Biliary Stasis. 



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84 (1544) 



A. Vicious activity of the gall bladder during biliary stasis. 

 B. The determining factor in the causation of white stasis bile. 



By Peyton Rous and Philip D. McMaster. 



[From the Rockefeller Institute for Medical Research.] 



Ligation experiments in dogs, cats, and monkeys show that 

 under stasis conditions the gall-bladder and bile-ducts act very 

 differently. The gall-bladder, continuing to exercise functions 

 that are normal to it, effects a great concentration of the 

 stasis bile and adds mucus thereto in quantity. As result, 

 when an obstruction is produced below the entrance of the cystic 

 duct all of the extralobular biliary channels come at length to be 

 filled with a thick, greenish-black fluid. The ducts, on the other 

 hand, have no concentrating faculty, and their lining secretes but 

 little mucus. In an obstructed duct system blocked off from the 

 gall bladder, or connecting with one so changed as to be incapable 

 of functioning, there regularly accumulates a limpid, watery fluid 

 devoid of pigment and bile salts even when the animal is heavily 

 jaundiced. This is the "white bile" of the surgeons. The 

 passages soon become so distended with it that true bile ceases to 

 enter them. 



The facts as given relate to uninfected and uninflamed bile 

 passages. So far as they go they point to cholecystectomy as a 

 wise measure in gall stone cases, and notably when the gall- 

 bladder is but little damaged. For an abnormal concentration 

 and thickening of the bile such as the gall bladder can effect must 

 act both to promote the formation of stones and to render ob- 

 struction by them more complete. The frequent rapid increase 

 in size of stones partially obstructing the common duct (Naunyn) 

 is attributable to the concentration of stasis bile by the gall 

 bladder. 



