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.

    739/856 (page 707)
    of the ducts, in which constipation is the rule. Attacks of diarrhoea may alternate with periods of obstinate constipation. By his tests Cammidge is unable to differentiate between carci- noma of the ampulla of Vater and a stone in the common duct.^ The clinical manifestations of the disease are illustrated by the following cases : Carcinoma of the Ampulla of Vater; Dilated Bile and Pancreatic Ducts; Haemorrhage into the Pancreatic Duct.—A man aged sixty-six was admitted into St. George's Hospital imder my care on July 22, 1900, with jaundice, pruritus, weakness, and wasting. He had never had any severe illness, and denied alcoholic excess and syphilis. Ten weeks before he had been quite well; jaundice then appeared quite painlessly. A month later he began to waste, became weaker and drowsy ; two weeks later the skin began to itch. Ou admission he was deeply jaundiced ; the liver was enlarged and quite smooth ; the gall-bladder could be indistinctly felt; the spleen could not be made out. The abdomen was somewhat distended, but there was no evidence of ascites. There was tenderness at a spot over the eleventh and twelfth ribs in the right hypochondrium. The urine contained albumin, bile- pigment, and bile acids, but no sugar. A tentative diagnosis of malignant disease of the head of the pancreas was made. On July 25 he had diarrhoea, on July 26 he vomited, had a rigor, and the temperature fell to 96°; pulse 96, small. Eespirations were 36 and the abdomen moved well. The liver seemed larger than on admission. He died eighteen hours after the onset of acute symptoms. The necropsy shewed a small, hard tumour arising from the mucous membrane of the ampulla of Vater, and not visible from the duodenum. The growth blocked the pancreatic and common bile-ducts. The common bile-duct was as big as one's thumb and contained dark bile and mucus ; when opened and explored in a downward direction with the finger, it was found to end blindly, like a test-tube. The hepatic ducts and the ducts in the left lobe of the liver were widely dilated ; except the main hepatic duct, the bile-ducts in the right lobe were bitt little dilated. The cystic duct and gall-bladder were greatly dilated; no calculi were found in the gall-bladder or in the bile-ducts. The liver (4 pounds) was smooth and of a deep green colour. Wirsung's duct was tortuous, dilated throughout its entire length, and near the head of the pancreas it formed a cyst into which recent haemorrhage had taken place. It is probable that the terminal acute symptoms depended on this haemorrhage. Towards the tail of the pancreas the duct contained dark fluid, probably altered blood of older date. The pancreas was attached to the posterior wall of the stomach by old adhesions. No calculi were found in the ducts of the pancreas. The pancreas itself was greatly fibrosed and hard. No secondary growths were found in any part of the body. The abdomen contained two pints of bile- stained fluid. The stomach and intestines shewed recent catarrh. Microscopic- ally the growth was a columnar-celled carcinoma and invaded the muscular coat of the ampulla of Vater {vide Fig. 102). The pancreas shewed extensive fibrosis, some recent small-celled infiltration, dilatation of the ducts, which con- tained minute calculous masses, and widespread atrophy of the glandular tissue. The islands of Langerhans were intact. ^ ' Cammidge. Proc. Roy. Sac. Med., Lond., 1910, iii (Med. Sect.), 205. 2 This case was reported in the Lancet, Lond., 1901, i, 467.