GALL-BLADDER AND BILE-DUCTS, Inflammation of.
The acute catarrhal form is an extension of a similar condition in duodenum and stomach, and its treatment is that of simple catarrhal Jaundice. When the cholecystitis is due to gall-stones the agents to be used will be found detailed in the next article.
Chronic catarrhal cholecystitis may also be the result of gall-stones, but more frequently it is due to causes which interfere with the periodical evacuation of the gall-bladder, as the pressure of scybala in the right bend of the colon, tight lacing and ptosis of the liver—a part of the condition present in Glenard's Disease. Rest in bed with the view of effecting replacement of the displaced organs, followed by free purgation, will meet the requirements of most cases. Drainage of the gall-bladder is generally undertaken only in the next type of the disease, but cure of a simple chronic catarrhal state of the gall-bladder may be confidently expected to follow the removal of calculi; drainage has proved effectual when an operation was undertaken to remove gall-stones and these were found absent.
Suppurative cholecvstitis, whether or not due to gall-stones, is the result of Bacillus coli or other infective agent. The treatment of this form and of its most virulent gangrenous type must be prompt if life is to be saved. The abdomen should be opened without delay, the gall-bladder freely incised, its purulent contents evacuated and free drainage provided. In the gangrenous or acute phlegmonous variety of the disease the gall bladder must be completely removed.
Catarrh of the Bile-Ducts (Cholangitis).—The term Acute catarrh of the common bile-duct is synonymous with catarrhal jaundice. As this condi tion is nearly always the result of a gastric or duodenal catarrh which extends up the entrance of the common duct its treatment is that of the primary affection. The error in diet which has caused the catarrh having probably been corrected before the jaundice appears, there is little use in administering emetics, which would only do harm by increasing the gastro duodenal inflammation. if vomiting is present, it may be encouraged, however, by directing the patient to drink large quantities of tepid water till the stomach has been thoroughly washed out. One dose of Calomel
(3 grs.) may then be given, followed by a smart saline purge (ass. Glauber's Salt). As the absence of bile in the intestine tends to cause constipation the saline will require repetition every second morning. The best routine treatment for the gastro-duodenal catarrh is to allay the nausea by a simple effervescing mixture of 4o grs. Bicarbonate of Potassium given in effervescence with Lemon-juice, after which the following gastric sedative should be administered: Bismuth. Carb. 3iij.
Sodii Bicarb. 3iij.
Sodii Salicyl. 3ij.
Acacia, Rec. 5iss.
Chlf. ad 3viij. Misce.
Fiat .Alist. Cpt. ter in die 1).1).a.
Pain, if present, over the hepatic region may be relieved by a large poultice or by the application of a warm liver pack covered up by mackin tosh tissue or oiled silk. The diet should consist of milk with the addition of a little lime or Kali water, and at a later stage soups free from fatty matter. The above treatment is equally efficacious in those cases arising from inflammation about the head of the pancreas.
Chronic Catarrhal Cholangitis is, practically always, the result of the irritation of gall-stones, and its general treatment will be discussed in the next article. When the obstruction of the common duct is incomplete there is often added the condition known as Charcors hepatic intermittent fever, owing to the admission of Bacillus coli or other infective organisms within the biliary passages. The treatment of the rigors and sweating resolves itself into the alleviation of the symptoms, as in other infections, by full doses of Quinine or Salicvlates and warm alcoholic drinks, etc., whilst hepatic pain is to be relieved by the liver pack and saline purgatives. The surgical removal of the biliary concretion or obstructive factor should be undertaken at the earliest stage possible in order to prevent suppurative cholangitis, cholecystitis and liver abscess, which, when once established, are liable to prove fatal. Where operative measures fail or are contra indicated Vaccine treatment by injections of sterilised Bacillus coli should be carried out.