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Title: Biliary motility in health and disease
Author: Luman, Widjaja
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1997
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The effect of nitric oxide (NO) upon gallbladder motility as examined in a group of volunteers after fatty meal during infusion with NO donors (glyceryltrinitrate and sodium nitroprusside), normal saline and hydralazine as a hypotensive control agent. Postprandial gallbladder emptying was significantly reduced during infusion with the NO donors. This inhibitory effect was independent of hypotension and CCK release. This inhibitory effect of NO donors was also observed on isometric contraction of isolated gallbladder muscle strips. The effect of NO on the SO was examined by infusion of glyceryltrinitrate to the ampulla during SO manometry. Basal tone and phasic activity were both suppressed. This finding may have therapeutic application for stone extraction during endoscopic retrograde cholangiopancreatography. Symptoms were assessed in 100 patients before and six months after laparoscopic cholecystectomy (LC) with standard questionnaire. 13% of patients had persistent biliary symptoms and abdominal bloating, constipation and consumption of antidepressant were fund to be significantly more prevalent in these subjects compared to patients who had successful operations. SO dysfunction is a cause of post-cholecystectomy pain. We hypothesised that LC could destroy cholecysto-sphincteric nerves leading to SO dysfunction. SO manometry was performed in a group of volunteers before and six months after LC. Following LC, the SO was not inhibited by CCK. This could lead to relative post-prandial biliary obstruction and result in post-cholecystectomy pain in susceptible individuals and to dilatation of the common bile duct. Several issues and concepts arose from the work of this thesis. The mechanism underlying the early release of CCK needs further investigation. The clinical relevance of the effects of NO upon biliary tract motility remains to be explored. It is hoped that future research in this area will help to clarify these issues.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available