bilious

adj.

気持ちが悪い、むかつく、吐き気がする
胆汁の/胆汁色の
(見た目が吐き気がするほど)不愉快な、いやな
不機嫌な、気難しい

関: bile 胆汁、bilious vomiting 胆汁性嘔吐

WordNet

suffering from or suggesting a liver disorder or gastric distress (同)liverish, livery
relating to or containing bile (同)biliary
irritable as if suffering from indigestion (同)bilious, dyspeptic, liverish
gastric distress caused by a disorder of the liver or gall bladder

PrepTutorEJDIC

胆汁(たんじゅう)の,胆汁質の / 気むずかしい,かんしゃく持ちの

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/09/12 19:31:45」(JST)

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[Wiki en表示]

For other uses, see Bile (disambiguation).

Bile (yellow material) in a liver biopsy in the setting of bile stasis, i.e. cholestasis. H&E stain

Action of bile salts in digestion

Recycling of the bile

Bile or gall is a bitter-tasting, dark green to yellowish brown fluid, produced by the liver of most vertebrates, that aids the digestion of lipids in the small intestine. In many species, bile is stored in the gallbladder and, when the organism eats, is discharged into the duodenum. Bile is 85% water, 10% bile salts, 3% mucus and pigments, 1% fats, and 0.7% inorganic salts.

Historical tradition[edit source | edit]

In medical theories prevalent in the West from Classical Antiquity to the Middle Ages, the body's health depended on the equilibrium of four "humors", or vital fluids: blood, phlegm, "yellow bile" (choler), and "black bile". Excesses of the last two humors were thought to produce aggression and depression, respectively; and the Greek names for them gave rise to the English words cholera and melancholia. Those same theories explain the derivation of the English word bilious from bile, and the meaning of gall in English as "exasperation" or "impudence". These theories derived from the four-element theory. Underlying this is the idea that the organs of the body are connected to the soul, specifically the astral body, and reflect the emotional state of the soul. Thus excess anger, for example, gave rise to liver derangement and imbalances in the humors. This is similar to Ancient Chinese medical beliefs. In the course of history, the metaphysical nature of this process was lost, and the theory fell from use.

Physiological functions[edit source | edit]

Bile acts to some extent as a surfactant, helping to emulsify the fats in food. Bile salt anions are hydrophilic on one side and hydrophobic on the other side; consequently, they tend to aggregate around droplets of fat (triglycerides and phospholipids) to form micelles, with the hydrophobic sides towards the fat and hydrophilic sides facing outwards. The hydrophilic sides are negatively charged, and this charge prevents fat droplets coated with bile from re-aggregating into larger fat particles. Ordinarily, the micelles in the duodenum have a diameter of around 14–33 μm.

The dispersion of food fat into micelles thus provides a greatly increased surface area for the action of the enzyme pancreatic lipase, which actually digests the triglycerides, and is able to reach the fatty core through gaps between the bile salts. A triglyceride is broken down into two fatty acids and a monoglyceride, which are absorbed by the villi on the intestine walls. After being transferred across the intestinal membrane, the fatty acids reform into triglycerides, before being absorbed into the lymphatic system through lacteals. Without bile salts, most of the lipids in food would be excreted in feces, undigested.

Since bile increases the absorption of fats, it is an important part of the absorption of the fat-soluble substances, such as the vitamins D, E, K and A.

Besides its digestive function, bile serves also as the route of excretion for bilirubin, a byproduct of red blood cells recycled by the liver. Bilirubin derives from hemoglobin by glucuronidation.

Bile is alkaline^{[citation needed]} and also has the function of neutralizing any excess stomach acid before it enters the duodenum, the first section of the small intestine. Bile salts also act as bactericides, destroying many of the microbes that may be present in the food.

Bile soap[edit source | edit]

Bile from slaughtered mammals can be mixed with soap. This mixture, called bile soap,^[1] can be applied to textiles a few hours before washing and is a traditional and rather effective method for removing various kinds of tough stains.

Abnormal conditions associated with bile[edit source | edit]

The cholesterol contained in bile will occasionally accrete into lumps in the gallbladder, forming gallstones. Cholesterol gallstones are generally treated through surgical removal of the gallbladder. However, they can sometimes be dissolved by increasing the concentration of certain naturally occurring bile acids, such as chenodeoxycholic acid and ursodeoxycholic acid.
On an empty stomach – after repeated vomiting, for example – a person's vomit may be green or dark yellow, and very bitter. The bitter and greenish component may be bile or normal digestive juices originating in the stomach.^{[citation needed]} The color of bile is often likened to "fresh-cut grass",^{[citation needed]} unlike components in the stomach that look greenish yellow or dark yellow. Bile may be forced into the stomach secondary to a weakened valve, the presence of certain drugs including alcohol, or powerful muscular contractions and duodenal spasms.
In the absence of bile, fats become indigestible and are instead excreted in feces, a condition called steatorrhea. Feces lack their characteristic brown color and instead are white or gray, and greasy.^[2] Steatorrhea can lead to deficiencies in essential fatty acids and fat-soluble vitamins. In addition, past the small intestine (which is normally responsible for absorbing fat from food) the gastrointestinal tract and gut flora are not adapted to processing fats, leading to problems in the large intestine.

