| dc.description.abstract | The hazardous technique of endoscopic manometry precludes the
investigation of "normal volunteers" required to advance our knowledge
of the physiology and pathophysiology of the sphincter of Oddi, a
suitable animal model is required. Large and small animal models have
been proposed, as yet no one model has been accepted as being
representative of the human sphincter of Oddi. Furthermore no animal
model of sphincter of Oddi dysfunction has been developed.
In this thesis a porcine animal model of sphincter of Oddi function has
been developed. The importance of selecting the appropriate
anaesthetic agent, enflurane, has been proven. The effect of
cholecystectomy on the porcine sphincter of Oddi is shown to have no
overall significant effect on sphincter motility when compared to a sham
laparotomy group. However, two of the seven pigs after
cholecystectomy showed a paradoxical rise in sphincter basal pressure
after cholecystokinin infusion, these animal may represent porcine
sphincter of Oddi dysfunction.
Although substance P is found throughout the intestinal tract including
the sphincter of Oddi of man and pig its action was hitherto unknown.
In this thesis exogenous substance P was shown to stimulate the
sphincter of Oddi in vivo.
In this thesis the first development in sphincter of Oddi manometry
catheter design in nearly twenty years is presented. A superior nine
lumen catheter has been evaluated in porcine model and subsequently
used to assess sphincter of Oddi asymmetry in man.
Two retrospective studies are reported in this thesis; an audit of the
largest U. K. series, and a study assessing the relationship of sphincter
of Oddi motility and duodenal activity. Tachyoddia dissociated from the
duodenal migrating motor complex was associated with a raised
sphincter of Oddi basal pressure and may be a part of sphincter of
Oddi dysfunction. | en_US |
