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Chinese Medical Information Portal Website (Taiwan Medical Network-TMN) - OldDoc Wu's Series
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(Established in March 1996)
liver-diseases
Bile acids metabolism
Dr. Wu's Liver diseases
for professionals (medical students and residents) and consumers

by Jau-Shin WU, M.D., Ph.D.

(Posted Sep. 16, 1996; Updated May 14, 2009)

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Bile acids metabolism

Merits of measurement of serum bile acids:

  1. Endogenous (physiological) excretion: therefore, the measurement of serum bile acids is the best method of reflecting the extent of liver function reserve, and with much less side effects as compared with dye (exogenous) excretion test
  2. Enterohepatic circulation: excreted from liver cell --- bile duct --- intestinal tract --- portal system --- and return to liver cell
  3. 95 % of excreted bile acids are reabsorbed from G-I tract
  4. Frequency of enterohepatic circulation --- 4 ~ 10 times / day
  5. Amount of bile acids excreted out of the human body per day --- 3 ~ 5 % of the total amount of body bile acids
Bile acids:

Primary and secondary acids:

  • Primary bile acids:
    • 1.1. - Cholic Acid (CA)
    • 1.2. - Chenodeoxyxxxxcholic Acid (CDCA)
    • Conjugation with Glycine and Taurine
      • 1.1.1. - Glycocholic Acid (GCA)
      • 1.1.2. - Taurocholic Acid (TCA)
      • 1.2.1. - Glycochenodeoxycholic Acid (GCDCA)
      • 1.2.2. - Taurochenodeoxycholic Acid (TCDCA)
  • Secondary bile acids:
    • 2.1. - Deoxycholic Acid (DCA)
    • 2.2. - Lithocholic Acid (LCA)
    • Conjugation with Glycine and Taurine
      • 2.1.1. - Glycodeoxycholic Acid (GDCA)
      • 2.1.2. - Taurodeoxycholic Acid (TDCA)
      • 2.2.1. - Glycolithocholic Acid (GLCA)
      • 2.2.2. - Taurolithocholic Acid (TLCA)
    • Sulfation
      • 2.2.1.1. - Sulfolithocholic Acid (SLCG)
      • 2.2.2.1. - Sulfolithochlyltaurine (SLCT)
  • Lithocholic acids
    • not hydrophilic and uneasy to be absorbed from G-I tract
    • toxic to liver cells
  • Sulfation:
    • uneasy to be reabsorbed from G-I tract
    • excretion from kidney
    • attenuate toxicity
Measurement of Total bile acids (TBA)

  • -- fasting, postprandial, tolerance test
  • -- Conjugate / Unconjugate
  • -- Primary / Secondary
  • Merits and demerits of measurement of total bile acids:

    • Of no use for differential diagnosis of liver diseases
    • Useful for evaluation of the extent of reservation of liver cell funtion of chronic hepatitis and cirrhosis -- esp. in silent stage
    • Elevated in the presence of port-caval shunt and cholestasis
BSP retension test ---

  1. reflect the extent of the reservation of liver cell function
  2. anaphylaxis: rare but grave -- thus seldom used now
  • Total bile acids measurement correlates well with BSP retensionm test
  • Measurement of sulplhate % (sulfonate / total) of urine bile acids is recommneded in recent years

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(By Jau-Shin Wu, M.D.; Posted Sep. 16, 1996; Revised May 12, 2009)

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