A dark green liquid composed of water, bile salts, and cholesterol that helps with digestion of food and absorption of fat and fat soluble nutrients and vitamins.

Made up of bile salts, bile pigments, and other substances dissolved in an alkaline solution that resembles pancreatic juice.

The liver continuously makes bile, which is then stored in the gallbladder and released when the meal is ingested.

About 500 mL secreted per day.

Bile helps absorption of the fat by emulsifying it, increasing its absorptive surface.

There is an enterohepatic circulation with some bile components reabsorbed in the intestine and excreted again by the liver.

Glucoronides of bile pigments bilirubin and biliverdin provide the yellow color of bile.

Bile salts are the sodium and potassium salts of bile acids.

Bile salts secreted into the bile are conjugated to glycine and taurine.

Bile acids are synthesized by cholesterol.

Cholesterol in bile can deposit in form thick crystals in the form of sludge, or stones in the form of ((gallstones)).

There are four bile acids: cholic acid, chenodeoycholic acid, deoxycholic acid, and lithocholic acid, making up 50%, 30%, 15% and 5% of bile acids, respectively.The two primary bile acids formed in the liver are cholic acid, and chenodeoxycholic acid.

In the colon bacteria convert cholic acid to deoxycholic acid chenodeoxycholic acid to lithocholic acid.

Because deoxycholic acid and lithocholic acid are formed by bacterial action they are ref2242ed to as secondary bile acids.

Bile salts reduce surface tension, and with phospholipids, and monoglycerides are responsible for the emulsification of fat prior to its digestion and absorption in the small intestine.

Bile salts have an important role in the lipolysis of triglycerides by pancreatic lipase as well as in the transportation of digested and fat soluble vitamins across the the intestinal mucosa.

Saturated fats and fat soluble vitamins are dependent on micellar solubilization for absorption (Barrett KE).

Bile salts and pancreatic enzymes combine to absorb 97% of ingested fat in the first 5 feet of the small intestine.

Bile salt pool is recycled twice per meal and up to 6-8 times a day.

95% bile salts are recycled via the enterohepatic circulation within the last 100 cm of ileum.

Loss of greater than 100 cm of ileum creates a bile salt deficiency.

Bile salt deficiency, can decrease fat absorption by up to 40-50%

Bile deficiency or insufficiency causes include: primary biliary cirrhosis, primary sclerosing cholangitis, cirrhosis, cholestatic processes, external bile drainage, gastric hypersecretion, distal bile duct obstruction, bacterial small bowel overgrowth, impaired enterohepatic obstruction with ileum resection or fistula disease (Parrish CR).

No adequate substitution for bile salts and a low fat diet or reinfusion of bile drainage if a drain is placed, are utilized.

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