Light liquid diet only should be given, as it is easy of digestion and less apt to ferment.
Tumors of the Biliary Tract.
Cancer.
E noLoGY.—Cancer may occur as a primary disease of the gall-bladder and of the bile-ducts or may be secondary to cancer of the liver, stomach, pancreas, or peritoneum.
Primary cancer of the gall-bladder affects females much oftener than males —in the ratio of 3 or 4 to 1. The bile ducts are affected about equally in the two sexes. The disease occurs usually from forty to seventy, but occasional cases are met with in early life and at advanced age.
Gall-stones are present in practically all cases of cancer of the gall-bladder. The relationship between the two condi tions is in dispute. Some regard the cancer as developing in the glands of the mucosa on account of the irritation by the calculi; while others look upon them as fornied subsequently to the com mencement of the cancer. The greater frequency of occurrence of gall-stones in females gives support to the view that their irritation frequently excites the de velopment of cancer.
Attention called to the frequency with mhich cancer and biliary lithiasis are associated. Of 44 cases of mammary can
cer in females, gall-stones were found in 16 per cent.: a ratio twice as high as that stated to hold for omen dead of causes other than cancer. Williams (Brit. Med. Jour., Aug. 26, '93).
The disease usually begins at the fundus of the gall-bladder, and at either extremity of the common bile-duct.
Cancer of the Bile-ducts.
SYMPTOMS.—It rarely forms a tumor that can be felt through the abdominal wall. The jaundice usually occurs early, and is intense and persistent. The stools are persistently clay colored. A fatal termination usually follows in. three or four months, from cholmmia. It may be the cause of cholangitis with inter mittent hepatic fever or there may be suppurative cholangitis.
DIA.GNOSIS.—It is practically impos sible to make a positive diagnosis with out an exploratory operation. The per sistent intense jaundice is suggestive, and may, in some cases, render the diagnosis extremely probable, especially in the ab sence of biliary colic.