Report of a case from heart-failure dur ing an attack of biliary colic in a dia betic patient. Changes in the myocar dium were found at the autopsy. Elsner (Med. News, Feb. 5, 'OS).
The presence of a tumor below the -costal line indicates dilatation of the gall-bladder, which takes place in early attacks. A distended gall-bladder may -occasionally exist in more or less chronic binary lithiasis as a result of impaction of the cystic and common ducts. It is, however, more frequently found in eases -of malignant disease. Enlargement of the spleen is present in some febrile cases.
_Hepatic. colie may also lie due to a simple spasm. 1. Clinical proofs: hepatic colic is common in eases of hysteria. where no g,all-storie is present. 2. Proofs from pathological anatomy: cases have been observed of jaundice and colics in which the only lesion found was contrac tion of the bile-duet. 2. Experimental proofs: spasm of the lower part of the CO111111011 duct can be set up in dogs. LC,pine (Lyon AI(A., Feb. 1S, '94).
At the commencement of an attack of cholelithiaMs—i.c., at a time when pain has not set in—a tumor represented by thc gall-bladder is, tangible. This disap pears directly the gall-stone reache.s the intestine. Not infrequently the pains do not at once subside; these may be caused by slight circumscribed local peri tonitis in the region of the gall-bladder, and may be lessened by ice-cold com presses. Swelling of the gall-bladder may also be caused, however, by occlu sion of the common duct by ascarides, Disti»na ltepirtirurn, or inflammatory ex udations and by a tumor of the head of the pancreas pressing on the gall-duct. Gerhardt (Dent. med. Woeh., Oct. 15, '93).
Catarrhal jaundice; cancer of the pancreas, gall-bladder, or duets; cancer or tuberculosis of the liver, malaria, or cardiac disea.se may give rise to symp toms simulating those of stone in the common duct. G. AN'. Webster (Jour. Amer. Med. Assoc., June 22, '95).
Possibility of confusion between a dis tended g,all-bladder and movable kidney. To distinguish between the two condi tions it must be remembered that a dis tended gall-bladder, as well as the kid ney. is a frequent cause of movable ab dominal tumor. The range of motion in the gall-bladder is, however, always in the arc of a circle, the centre of which is a point beneath the right lobe of the liver. The history of a distinct attack of
jaundice is an important factor in diag nosis. distended gall-bladder can gen erally he felt, whereas a movable kidney often cannot. The gull-bladder, if dis tended with stones, is much harder than the kidney. Henry Morris (Brit. ...Vied. Jour., Feb. 2, '95).
In ca.ses of gall-stones in which biliary colic is not present diagnosis is usually not made till the autopsy. Dull pain in the region of the liver and vomiting noted in several cases. The gall-bladder Is not usually palpable; it could be felt in one of the eases described, but not in the others. A. L. Benedict (Aled. News, .lmie S. '95).
Krauss, who was himself a sufferer from biliary colic, g,ives the following chief symptoms:— 1. Sudden onset between two and three hours after a meal.
2. Violent, spasmodic, paroxysmal pains over the hepatic and epigastric re gion radiating upward over the right half of the thorax.
3. Labored respiration, feeling of dis tress, nausea, and vomiting.
4. Slow, hard pulse and cold extremi ties.
5. Sudden or gradual termination of the attack.
6. Onset of jaundice, which under certain circumstances follows the attack.
The amount of pain does not depend so much upon the size of the stone as upon its shape. A small calculus with sharp projections will cause more pain than a much larger one which is round or oval.
When the stone is arrested in the common bile-duct, similar symptoms to those already described manifest them selves, together with jaundice. It is generally thought that the pain is not so sharp or severe when the calculus lodges in the common bile-duct as when it is arrested in the cystic duct.
Icterus ensues a day or two after the commencement of the attack, and its intensity will depend upon the amount of obstruction. Bile-pigment may be found in the urine before any change is no ticed on the skin or conjunctiva. In severe cases the liver may be slightly enlarged and tender and the skin of a dark-yellow color. The urine is dark and the aces clay-colored. When the obstruction remains, symptoms of a chronic jaundice are observed, accom panied by intense itching of the skin and extravasations. Want of appetite. I foul breath, and slow pulse are symp toms often met with.