Volume 2

The principles and practice of medicine / by Rustomjee Naserwanjee Khory.

  • Khory, Rustomjee Naserwanjee.
Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of medicine / by Rustomjee Naserwanjee Khory. Source: Wellcome Collection.

    692/764 (page 680)
    milation ; and the secretion ceases altogether if the portal vein is tied. The flow of bile is said to be continuous. It is increased an hour or two after taking food, and continues till the digestion is completed. About forty or fifty ounces are secreted in twenty- four hours. In cases of obstructive jaundice, where most of the bile is reabsorbed, the blood is found rich in fat and soda. In cases of gall-stones obstructing the common duct, the patient rapidly loses fat. In cases where the liver continues to be inert, or acts inefficiently the bile is not properly secreted, but the intestines by a kind of vicarious action supply a fluid resembling bile. A similar vicarious excretion of urine is known to occur when the function of the kidneys is suppressed. Where bile is prevented from reaching its proper destination it becomes a source of irritation and mischief; thus, in jaundice, the constituents of bile display them- selves in every tissue and fluid of the body. Advantage is taken of the fact of this vicarious elimination of bile from the intestine in cases of portal congestion where the liver is presumably inactive. A dose of calomel or other cholagogue is given to relieve constipation in one person and to check diarrhoea in another ; under its use, the motions which were formerly colour- less become more or less green, or sometimes when seen by reflected light they appear black. This change in the colour of the faeces is partly owing to the discharge of the bile which was probably long retained in the gall-bladder. In tropical countries a tempo- rary suspension of the functions of the liver and the consequent absence of bile in the faeces are common causes of irritation of different portions of the intestine, producing or aiding in the pro- duction of different diseases as diarrhoea, dysentery, and cholera. Disorders of the biliary function.—The secretion of bile may be deranged in two ways; there may be either excessive or defective secretion. In cases of insufficiency the secretion is defective or even altogether suspended ; and besides this the bile may be pro- perly secreted by the liver, but may be retained in the bile passages. In both cases the normal quantity of bile is prevented from flowing into the intestine. The bile elements are partly retained in the portal system and partly carried by the hepatic veins into the general circulation. In that form of jaundice in which the function of the liver is altogether suspended (owing to malaria), the elements of bile are retained in the portal system, and a severe form of enteric derangement is the consequence. In obstructive jaundice the bile, although properly formed, is prevented from passing into the intestine, and it enters the general circula- tion whence it is taken up by various tissues and excretions. In