A major limitation in understanding bile formation has been technical. The liver and ductular epithelium are relatively inaccessible, necessitating indirect techniques of uncertain validity. This is well seen in attempts to define the role of electrolyte secretion in bile. It is widely agreed that bile salts stimulate a component of canalicular flow and that inorganic electrolyte secretion is stimulated by bile salts. The choleretic efficiency of a bile salt is directly related to the magnitude of the electrolyte effect. But there is no consensus regarding how and where bile salts stimulate electrolyte secretion. Some evidence points to a paracellular route by processes of solvent drag and diffusion. Other studies suggest stimulation of specific transcellular electrolyte pathways. It has been believed that canalicular bile salt‐independent bile flow is generated by active blood‐to‐bile electrolyte transport. Actually, available methods do not permit us to conclude with absolute certainty that there is canalicular bile salt‐independent flow, although there is considerable evidence for it. New studies suggest that electrolyte transport in this type of flow is passive and that flow is due to transport of organic anions. Ductular flow does seem to be due to active transport of electrolytes, particularly bicarbonate. Better and more direct techniques are required to settle the controversies in this area.
|Issue number||2 S|
|State||Published - Jan 1 1984|