Principal bile acids[edit source | edit]

Cholic acid
Chenodeoxycholic acid
Glycocholic acid
Taurocholic acid
Deoxycholic acid
Lithocholic acid

References[edit source | edit]

Notes

^ Newton, W. (1837). "The invention of certain improvements in the manufacture of soap, which will be particularly applicable to the felting of woollen cloths.". The London Journal Of Arts And Sciences; And Repertory Of Patent Inventions IX: 289. Retrieved 2007-02-08.
^ Barabote RD, Tamang DG, Abeywardena SN, et al. (2006). "Extra domains in secondary transport carriers and channel proteins". Biochim. Biophys. Acta 1758 (10): 1557–79. doi:10.1016/j.bbamem.2006.06.018. PMID 16905115.

Bibliography

Bowen, R. (2001-11-23). "Secretion of Bile and the Role of Bile Acids In Digestion". Colorado State Hypertextbook article on Bile. Archived from the original on 29 May 2007. Retrieved 2007-07-17.
Krejčí, Z; Hanuš L., Podstatová H. & Reifová E (1983). "A contribution to the problems of the pathogenesis and microbial etiology of cholelithiasis". Acta Universitatis Palackianae Olomucensis Facultatis Medicae 104: 279–286. PMID 6222611.
Maton, Anthea; Jean Hopkins, Charles William McLaughlin, Susan Johnson, Maryanna Quon Warner, David LaHart, Jill D. Wright (1993). Human Biology and Health. Englewood Cliffs, New Jersey, USA: Prentice Hall. ISBN 0-13-981176-1.

External links[edit source | edit]

Photo of bear bile sample in an animal welfare blog by Paul Kraaijer.

UpToDate Contents

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1. 敗血症を起こした幼児に対するアプローチ approach to the septic appearing infant
2. 腸管閉鎖症 intestinal atresia
3. 腸回転異常 intestinal malrotation
4. 悪心および嘔吐を呈する幼児または小児に対するアプローチ approach to the infant or child with nausea and vomiting
5. 急性腹症を有する小児の緊急評価 emergent evaluation of the child with acute abdominal pain

English Journal

The Question of an Infectious Etiology or Contribution to the Pathogenesis of Infantile Hypertrophic Pyloric Stenosis.

Modarressi T.Author information *Massachusetts General Hospital, Boston, MA †Department of Internal Medicine.AbstractInfantile hypertrophic pyloric stenosis (IHPS) is a concerning cause of non-bilious vomiting in the neonatal population. While a number of etiological theories exist, its exact cause remains nebulous. The question of an infectious etiology (or contribution) has been previously examined in case reports and case series, with recent support through suggestions of seasonality and familial aggregation with unclear inheritance patterns. This review discusses the published literature regarding infectious etiologies of IHPS. Further, it attempts to demonstrate that newer research regarding a NOS1 genetic etiology does not exclude, but rather can be consistent with, an infectious etiology.
Journal of pediatric gastroenterology and nutrition.J Pediatr Gastroenterol Nutr.2013 Dec 16. [Epub ahead of print]
Infantile hypertrophic pyloric stenosis (IHPS) is a concerning cause of non-bilious vomiting in the neonatal population. While a number of etiological theories exist, its exact cause remains nebulous. The question of an infectious etiology (or contribution) has been previously examined in case repor
PMID 24345839

Small bowel injury after suprapubic catheter insertion presenting 3 years after initial insertion.

Gallagher KM1, Good DW, Brush JP, Al-hasso A, Stewart GD.Author information 1Department of Urology, Western General Hospital Edinburgh, Edinburgh, Mid Lothian, UK.AbstractA 77-year-old woman was referred to urology with blockages of her suprapubic catheter (SPC). The catheter was replaced easily in the emergency department, however, no urine was draining, only a cloudy green fluid was visible. On cystoscopy bilious material was identified in the bladder. There was no catheter visible. There seemed to be a fistulous tract entering the bladder at the left dome. The urethra was dilated, a urethral catheter was placed and the SPC was removed. A CT demonstrated that the SPC tract transfixed a loop of pelvic small bowel and entered the bladder with no intraperitoneal contrast leak. The patient recovered well and did not require laparotomy. This case emphasises that bowel perforation, although rare, must be considered as a complication of SPC placement even years after initial insertion when catheter problems arise. Unusually, we learn that this complication may not present with abdominal pain or peritonism.
BMJ case reports.BMJ Case Rep.2013 Dec 10;2013. pii: bcr2013201436. doi: 10.1136/bcr-2013-201436.
A 77-year-old woman was referred to urology with blockages of her suprapubic catheter (SPC). The catheter was replaced easily in the emergency department, however, no urine was draining, only a cloudy green fluid was visible. On cystoscopy bilious material was identified in the bladder. There was no
PMID 24326435

Postoperative intussusceptions in children and infants: a systematic review.

