The overloading of the urine with urates and uric acid, which are still further increased by the frequent complication of obesity with the uric-acid diathesis and gout, leads to the development of concre tions in the urinary passages, in the pelvis of the kidney, and in the bladder, and adds to the discomfort of the patients. The-stones con sist mainly of urates and free uric acid, more rarely of oxalic acid and phosphates.
The liver of the patients is not only influenced by the chronic hyperaemia which by itself may lead to swelling and enlargement, but has absorbed in its cells large masses of fat in consequence of the ex cessive fat-formation in the body, and hence presents usually a very considerable increase, especially in thickness, while the anterior margin has lost its sharpness and has become rounded and tumid.
The enlargement of the liver can be easily demonstrated by per cussion, owing to the thickening and the sharper demarcation of the lower margin, especially on percussing from the abdomen upward, when the liver dulness begins farther clown below the ribs; but a marked enlargement upward is rarely found. The resistance of the liver can be less readily felt on palpation by reason of the thickened abdominal walls. The liver is not painful on pressure and causes no other notable symptoms. The patients are inconvenienced chiefly when they lie on the left side, as the bulky liver, which sinks down from its great weight and presses on the remaining organs, interferes with quiet sleep.
The secretion of bile by the liver is not disturbed by the excessive absorption of fat. Not very rarely, however, the outflow of bile may be impeded, and the incarceration of gall-stones in the bile ducts may cause painful attacks of colic.
With an abundant consumption of alcohol the fatty liver may early present symptoms of degeneration, and cirrhosis may develop so that the organ is found smaller than normal. The chronic diar Amens observed in corpulent persons should be ascribed, according to Kisch, rather to the alcoholism than to the fatty degeneration of the liver, since the latter condition is generally associated with habit ual constipation.
Stomach and Intestinal Canal.—In the early years of obesity, in the great majority of cases, nutrition is excessive, often enormous quantities of solid and liquid, suitable and unsuitable foods and drinks being consumed.
By the overloading with, as a rule, very indigestible substances the stomach is dilated, gastrectasia results, with abnormally long re tention of the contents. Associated with this condition are dyspep sias and gastric catarrhs of various kinds, partly due to the insult by the inappropriate nutrition, partly to the circulatory disturbances in the portal system. The plentiful meals are followed by sour eructa tions, heartburn, or extensive development of gases which may pro duce a more or less troublesome distention of the stomach and tym panites. Only after several painful hours larger masses of slightly odorous gases pass by the intestine and in a short time ease the patient. However, the gases escaping upward and downward may also often acquire a very offensive quality from the retained ingesta. Smaller quantities of gas are frequently expelled by vigorous peri staltic movements, when a rumbling, gurgling noise may be heard at a distance.
Another, but on the whole rare, symptom is the occasional sensa tion of boulimia. In this condition the patients not only consume during the day the usual and perhaps more than ample meals, but they are obliged, when the attacks occur, to ingest additional and large amounts of the most heterogeneous and bulky foods; even at night the patients are awakened from sleep by a sensation of hunger and eat considerable quantities of bread, meat, eggs, etc. Extensive dilatation of the stomach is seldom absent under such conditions.
Much more frequently than boulimia, a sensation of thirst comes into the foreground in the course of obesity. Great eaters are usu ally also great drinkers. The consumption of large quantities of food, much of which is spiced, sharp, and thirst-producing, likewise calls for increased ingestion of fluids, and when the thirst is once thoroughly aroused it can hardly be quenched by ever so large amounts of liquids. Besides, the strongly spiced dishes lead to chronic catarrhs of the oral and pharyngeal cavities (pharyngitis sicca) which are associated with altered secretion and dryness of the mucous membrane:. With the gradually developed dyspepsia, how ever, the appetite is lost and the craving for drink becomes the more imperative and unquenchable. The patients at last eat very little but consume instead quite incredible quantities of fluids, even plain water.