Function Tests in the Diagnosis of Biliary Tract Disease Using Sodium Dehydrocholate Or Secretin

Studies by Agren and Lagerlof3 on pancreatic function using intravenous secretin demonstrated that changes in the duodenal biliary pigment concentration might be of use in determining the functional status of the gallbladder. Diamonds, Lakel7 , Snape22 , Dreiling and Hollander9 , have described this biliary pigment response in the secretin test and concluded that good correlation exists between the results of the test and gallbladder function. These workers found that prior to injection of secretin, bile was present in the duodenal contents and that after secretin was injected, all visible evidences of bile disappeared for a variable period of time if a normally functioning gallbladder was present; otherwise the bile color persisted throughout the test period. Tanturi25 , and Still24, have demonstrated that secretin acts directly upon the liver in producing hydrocholeresis. The secretin induced hydrocholeresis tests the capacity of the gallbladder to act as an expansile reservoir. Grossman and co-workers12, have shown that the hydrocholeresis reSUlting from secretin stimulation is less than that resulting from the injection of bile salts. Dr. M. 1. Grossman, suggested to us the use of a bile salt as a means of testing the reservoir capacity of the gallbladder. Sodium dehydrocholate was chosen for use in this study because of its potent hydrocholeretic effect and low toxicity4. 5. ll. 21, even when administered intravenously. Studies by Ivy14, Berman5, Grodinsll, and their associates, have demonstrated that sodium dehydrocholate produced agreater increase in the volume output of bile than did any other agent tested. Clinically, these results have been confirmed in patients with T -tubes. Our previous studies using duodenal intubation, show that an increased volume output of at least 100 per cent over a one-hour period occurs in response to 10 cc of 20 per cent sodium dehydrocholatet intravenously. The peak of this response occurs, on the average, fifteen minutes after injection and an increased flow of bile is noted for at least forty minutes after injection.