Yang G1, Wang X, Jiang W, Ma J, Zhao J, Liu W.Author information 1Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China.AbstractBACKGROUND: Postoperative intussusception (POI) is an unusual complication in children and infants who underwent various kinds of surgery. The early recognition was difficult for its rarity and atypical presentations. This study evaluates the clinical features of POI through a literature review.
Pediatric surgery international.Pediatr Surg Int.2013 Dec;29(12):1273-9. doi: 10.1007/s00383-013-3345-1. Epub 2013 Jul 13.
BACKGROUND: Postoperative intussusception (POI) is an unusual complication in children and infants who underwent various kinds of surgery. The early recognition was difficult for its rarity and atypical presentations. This study evaluates the clinical features of POI through a literature review.METH
PMID 23852556

Duodenal haematoma following endoscopy as a marker of coagulopathy.

Hameed S1, McHugh K, Shah N, Arthurs OJ.Author information 1Departments of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, and Institute of Child Health, University College of London, London, WC1N 3JH, UK.AbstractBACKGROUND: Intramural duodenal haematomas (IDHs) are a rare complication of endoscopic biopsy but can cause significant morbidity and mortality, including duodenal obstruction, hospitalization and needing intravenous feeding. They are extremely uncommon in those with normal haematology.
Pediatric radiology.Pediatr Radiol.2013 Nov 29. [Epub ahead of print]
BACKGROUND: Intramural duodenal haematomas (IDHs) are a rare complication of endoscopic biopsy but can cause significant morbidity and mortality, including duodenal obstruction, hospitalization and needing intravenous feeding. They are extremely uncommon in those with normal haematology.OBJECTIVE: T
PMID 24292805

Japanese Journal

1歳3か月時に診断された空腸膜様狭窄の1例

高見尚平,中原さおり,武山絵里子 [他]
日本小児外科学会雑誌 50(1), 92-95, 2014-02
NAID 40019986282

Ball valve syndromeに対する手術待機中に胆嚢穿孔をきたした1例

鍋谷雅史
日本臨床外科学会雑誌 75(5), 1376-1380, 2014
症例は86歳，女性．以前より有茎性胃腫瘍を指摘されていた．腹痛・嘔吐にて近医を受診し，上部消化管内視鏡検査にてball valve syndrome（以下BVS）を認め，内視鏡的に整復された．しかし，再度同じ状態となり内視鏡的整復が困難であったため，手術目的で当院に紹介となり入院．入院4日目に突然の腹痛が出現し，ショック状態となったため緊急開腹手術を行った．腹腔内は胆汁で黄染しており，胆嚢底部に径 …
NAID 130004706295

手術にて切除し得たKasabach-Merritt 症候群を合併した回腸結腸カポジ肉腫様血管内皮腫の1 例

竜田恭介,山内健,白井剛 [他],有馬透,孝橋賢一
日本小児外科学会雑誌 50(6), 1043-1047, 2014
症例は10 生日の男児，38 週1 日，出生体重3,242 g で出生したが，4 生日より発熱，哺乳低下を認め，前医にて敗血症性DIC（播種性血管内凝固症候群）と診断され治療が行われた．しかし検査所見の改善は乏しく，翌日より腹部膨満胆汁性嘔吐を認めるようになり，10 生日の単純CT 検査にて門脈内ガス像を認めたため，壊死性腸炎を疑われ当院に転院となった．腹部超音波検査，造影CT 検査にて回盲部から …
NAID 130004699771

Rendezvous Technique Treatment for Late-Onset Biliary Leakage after Major Hepatectomy of a Living Donor : Report of a Case

Kimura Koichi,Ikegami Toru,Yamashita Yo-ichi,Saeki Hiroshi,Oki Eiji,Yoshizumi Tomoharu,Uchiyama Hideaki,Kawanaka Hirofumi,Soejima Yuji,Morita Masaru,Shirabe Ken,Ikeda Tetsuo,Maehara Yoshihiko
Fukuoka Acta Medica 104(9), 309-314, 2013-09-25
… Physical examination suggested panperitonitis, and abdominocentesis showed bilious ascites. … There was bilious ascites in the peritoneal cavity. …
NAID 120005372096

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