An unusual gall bladder - 23/08/11
Doi : 10.1016/j.gie.2007.08.012
| Commentary Uric acid is the end product of purine metabolism in man, other primates, Dalmatians, birds, snakes, and lizards. Urates also constitute a large part of the body waste matter of birds (guano) and of reptiles. Uric acid is filtered by the glomerulus, reabsorbed in the proximal tubule, and excreted in the urine. Precipitation of uric acid in concentrated acid urine is not of pathological significance, but clinicians should be aware that apricot- or pink-colored (acid) urine has been described in up to a third of morbidly obese patients after gastric partitioning and that microscopy of the urine shows the same urate crystals as in this patient’s bile. The phenomenon also is known in infants and children, who have a higher uric acid clearance and excretion than adults when expressed as mg/kg body weight. Nephrologists in medieval times examined their patients’ urine by placing the liquid in a glass receptacle called a matula, which they held up to the light to judge the color and turbidity of the urine. We no longer do this, possibly because of regulations from the Clinical Laboratory Improvement Amendments (CLIA), or because more sophisticated means of evaluating body fluids have been developed. Uric acid also is excreted in bile, but at the alkaline pH of bile, it should be fully dissolved; its precipitation in the gallbladder is curious and unexplained by chronic cholecystitis. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2008
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 67 - N° 2
P. 347-348 - février 2008 Retour au numéro
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