Effects of Pregnancy and Contraceptive Steroids on Gallbladder Function

Motility of the biliary system

“…Since 1980 investigators (20,45,46) have capitalized on the virtues of ultrasound for noninvasive imaging of the gallbladder and major bile ducts. Sonographic imaging does not require the administration of a radioactive marker or contrast agent nor the use of ionizing radiation.…”

“…Vagotomy and diabetes are believed to compromise gallbladder emptying by interfering with excitatory autonomic innervation (29, 82, 164). In pregnancy, hypotonia of the gallbladder is thought to result from Duodenum 15 high circulatory levels of female hormones, such as progesterone, that depress the smooth muscle of the gallbladder as well as that of the lower esophageal sphincter and ureters (20,90). In a guinea pig model, the decreased contractility of gallbladders harvested from pregnant animals was due to an abnormality in the excitation-contraction coupling common to acetylcholine and CCK-8 stimulation (153).…”

Acute diarrhoea induces rectal sensitivity in women but not men.

“…Exactly why women may have a lower visceral sensitivity threshold is unknown, but it is possible that it may be related to the sex steroid hormones, particularly as irritable bowel syndrome is more common in women, both in those seeking health care7-10 and in those who do not.1' 12 Female sex hormones have been shown to influence oesophageal,'3 gastric,'4 small and large bowel15 16 motility, as well as gall bladder motility. 17 18 A recent study conducted by ourselves showed, however, that the menstrual cycle does not affect anorectal motility or sensitivity. '9 In addition, in this study there seemed to be no association between the degree to which the anorectum responded to the diarrhoea and the menstrual or contraceptive status of the female volunteers, suggesting that the presence of female sex hormones rather than their cyclical changes are more important.…”

“…The anorectal responses to balloon distension were measured in 20 healthy volunteers (aged 20-43 years, 10 female) eight hours after laxative induced diarrhoea or under control conditions. Ingestion of an isoosmotic laxative increased stool output from 1.1 (0.7-2.3) (median (range)) to 8 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) bowel movements per day with no significant differences between men and women. In women rectal sensitivity was significantly increased after diarrhoea compared with control conditions (vol to induce discomfort (ml): 116 (96, 136) v 153 (137, 168), mean (95°/O CI); p<0.001).…”

Pathogenetic Factors in Cholesterol Gallstone Disease

“…Cholesterol crystals may nucleate from aggregated vesicles when nucleation-promoting factors Table I. Risk factors in cholesterol gallstone development or gallstones increases during total parenteral tying may also play a role in the increased risk of gallbladder disease in obesity (59), diabetes mellitus (60), and somatostatinoma (61,62) and during pregnancy (63).…”