstone disease. The effect of cholecystectomy and obesity. J Clin Invest 59:828–840PubMedCrossRefGoogle Scholar
  56. 56.
    Siffert G (1976) Chronic noncalculous cholecystitis. In:Bockus HL (ed) Gastroenterology, 3rd ed, vol III. Saunders Co, Philadelphia, pp 811–815Google Scholar
  57. 57.
    Sjödahl R, Tagesson Ch (1976) Formation and inhibition of lysolecithin in human gallbladder bile. Acta Chir Scand 142:395–399PubMedGoogle Scholar
  58. 58.
    Soloway RD, Trotman BW, Ostrow JD (1977) Pigment gallstones. Gastroenterology 72:167–182PubMedGoogle Scholar
  59. 59.
    Sutor DJ, Wooley SE (1971) A statistical survey of the composition of gallstones in eight countries. Gut 12:55–64PubMedCrossRefGoogle Scholar
  60. 60.
    Szalatnay Z, Möhr P. Akovbiantz A (1976) Zur nichtchirurgischen Behandlung postoperativ retinierter Hepato-Choledochussteine. Schweiz Med Wochenschr 106:876–880PubMedGoogle Scholar
  61. 61.
    The Coronary Drug Project Research Group. The coronary drug project:Clofibrat and niacin in coronary heart disease. J Am Med Assoc 231:360–381Google Scholar
  62. 62.
    Thistle JL, Hofmann AF, Ott BJ, Yu PYS (1976) Gallstone dissolution with chenodeoxycholic acid, 1969–1976:The Mayo Clinic studies. Gastroenterology 70:943Google Scholar
  63. 63.
    Tompkins RK, Kraft AR, Zimmermann E, Lichtenstein JE, Zollinger RM (1972) Clinical and biochemical evidence of increased gallstone formation after complete vagotomy. Surgery 71:196–200PubMedGoogle Scholar
  64. 64.
    Trotman BW, Soloway RD (1975) Pigment vs cholesterol cholelithiasis:clinical and epidemiological aspects. Am J Dig Dis 20:735–740PubMedCrossRefGoogle Scholar
  65. 65.
    Vagne M, Troitskaja V (1976) Effect of secretin, glucagon and VIP on gallbladder contraction. Digestion 14:62–67PubMedCrossRefGoogle Scholar
  66. 66.
    Valberg LS, Jabbari M, Kerr JW, Curtis AC, Ramchand S, Prentice RSA (1971) Biliary pain in young women in the absence of gallstones. Gastroenterology 60:1020–1026PubMedGoogle Scholar
  67. 67.
    Van der Linden W, Nakayama F (1973) Gallstone disease in Sweden versus Japan. Clinical and etiological aspects. Am J Surg 125:267–272PubMedCrossRefGoogle Scholar
  68. 68.
    Wheeler HO, Ross ED, Bradley SE (1968) Canalicular bile production in the dog. Am J Physiol 214:866–874PubMedGoogle Scholar
  69. 69.
    Wolpers C (1968) Spontanauflösung von Gallensteinen. Dtsch Med Wochenschr 93:2525–2532PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1981

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  • G. Paumgartner

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