THOMAS GAFFNEY TAAFFE.
the reservoir for the bile, a pear-shaped membranous sac, about four inches long, one inch in breadth at its widest part and holds from an ounce to an ounce and a half, is lodged in a depression on the under surface of the right lobe of the liver. Its fundus or broad extremity is directed down ward and forward and occasionally projects a little beyond the edge of the liver, almost touch ing the abdominal wall about three inches from the middle line of the body, its body and neck extend upward and backward. The bile is conveyed to the small intestine by biliary ducts or canals about the size of a quill except when distended. The cystic duct, the smallest, and about an inch in length joins the neck of the gall bladder with the hepatic duct, about one inch and a half long, which issues from the liver and so is formed the common excretory duct of the liver and gall bladder, the largest of the biliary ducts and about three inches in length, which empties into the duodenum. Bile is not conveyed into the intestine until it is needed in the process of digestion, but as secreted in the liver passes into the'gall-bladder through the hepatic and cystic ducts to be stored until needed.
Catarrhal cholangitis, acute or chronic, is an inflammation of the lining membrane of the ducts, causing swelling of them and obstruc tion to the flow of bile. Usually it is an exten sion of a gastritis or duodenitis, or may be due to the presence of gall stones, to stricture, to cancerous disease or pressure from enlarged or contracted liver, etc. Whenever there is an interference with the flow of bile from the liver there is usually jaundice more or less pro nounced. Catarrhal jaundice is attended by few symptoms, no emaciation, some discolora tion of skin, liver little larger than usual and tender to pressure — usually runs a course of about six weeks. Marked jaundice coming on gradually and attended by severe pain-points to gall stones or something worse. Biliousness, sallow complexion, depression of spirits, di gestive disturbance is probably more often due largely to a deficient flow of bile rather than to an excessive amount, and may end in gall stones.
Cholecystitis, inflammation of the gall bladder due to infection by microbes from the intestines may be a mild catarrh, or suppuration may occur leading to perforation and peri tonitis. If a severe attack there is violent pain, great tenderness and a high temperature. If
persistent, and 'especially if stones are believed to be present, an operation is necessary. Chole lithiasis, the tendency to the formation of stones, occurs mostly among persons engaged in sedentary occupations who take but little if any exercise in the open air and who eat too much nitrogenous and fatty food. The bile becomes too thick and is retained, and stagnant, infec tion occurs and gall-stones form chiefly from cholesterine, a normal constituent of the bile. The congestion of the biliary tracts may result from poisons taken into the body or manu factured within the body, from interference with the circulation of the liver, and from dis placements of the liver.
Gall-stones, even in large numbers (100 or more) may be formed and held in the gall bladder for years without causing discomfort, but there is always the tendency to local inflam mation of the gall-bladder or of one or more stones being forced into the cystic or common duct, damming back the bile, causing adhesions and intense pain. Getting rid of gall-stones by medicines is unsatisfactory. There is no known solvent. Operation for their removal in ob stinate cases is necessary. Statistics show that only 1.4 per cent of operated cases die, under the care of experienced surgeons. The opera tion is not so much in reality to get rid of the stones as to get rid of the bacteria causing infection, and of inflammation, irritating fluids, etc.
Hepatic or gall-stone, colic, is the name given to the intense cramp that accompanies the pas sage of a gall-stone through the bile-ducts or an attempt at such a passage. There is a sudden excruciating pain in the right side at the free border of ribs or even over the whole abdomen; frequently the pain may shoot up to the right shoulder blade and arm. The patient rolls and tosses in agony with his face suffused with cold perspiration. Sometimes there is a chill followed by fever. The duration depends on the course of the stone; frequently relief is had in a few hours, only soreness remaining.
Cholecystectomy — surgical removal of the gall-bladder, now-a-days quite frequently re sorted to.
Cholecystotomy— surgical incision of the gall-bladder.
Cholecystastomy — surgical creation of per manent opening into gall-bladder through the abdominal wall.
one of the several minute gall making insects, as the British ash-fly. See GALLS AND GALL-MAKERS.