Acholia

ACHOLIA (from Greek a-, negative particle, and chole, bile), the partial or complete absence of bile flow into the intestine due to mechanical obstruction of the bile duct by a gallstone, neoplasm, scar strictures, or external pressure from neighboring organs. The stool becomes acholic, acquiring a whitish-gray, clay-like appearance, partly due to the absence of urobilin, and to a greater extent due to increased fat content. Aside from inadequate fat absorption, one observes constipation—explained by the lack of normal stimulation of intestinal peristalsis by bile—abundant gas formation, and a putrid odor of the feces due to abnormal decomposition of the intestinal contents; in the urine, there are bile acids and urobilin. From the nervous system, phenomena of intoxication. Pigmentary acholia is the absence of bile pigments in the bile. The excretion of such so-called "white bile" is extremely rare and indicates severe damage to the hepatic parenchyma, for example, in phosphorus poisoning. Analysis of the colorless mucoserous fluid reveals protein and traces of bilirubin and bile acids, and sometimes cholesterol. Liver cells in pigmentary acholia do not produce bile pigment at all or secrete bile pigment only into the bloodstream. Acholic stool, feces containing no bile or with an insufficient admixture of it, grayish-white, clay-like in color, with a pungent odor, usually of an acid reaction; under the microscope, they often contain many fat droplets, fatty acids, and fatty-calcium salts (soaps). In contrast to fatty stool, in acholic stool, after extraction with ether, the normal (yellow) color does not appear, since the gray color depends on a lack of bile pigments rather than an excess of fat. Pathogenesis: retention of bile excretion into the intestine due to obstruction of the large bile ducts (hepatic or common) by a gallstone, salts, a mucous plug, parasites (Distoma, Ascarides), scar tissue, or a tumor (of the head of the pancreas, papilla of Vater, retroperitoneal glands). Furthermore, acholic stool usually also accompanies acute infectious jaundice (so-called catarrhal jaundice) and depends here on the retention of bile secretion within the liver cells themselves. Obstruction of the bile duct, as well as cirrhosis of the liver, usually does not cause the appearance of acholic stool. Thus, in the majority of cases, it is a symptom of diseases of the biliary tract or pancreas and is accompanied by their other characteristic symptoms. For treatment, see Jaundice.