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Bile acids are steroid acids found predominantly in the bile of mammals and other vertebrates. Diverse bile acids are synthesized in the liver. [1] Bile acids are conjugated with taurine or glycine residues to give anions called bile salts. [2] [3] [4] Primary bile acids are those synthesized by the liver.
Finally, the conjugated bile acids which remained un-ionized conjugated bile acids are passively absorbed. Venous blood from the ileum goes straight into the portal vein and then into the liver sinusoids. There, hepatocytes extract bile acids very efficiently, and little escapes the healthy liver into systemic circulation.
Bile consists of water, electrolytes, bile acids, cholesterol, phospholipids and conjugated bilirubin. [2] Some components are synthesized by hepatocytes (liver cells); the rest are extracted from the blood by the liver. [3] Bile is secreted by the liver into small ducts that join to form the common hepatic duct. [4]
In the human liver, bile is composed of 97–98% water, 0.7% bile salts, 0.2% bilirubin, 0.51% fats (cholesterol, fatty acids, and lecithin), and 200 meq/L inorganic salts. [2] [3] The two main pigments of bile are bilirubin, which is orange-yellow, and its oxidised form biliverdin, which is green.
Primary bile acid diarrhea (Type 2 bile acid "malabsorption") may be caused by an overproduction of bile acids. [5] [9] Several groups of workers have failed to show any defect in ileal bile acid absorption in these patients, and they have an enlarged bile acid pool, rather than the reduced pool expected with malabsorption. [10]
Ursodeoxycholic acid (UDCA), also known as ursodiol, is a secondary bile acid, produced in humans and most other species from metabolism by intestinal bacteria.It is synthesized in the liver in some species, and was first identified in bile of bears of genus Ursus, from which its name derived. [8]
This is why chenodeoxycholic acid, and not cholic acid, can be used to treat gallstones (because decreasing bile acid synthesis would supersaturate the stones even more). [6] [7] Cholic acid and chenodeoxycholic acid are the most important human bile acids. Other species may synthesize different bile acids as their predominant primary bile ...
In chronic liver diseases such as cirrhosis, bile acids may deposit in the skin, causing pruritus (itching). Hence, bile acid sequestrants may be used for the prevention of pruritus in patients with chronic liver disease. [10] Bile acid sequestrants may also be used to treat hyperthyroidism as an adjunct therapy.