physiology of the biliary tree motility of the gallbl bladder-part 1

An incomplete picture has emerged of the complex means by which gallbladder motility is controlled under normal and pathophysiological conditions. In the first part of this review an overall account is presented. The mechanisms of cholecystokinin release, its stimulation by dietary factors and peptides elaborated by both pancreas and small intestine are discussed. The inhibition of cholecystokinin release by bile acids and proteases is also described. In the second part attention is focussed on other peptides affecting motility. These include [a] octreotide, effective for treatment of acromegaly, [b] peptide YY, contributing to a "colonic brake", [c] motilin, associated with interdigestive contractions, analogues of which possibly correct gallbaldder hypomotility, and d] substance P and calcitonin gene- related peptide, which facilitate ganglionic transmission after release from exrinsic sensory neurones and alter gallbladder responses to vagal stimulation. The sympathetic nervous system and diabetes mellitus also influence vagal responses. The former, acting presynaptically, may provide a "brake" to prevent vagal overactivity. The latter could cause hypomotility via autonomic neuropathy, although hyperglycaemia, itself, may play a role. The role of nitric oxide, released from neurones also producing vasoactive intestinal peptide is recognized. Both lengthen muscle, the former producing responses without requiring plasma membrane receptors. Gallbaldder motility also changes during pregnancy and stone formation. Progesterone and cholesterol can limit G protein actions, thus impairing contractions. Inflammation is associated with abnormal motility. The production of reactive Oxygen metabolites, acting directly or releasing prokinetic prostaglandins, may be responsible. It has been proposed that the gastrointestinal tract may be normally in a state of controlled inflamation, primed to react to harmful challenges

Pancreato-colangiografía endoscopica con el gastroscopio de visión lateral / Endoscopic pancreatic-cholangiography by means of a lateral vision gastroscope

Ante la situación de que numerosas instituciones , grupos o entes individuales de la especialidad de gastroenterología, existen por variadas razones, limitaciones complementarias endoscópicas, mostramos nuestra experiencia sobre el logro obtenido en el estudio del páncreas y tracto biliar con un gastroscopio de visión lateral, el cual además es un endoscopio que permite al especialista el examen del esófago terminal y región esófago-gástrica, óptimo estudio del estómago y exploración del duodeno. Aportamos con nuestro reporte una alternativa para lograr el diagnóstico definitivo y terapéutico del páncreas y tracto biliar, en los momentos en que el especialista no cuente con los fibroduodenoscopios y tenga al alcance un gastroscopio de visión lateral. Palabras claves: Pancreato-colangiografía. Gastroscopio