There is very little doubt today that the gall bladder empties by the contraction of its wall muscle and which is induced by cholecystokinin liberated from the duodenal mucosa as a consequence of the entry of foodstuff or gastric acid in it (Ivy and Oldberg, 1928). Hong et al.(1956) claimed that there are receptors in the duodenum which stimulated, cause some cell via a synapse to releas the hormone into the blood stream and ensue gall bladder evacuation.
It is clear from the work Boyden (1923) that feeding of egg yolk and cream and later (1925) egg yolks alone causes the gall bladder to contract and its X-ray shadow to get smaller in human. Sussman (1937) reported in the human that morphine interfered seriously with gall bladder evacuation following a fat meal.
The purpose of this experiment was to study the rate and degree of emptying of the normal gall bladder under the stimulus of cholecystokinin as well as fat meal, together with a study on some pertinent experiments using several drugs having chole-dyskinetic effect that have been performed in healthy human subjects.
Healthy Koreans with both sexes, age range of 20 65, and no history or symptoms of gall bladder disease were used. The six volunteers Navy enlisted men were specifically assigned for the double cholographic studies with oral test meal once and following intravenous cholecystokinin more than a month apart. Their ages varied between 25 and 27 years and their weight was an average of 57 kg.
On the evening proceeding the experiment a light meal was eaten. Two hour afterwards, the volunteers began taking tablets of Telepaque in a dose of 3g. No other food was eaten until after the first X-ray picture of next morning. The second picture was taken one minute after completed swallowing test meal, which consisted of 2 half-boiled eggs mixed with 100cc of milk and followed subsequent serial X-ray pictures in 3, 5, 10, 15, 20, 30, and 60 minutes postcibum. Each X-ray picture was made by anterior-posterior and lateral. The similar consecutive pictures were taken after intravenous cholecystokinin injection. The
cholecystokinin (Cecekin, Vitrum) was administered intravenously in a dose of 1 clinical unit per kilo gram of body weight.
A series of experiments with pretreatment of several drugs, having considerable action on gall bladder contraction, was performed. Hexamethonium chloride in 10 subjects, atropine sulfate and morphine sulfate in 6 subjects of each were administered in the doses of 1mg, 0.01mg and 0.1mg per kg, respectively.
The volume of the gall bladder was determined mainly by the adopted Simpson's formula and the magnification was corrected using pelvimetric metalic ruler. The other cautions were followed by the description of Edholm (1960). The simple method for computing the gall bladder volume proposed by Silva (1949) was also used.
Summary and Conclusion
The emptying of the normal gall bladder induced by cholecystokinin or oral test meal was studied radiologically in the human subject. The effect of several drugs, of those having an dyskinetic action to biliary tract, was also studied in normal
gall bladder. The abnormal gall bladders observed in Yonsei Medical Center during past four years between 1964 and 1967 were included in this study.
1. Intravenous cholecystokinin as well as oral test meal induced a typical evacuation of fasting gall bladder in young healthy human subjects, and the response of cholecystokinin was for prompt and rapid than that of test meal. The gall bladder emptying by test meal in women was faster than in man.
2. The volume of gall bladder determined by oral telepaque was 25cc and the volume was decreased 9 to 10cc at 20 minutes after the test meal in men and women.
3. The volume of gall bladder occurred at 30 minutes or 60 minutes following intravenous Cholografirn administration was equivalent to that occurred at 12 hours after oral Telepaque. Gall bladder volume was slightly increased during the time course and reached the maximum at 120 minutes after Cholografin.
4. Transient slight decrease in the volume of gall bladder was seen following administration of atropine, hexamethonium or morphine.
5. Both hexamethonium and morphine completely prevented evacuation of the normal gall bladder after a test meal and atropine also produced a definite inhibition of gall bladder emptying.
6. The gall bladder anomalies found in Yonsei Medical Center during past four years were such as Phrygian cap, double gall bladder, septate gall bladder, bilobed gall bladder, triple gall bladder and hour glass gall bladder. (Partly supported by grant No. 65-847, China Med. Board of New York)