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.

    712/856 (page 680)
    ducts ; and that cholangitis complicates diseases of the liver, such as portal cirrhosis, chronic venous engorgement, hepatitis, and malignant growths. Chronic cholangitis occurs in hypertrophic biliary cirrhosis with chronic jaundice, but all cases of chronic catarrh of the intraheimtic ducts do not conform to the type of Hanot's disease, though the conditions are allied. The small ducts shew proliferation of the lining epithelium, which may block up the lumen ; there may be some dilatation of the small bile-ducts, and there is pericholangitic fibrosis. The following conditions have been ascribed to chronic angiocholitis, but their pathological nature requires confirmation. Klippel and Vigouroux ^ described a case of chronic cholangitis with hepatic insufficiency, diarrhoea, no jaundice or enlargement of the sjjleen, in which signs of acromegaly developed. The authors suggest that this was due to hepatic insufficiency in the same way that clubbed fingers develop in hypertrophic biliary cirrhosis. The liver shewed angiocholitis and fibrosis of the portal spaces. Lereboullet ^ described a somewhat similar condition under the name meta-icteric splenomegaly. Jaundice due to cholangitis occurs first, and subse- quently as it recedes, the spleen becomes enlarged. The enlargement of the spleen is supposed to be due to passive venous engorgement produced by pressure on the branches of the portal vein by sclerosing cholangitis. Cases thought to be due to chronic catarrhal inflammation of the small intrahepatic ducts should be treated with plenty of water and occasional courses of salicylate of sodium, combined with urotropin, so as to wash out the ducts and remove catarrh. Minute doses of calomel (2V '^^y given two or three times a day to minimise intestinal fermentation, and the bowels should be kept freely open and the diet should be simple and nourishing. Alcohol should be forbidden. Spa treatment on the same lines as in chronic catarrhal cholangitis of the larger ducts may be adopted. Pekicholangitis Pericholangitis may be divided into : (a) Extrahepatic, affecting the larger bile-ducts; and (6) intrahepatic. Extrahepatic pericholangitis may accompany changes in the larger ducts, but is entirely subordinate to that condition. Intrahepatic Perieholangitis. — This is chiefly of pathological interest, since it either occurs as part of other morbid lesions or has no definite clinical associations. It is met with under different conditions and may be acute, as in suppurative cholangitis, of which it forms part, or it may be chronic. ^ Klippel et Vigouroux. Pnsse mid., Paris, 1903, i, 245. 2 Lereboullet. Semaine mid., Paris, 1903, .x.xiii, 180.