The gallbladder is a very important digestive organ and immune organ in the human body, and has the role of regulating the pressure in the bile ducts inside and outside the liver and maintaining the balance of fluid mechanics in the bile ducts, so it occupies a very important position in the human body. It is not just a simple bag that can hold bile as people think, it can store some bile, without it bile is discharged to the duodenal cavity to participate in digestion, which is a great misunderstanding! So, what are the important functions of the gallbladder?
I. Digestive function.
As far as we know, the gallbladder has at least storage, concentration, contraction and secretion functions. Of course it also has complex chemical and immune functions. But as far as digestive function is concerned, the gallbladder has an important regulatory role.
The liver secretes 800-1000 ml of bile per day by hepatocytes, so much bile cannot be accommodated by the gallbladder, but the gallbladder has a special concentration function that can suck back the water from the original dilute bile and concentrate it 30 times as much as liver bile. The concentrated bile is reserved for eating high-fat meals before the party is subject to the dual innervation of the vagus nerve and body fluids (cholecystokinin) to make the gallbladder contract, thus discharging into the intestine to participate in digestion.
The small gallbladder has an important and wonderful function of regulating digestion. The gallbladder drains bile when it eats, more when it eats a high-fat, high-protein diet, less when it eats a vegetarian diet, and not when it does not eat. If the gallbladder has been removed, then the liver bile from the liver discharge nowhere to store, regardless of whether the body needs to continue to discharge into the intestines, for nothing, thus causing a series of pathophysiological changes;
When you go to a banquet to eat thick sorghum, urgently need a lot of bile to help digestion, but unfortunately at this time the lack of the body’s gallbladder has no answer, more “surplus bile” to help, the body has to endure indigestion, bloating and diarrhea suffering. Even a little meat and oil meat can not eat, if reluctantly eat high-fat thick taste, it often happens bloating diarrhea, and even the symptoms of fatty diarrhea, become extremely difficult to treat the internal medicine of the difficult disease.
Second, reflux gastritis and esophagitis.
As mentioned above, the gallbladder has the function of storing bile and contraction, which can effectively and skillfully control the gallbladder to excrete bile according to the eating situation. That is, bile is excreted during feeding, bile is present in the bulb and descending part of the duodenum, and rarely excreted when not feeding, that is, there is little bile in the intestinal lumen of the bulb and descending part of the duodenum, that is, the possibility of bile reflux is small. When the gallbladder is removed, bile is continuously excreted within 24 hours, i.e. there is continuous bile in the lumen of the duodenum within 24 hours;
When the pylorus is closed abnormally, bile can easily reflux into the stomach, leading to the extremely difficult to treat “reflux gastritis” and “reflux esophagitis”; this causes a lot of pain to the patient. The cause of this disease is mostly caused by gallbladder removal, which has become another persistent clinical disease in gastroenterology.
Third, the role of the gallbladder in regulating the pressure in the bile duct.
Another important function of the gallbladder is to regulate the pressure balance in the bile duct. When 800-1000cc of bile is produced in the liver every day and continuously discharged into the gallbladder and the extrahepatic bile duct, and a certain pressure is maintained, the regulation of the gallbladder is an important factor at this time. The gallbladder can hold and concentrate more bile during increased pressure in the intra- and extrahepatic bile ducts and maintain a normal pressure balance in the bile ducts.
When the gallbladder is removed, the role of regulating pressure balance disappears, however, the bile secreted by the liver does not decrease, but all the bile must be discharged into the duodenal cavity through Oddi’s opening every day, at which time the party feels that the opening is narrow and the excretion is not smooth. Inevitably, compensatory dilated CBD lesions occur over time. The dilated CBD often turns the beak-like end into a rounded shape, at which time the bile flow that is eager to be discharged becomes vortex-like, the latter being one of the important theories of gallstone formation vortex theory.
This phenomenon is very easy to form common bile duct stones. Clinical practice also proves this. People often see a history of cholecystectomy when receiving patients with acute obstructive jaundice. Among 795 cases of common bile duct stones in Peking University First Hospital (confirmed by ERCP and EPT), the group of resected gallbladder cases was significantly higher than the group of unresected gallbladder (425:370) with significant statistical significance. Thus, cholecystectomy often leads to compensatory dilatation of the common bile duct and an increased incidence of common bile duct stones.
Similarly, because the gallbladder has an important role in regulating the internal pressure of the bile duct, patients who lose the organ of the gallbladder lose the balance of pressure in the bile duct, the pressure increases, and the sphincter of Oddi loses the regular pressure regulation of the gallbladder, and regulatory disorders occur, forming the post-cholecystectomy syndrome.
Fourth, the gallbladder has important secretory, chemical and immune functions.
The gallbladder not only has the functions of storage, concentration and contraction; but also has the functions of secretion and immunity. The gallbladder can secrete 20 ml of white liquid every day, which, according to scientific experiments, is the immunoglobulin (IgA) secreted by the lamina propria of the gallbladder mucosa. Moreover, the concentration of IgA in the gallbladder is much higher than that in the blood, which has the function of protecting the intestinal mucosa from (secondary bile acids, etc.) invasion.
The gallbladder mucosa has the function of secreting IgA antibodies, and the gallbladder becomes the main source of supply of intestinal Ig, and therefore the main organ with protective antibodies, which is important for the immune defense of the biliary system.
Immunoglobulin (Ig) is present in normal human bile, and the role of this substance is.
1, lack of Ig substances can cause deficiencies in the defense of the small intestine, infectious diarrhea, infectious ascites and sepsis of digestive tract origin.
2, the protective effect on the biliary system. the main role of Ig in bile is to remove antigens and protect the biliary tract mucosa.
Morvay pointed out through animal experiments that secondary bile acids can directly increase the incidence of colon cancer in animals;
Vernivk et al. suggest that secondary bile acids are responsible for the predisposition to colon cancer after cholecystectomy. Secondary bile acids can enhance mitosis of colonic mucosal cells and predispose to colonic carcinogenesis. Because the concentration of secondary bile acids in the proximal colon is higher and the absorption of secondary bile acids in the right hemicholon is greater than that in the left hemicholon, the cancer after cholecystectomy is more likely to occur in the right hemicholon.
The pathophysiological changes are mainly as follows
① Origin of secondary bile acids: bile acids secreted from the hepatic bile ducts are primary bile acids, which are changed into secondary bile acids after entering the intestine and coming into contact with bacteria.
After cholecystectomy, the gallbladder loses its function and cannot control the excretion of bile and its residence time in the intestine; therefore, primary bile acids continuously flow into the intestine 24 hours a day and come into contact with bacteria, producing a large amount of secondary bile acids, which undoubtedly increases the risk of colon carcinogenesis.
In recent years, many European scholars found a phenomenon and doubt, that is, among the cases of colon cancer, many cases were found to have a history of gallbladder removal, and Moorehead analyzed 100 cases of bile-cutting and 100 cases of non-bile-cutting over 60 years old and found that the number of those who had colon cancer was 12:3 respectively, which was very surprising.
However, when the gallbladder functions normally, bile is only discharged into the intestine when eating, and there is no more bile in the intestine during fasting, so obviously there are few opportunities for primary bile acids to come into contact with bacteria, and therefore the amount of secondary bile acids produced is very small, and coupled with the existence of normal gallbladder, there is a large amount of Ig in the bile to protect the intestinal mucosa from foreign antigens and secondary bile acids, which of course reduces the possibility of colon cancer. Therefore, the advice of Nordic doctors who study colon cancer to not remove the gallbladder casually is very reasonable.