ETIOLOGY OF GALLSTONES

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Abstract
In a former paper1 it was shown that the cholesterol in bile is held in solution in a more or less stable complex with the different bile salts, and that any lowering of the bile salt-cholesterol ratio below a certain point would bring about a precipitation of the cholesterol. It was also demonstrated that while the normal dog's gallbladder absorbed neither in appreciable amounts, the abnormal gallbladder absorbed bile salts and thus lowered the ability of the bile to hold cholesterol in solution, and brought about crystallization. It was then mentioned as theoretically possible that the liver itself might be a factor, in that bile might be excreted with a very low bile salt-cholesterol ratio, and that this might even be low enough to bring about precipitation of cholesterol. While it is difficult to see how the excretion of solid undissolved cholesterol would be possible, nevertheless, if the bile

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