Physical and chemical properties of bile

The color of bile is normal: portions A - golden yellow, amber; B - deep yellow, dark olive, brown; C - light yellow.

• Change in the color of portion A: dark yellow - with reflux of bile of portion B and with hemolytic jaundice; light yellow - with damage to
  the liver parenchyma, viral hepatitis, cirrhosis of the liver, blockage of the sphincter of Oddi by a stone, compression by the enlarged head of the pancreas, sphincter spasm; blood staining - with duodenal ulcer, tumor of the ampulla of Vater, hemorrhagic diathesis; greenish color (transparent bile) - with stagnation or infection.
• Change in the color of portion B: weak color (white bile) - in chronic inflammatory processes with atrophy of the bladder mucosa; very dark color - in pathological thickening of bile in the bladder (stagnation) and in hemolytic conditions.
• Change in the color of portion C: pale color - with viral hepatitis, liver cirrhosis; dark color (pleochromia) - with hemolytic jaundice; green color - with inflammatory processes of the bile ducts, cholangitis (caused by the oxidation of bilirubin to biliverdin), red color - from an admixture of blood in peptic ulcer of the duodenum, malignant neoplasms of the pancreas, pyloric part of the stomach.

Transparency. Normally, all portions of bile are transparent. A slight uniform turbidity that appears immediately is associated with an admixture of hydrochloric acid and does not indicate the presence of inflammatory changes. Turbidity of portion A is possible with increased acidity of gastric juice, pyloric insufficiency or duodenal reflux; flakes are detected with duodenitis. Turbidity of portion B is possible with inflammatory processes in the gallbladder. Flakes of mucus fall out in portion C with inflammatory processes of the intrahepatic ducts, cholecystocholangitis.

Reaction. Normally, portion A has a neutral or basic reaction; portions B and C - basic. An acidic reaction of portion A is possible with an inflammatory process in the duodenum. An acidic reaction of portion B is characteristic of inflammation of the gallbladder, and other portions - for inflammatory processes in the corresponding parts of the bile ducts.

Density. Normally, the relative density of portion A is 1.003-1.016; B - 1.016-1.032; C - 1.007-1.011.

• The relative density of portion A increases with the addition of portion B, with hemolytic jaundice, and decreases with impaired liver function, damage to the liver parenchyma (viral hepatitis, liver cirrhosis), and impaired flow of bile into the duodenum.
• The relative density of portion B increases with thickening of bile (stagnation), cholelithiasis, and dyskinesia of the biliary tract; it decreases with a decrease in the concentrating capacity of the gallbladder.
• The relative density of portion C increases with hemolytic jaundice and decreases with decreased bilirubin secretion (hepatitis, liver cirrhosis).

Bile acids. In a healthy person, the content of bile acids in portion A is 17.4-52 mmol/l, in portion B - 57.2-184.6 mmol/l, in portion C - 13-57.2 mmol/l. An increase in the concentration of bile acids in portion C is observed with increased secretion of cholic acids by liver cells, a decrease - with secretory insufficiency of liver cells.

Cholesterol. In a healthy person, the concentration of cholesterol in bile in portion A is 1.3-2.8 mmol/l, in portion B - 5.2-15.6 mmol/l, in portion C - 1.1-3.1 mmol/l. An increase in the concentration of cholesterol in portions A and B is noted in cholelithiasis, cholecystitis; a decrease - in case of impaired concentrating ability of the gallbladder.

Bilirubin.

Reference values for bilirubin concentration in different portions of bile

Portion of bile	Van den Bergh method, g/l	Jendraszek method, mmol/l
A IN WITH	Up to 0.25 Up to 2-4 Up to 0.25	0.17-0.34 6-8 0.17-0.34

The concentration of bilirubin in bile decreases with mechanical jaundice, viral hepatitis, liver cirrhosis, calculous cholecystitis, and increases with hemolytic jaundice, Addison-Birmer anemia, and malaria.

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