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The Enterohepatic Circulation of Bile Salts

Donald M. Small, MD; Robert H. Dowling, MD, MRCP; Richard N. Redinger, MD, FRCP
Arch Intern Med. 1972;130(4):552-573. doi:10.1001/archinte.1972.03650040078008.
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Bile salts secreted by the liver pass into the intestine, are absorbed in large part by the ileum, and return to the liver by way of the portal vein, thus completing a portal enterohepatic circulation (EHC). An extraportal EHC also exists, which is minor in health but may become a major determinant of bile metabolism in disease. A long-term monkey preparation allows direct measurement of bile volume, secretory rates of bile salts and biliary lipids, bile salt synthetic rates and pool size, and intestinal absorption in both the steady state and during change from one steady-state condition to another. We define in quantitative terms the effects of progressive bile salt loss, ileectomy, surgical trauma, drugs (especially phenobarbital), diet composition, starvation, and partial and complete obstruction. In some instances, the specific alterations in bile salt metabolism found in the monkey can be related to certain human disease states in which the


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