Ursodiol and the Bile acids & Gallstones
The Gallbladder
  • Gallbladder
  • The gallbladder (or cholecyst, sometimes gall bladder) is a small organ whose function in the body is to harbor bile and aid in the digestive process.

The cystic duct connects the gallbladder to the common hepatic duct to form the common bile duct.
The common bile duct then joins the pancreatic duct, and enters through the hepatopancreatic ampulla at the major duodenal papilla.
The fundus of the gallbladder is the part farthest from the duct, located by the lower border of the liver. It is at the same level as the transpyloric plane.

Bile acids
Most people have heard that one’s liver produces greenish fluid called “bile” and that this mysterious substance is stored in the gall bladder but beyond this, knowledge of the composition and function of bile simply is not “mainstream".
Bile is indeed the greenish under-appreciated fluid, produced in the liver and stored in the gall bladder. At the appropriate time in digestion, the gallbladder contracts and bile squirts along the bile duct and into the small intestine. Bile carries with it an assortment of the body’s toxins which are thus dumped safely into the gastrointestinal tract and ultimately eliminated in stool. Bile also assists in the absorption of dietary fats, fat-soluble vitamins, and other desirable substances..
Bile consists mostly of cholesterol derivatives called “bile acids".
There are many types of bile acids, each with different functions. Some are simply lost in the intestine and eliminated as mentioned in stool some are reabsorbed (i.e. recycled) for reuse by the liver. If more bile acids are required than were reabsorbed, then the body must make more. If the liver is in failure, reabsorbed bile acids are not captured by the liver but are instead released into the body’s circulation (hence the basis for the “bile acids” test that has become a popular diagnostic in the evaluation of veterinary liver patients.)

Ursodeoxycholic acid:
  • Urso-deoxy colic acid Chemical Structure
  • Also called “Ursodiol” is one of the bile acids produced by the Chinese black bear and it has been used in the treatment of liver disease for centuries. Nowadays, it is produced in the laboratory and not extracted from bear gall bladders. The therapeutic properties are reviewed below.

How this medication is used?
There are many benefits to the use of ursodeoxycholic acid in the treatment of liver disease:

Removal of Toxic Bile Acids:
Not all bile acids were created equal, meaning that some are more toxic to the liver than others. These toxic bile acids are reabsorbed back into the body where they damage the liver if they are allowed to build up.
Ursodeoxycholic acid is a non-toxic bile acid. The intestine will preferentially reabsorb ursodeoxycholic acid over more toxic bile acids when the two types are together in the intestine. Unabsorbed toxic bile acids are eliminated in stool.

Increased bile flow:
Small amounts of toxic bile acids get reabsorbed into the liver and are dealt with promptly when the  liver is healthy.
When the liver is not healthy, though, these bile acids build up and damage the liver further.

Ursodeoxycholic acid is what is called a “choleretic” which means it improves the flow of bile through the tiny ducts into the gall bladder and improves the flow of bile from the gall bladder into the intestine. In other words, it helps the flow of bile, which in turn facilitates the removal of toxic bile acids (as well as other toxins excreted in bile), from the body.

Ursodeoxycholic acid also appears to have beneficial effects in normalizing immune reactions in the liver and may be useful in the treatment of cirrhosis and chronic active hepatitis.

Side effects:
  • No serious side effects have turned up in any of the testing of this medication. The occasional patient has experienced some nausea.
  • The use of ursodeoxycholic acid can lower blood cholesterol levels.

Interactions with other drugs:
Ursodeoxycholic acid should not be given at the same time as aluminum containing antacids (such as Sedomag) as these compounds may bind together and interferes the action of the ursodeoxycholic acid.

If the common bile duct is obstructed with a gallstone, it is not appropriate to increase bile flow. In such a situation, the use of ursodeoxycholic acid would be contraindicated.

What are gallstones?

  • Gallbaldder Gallstones
  • Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material. The liquid, called bile is used to help the body digest fats. Bile is made in the liver, and then stored in the gallbladder until the body needs to digest fat. At that time, the gallbladder contracts and pushes the bile into a tube-called the common bile duct-that carries it to the small intestine, where it helps with digestion.
    Bile contains water, cholesterol, fats, bile salts, proteins, and bilirubin. Bile salts break up fat, and bilirubin gives bile and stool a yellowish color. If the liquid bile contains too much cholesterol, bile salts, or bilirubin, under certain conditions it can harden into stones.
The types and causes of gallstones stones:
Cholesterol stones:
  • Gallstones
  • They are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones.
    Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason.
Pigment stones:
  • Gallstones
  • They are small, dark stones made of bilirubin.
    The cause of pigment stones is uncertain. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders, such as sickle cell anemia, in which too much bilirubin is formed.

Gallstones can be as small as a grain of sand or as large as a golf ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or almost any combination.
Gallstones can block the normal flow of bile if they lodge in any of the ducts that carry bile from the liver to the small intestine. That includes the hepatic ducts, which carry bile out of the liver; the cystic duct, which takes bile to and from the gallbladder; and the common bile duct, which takes bile from the cystic and hepatic ducts to the small intestine. Bile trapped in these ducts can cause inflammation in the gallbladder, the ducts, or, rarely, the liver. Other ducts open into the common bile duct, including the pancreatic duct, which carries digestive enzymes out of the pancreas. If a gallstone blocks the opening to that duct, digestive enzymes can become trapped in the pancreas and cause an extremely painful inflammation called gallstone pancreatitis.
If any of these ducts remain blocked for a significant period of time, severe-possibly fatal-damage or infections affecting the gallbladder, liver, or pancreas can occur. Warning signs of a serious problem are fever, jaundice, and persistent pain.