Diseases of the liver, gall-bladder and bile-ducts.

  • Rolleston, Humphry Davy, Sir, 1862-1944.
Date:
1912
Catalogue details

Licence: In copyright

Credit: Diseases of the liver, gall-bladder and bile-ducts. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    of the upper part of the rectus muscle and of the costal arch on the right side. Monsarrat^ insists on the shallow jerky respiration in acute cholecystitis. The gall-bladder may be felt and sometimes seen as a pear-shaped tumour, fluctuating or tense, which usually moves with respiration and can be displaced laterally like a pendulum. It may, however, be fixed by old adhesions. The distension of the gall-bladder is due to inflammatory exudation which cannot escape because the cystic duct is occluded by swelling of the mucosa. As the inflammation subsides, the fluid discharges through the cystic duct and the tumour disappears. There may be distinct tenderness, but no palpable tumour, in the position of the gall-bladder, which is concealed by intestines in a condition of paralytic distension due to peritonitis spreading from the gall-bladder. From this tympanitic distension the right hypochondrium and epigastrium may become somewhat prominent. Halsted ^ recorded a case in which sharply localised paralytic dilatation of the first part of the duodenum and pyloric end of the stomach, corresponding to circumscribed peritonitis, was found at an operation for gall-stones. The paralysed bowel was glued to the gall-bladder by recent exudation. The walls of the gall-bladder were white and thickened, and its cavity contained fluid like white of egg. Local peritonitis around the gall-bladder often sets up vomiting, and acute intestinal obstruction may arise (Eobson,^ Eichardson*) from paralysis probably of the hepatic flexure of the colon. The symptoms usually pass oS without surgical interference. The liver is not enlarged unless the inflammation has spread to the ducts, and so into the organ. Elongation of the lower part of the right lobe covering the gall-bladder (Riedel's lobe) is met with as the result of gall-stones and past or chronic cholecystitis, and so might be present when an acute attack supervenes in these conditions. Jaundice is not a necessary accompaniment of cholecystitis; Kehr,^ indeed, emphasises its rarity. It may depend on an extension of inflammation and spasm to the ducts or on the presence of some obstruction in the ducts. In the mild degrees of serous and catarrhal cholecystitis the temperature is usually normal. But if the inflammation is severe or extends to the ducts or to the peritoneal coat of the gall-bladder, there may be fever, sometimes of such a degree as to suggest suppuration, which, however, as shewn by operation, is not present. In rare instances micro-organisms absorbed from the gall-bladder may give rise to appendicitis (Dieulafoy ^), endocarditis (Lorrain '^), or infection of the urinary tract with B. coli. ^ Monsarrat. Practitioner, Lond., 1908, Ixxx, 775. 2 Halsted. Johns Hopkins Hasp. Bull., Bait., 1900, xi, 1. Mayo Robson. Mtd.-Ohir. Trans., Lond., 1895, Ixxviii, 117. Riohardson. Boston Med. and Surg. Jmwn., 1899, cxli, 662. Kehr. Diagnosis of Gall-stone Disease, p. 39, American translation, 1901. ^ Dienlafoy. Presse med., Paris, 1903, p. 445. Lorrain. BiUl. Soc. Anat. Paris, 1903, Ixxviii, 527.