Hepatic Secretion of Bilirubin and Biliary Lipids in Patients with Alcoholic Cirrhosis of the Liver

Abstract

In patients with cirrhosis of the liver elevated bilirubin concentrations in the plasma could be the result of decreased bilirubin excretion or an oveφroduction of bilirubin with insufficient excretion of the increased amounts of bilirubin. Under steady state conditions with constant serum bilirubin concentrations bilirubin synthesis equals biliary and urinary bilirubin excretion. In the present study in 10 healthy volunteers and 11 patients with alcoholic cirrhosis of the liver and serum bilirubin concentrations of 7.0 ± 1.9 mg/dl the biliary excretion of bilirubin was studied by the intestinal perfusion method and compared with the excretion of bile lipids. Biliary excretion of bilirubin in the cirrhotics was 38.7 ± 8.8 μmol/h, the 10 healthy controls excreted 17.9 ± 0.9 μmol/h bilirubin. Only minor amounts of bilirubin were excreted in urine. In 4 of the 11 cirrhotics ⁵¹Cr-red blood cell half-lives were studied revealing ongoing hemolysis. Bilirubin production calculated from red cell life span was identical to biliary excretion of bilirubin with an error less than 5 %. The data indicate that in patients with alcoholic cirrhosis of the liver serum concentrations of bilirubin may be elevated due to oveφroduction of bilirubin and a concomitant decrease of the biliary transport capacity of bilirubin.

Hepatic and extrahepatic glucuronidation of bile acids in man. Characterization of bile acid uridine 5'-diphosphate-glucuronosyltransferase in hepatic, renal, and intestinal microsomes.

“…According to the results of the present study, the reduced relative amounts of serum (36) or urinary bile acid glucuronides (2, 3) that were observed in patients with liver cirrhosis (2,3,36) or in patients with other intrahepatic (4) or extrahepatic cholestasis (36), compared with the relative amounts ofbile acid glucuronides in serum (35,36) or urine (4) of healthy subjects, may be explained by a decrease in hepatic bile acid UDP-glucuronosyltransferase activity in liver cirrhosis as well as in liver disease in connection with high serum bilirubin values. The decreased hepatic UDP-glucuronosyltransferase activity toward chenodeoxycholic acid that was observed in patients with liver cirrhosis or granulomatous hepatitis (Fig.…”

“…Previous studies have shown that glucuronidation is an important end step in bile acid metabolism, both in health (4,35) as well as in liver disease (1)(2)(3)(4)36). However, up to now only the liver has been known as a site of bile acid glucuronidation in man (10, 1 1).…”

“…Furthermore, bile acid glucuronides, most of which were otherwise unconjugated, have been found in urine and bile of patients with liver disease (1)(2)(3)(4).…”

Prevalence and Incidence of Cholecystolithiasis in Cirrhosis and Relation to the Etiology of Liver Disease

“…The factors which increase the risk of cholecystolithiasis in cir rhosis are still largely unknown. It has been reported that alcoholism could predispose to the formation of pig mented gallstones both in cirrhotic [5][6][7][8] and in noncir rhotic [8,9] patients, and this kind of gallstones is that most frequently associated with cirrhosis [8,10]. suggest ing that alcohol abuse might be involved.…”

The effect of vanadium on rat hypercholesterolemia in the presence and absence of statins

“…Serum glutamate oxaloacetate transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT) (Reitman and Frankel, 1957), alkaline phosphatase (ALP) (Kind and King, 1954), gammaglutamyl transferase (GGT) (Fiala et al, 1972) and bilirubin (Raedsch and Stiehl, 1983) were determined using a Reflotron Plus Analyzer as well as Roche kits (Roche Diagnostics GmbH, Mannheim, Germany).…”