So if bile is a detergent...?

[canesdukegirl, BSN, RN]

I was doing a lap chole with a trauma surgeon last month. He was quizzing the med student on the function of bile. When we started taking down the gallbladder from the liver, the gallbladder was nicked and bile started to leak. When this happens, we as nurses must then classify the wound as "clean contaminated". While listening to the surgeon lecture, he asked the med student why we saw bubbles when we irrigated. No response from the student. The surgeon went on to say that bile is actually a detergent.

Now I am a self admitted airhead. I know that detergent doesn't always mean "scrubbing bubbles". However, upon further pondering of his statement, I researched further on the detergent properties of bile. So my question is this:

If bile is spilled into the abdominal contents during surgery, why is it considered clean-contaminated? I am surmising that since bile is a protein and can denature if the gallbladder ruptures well BEFORE surgery, it can be considered contaminated at that point. But DURING surgery?

Thoughts?

[azhiker96, BSN, RN]

Just a guess here but I think "contaminated" because bile usually is not in that area. "Clean" because bile comes from the liver and would usually be devoid of pathogens.

Bile does hydrolyze fats and as such I guess you could properly call it a detergent. Reminds me of my dad (a physician) who referred to his pacer as a spark plug and the coumadin as rat poison.

[JulieCVICURN, BSN, RN]

I would tend to agree with azhiker - it's bile where it shouldn't be (contaminated) but doesn't contain bacterium, etc., (like, say, a contaminant from a bowel would) so it's clean.

I had been a nurse for two years before someone pointed out to me that coumadin is just D-Con rat poison. I had to read the box in the grocery store before I believed it, too!

[canesdukegirl, BSN, RN]

Thanks y'all. Yep, good ol' warfarin sure can make the rats bleed out!

[DLS_PMHNP, MSN, RN, NP]

Thanks y'all. Yep, good ol' warfarin sure can make the rats bleed out!

Sounds yummy, canes.

When's lunch?

[GilaRRT]

Just to be clear; bile does not hydrolyse fats. Fats are actually hydrolysed by pancreatic enzymes. Bile is similar to detergent in that it emulsifies triglycerides (the most common fat that humans eat).

Fats are for the most part non-polar. Essentially, there is little to no separation of charge. Because water is a polar molecule (separation of charge), other charged (polar) molecules will easily dissolve in water, but non-polar molecules will not easily dissolve in water. However, detergent like substances can basically be seen as having a polar component and a non polar component. The non-polar component can surround the fat, while the polar component can interact with water. This action allows the fat to be broken down into much smaller particles and allows for easier digesting by various enzymes. This special characteristic of detergents is characterised by the term amphipathic.

[AgentBeast, MSN, RN]

I :redbeathe micelles.

[Blindsided]

Thank you "peeps." Interesting.

[nursel56]

I love Gila's detailed explanations! Now where did I read that detergents don't make suds and that sodium laureth sulfate is added because people don't think anything is happening unless they see the suds - soap=suds.

[MickeyTong]

Bile is similar to detergent in that it emulsifies triglycerides (the most common fat that humans eat)......etc

God bless allnurses.com, and all the wise souls who sail on her.

Quite often, when MickeyTong dry-retches on the day's plates and pans before they go into the dishwasher, my fastidious other-half will throw me a filthy look and a hurtful remark about my vile personal habits.

Now I can tell her: "Hey! It's clean. Look it up on the interwebthing."

[AgentBeast, MSN, RN]

If you are puking up bile you probably should see a doctor.

[MickeyTong]

If you are puking up bile you probably should see a doctor.

I see doctors every day. They have no comment. Even when I dry-retch over them....