Treatment. — Spirit - drink ing must be en tirely stopped. It is to be remembered that constant tippling is even worse in the produc tion of the disease than occasionally getting drunk. This is the main point in the treatment. The other treatment to be adopted is practically the same as that already recommended for con gestion. Dropsy, bleeding, &c., are to be treated as noted under these diseases.
Inflammation of the Bile-duets (Catarrh of the Bile-ducts).--This is usually a result of cold, and frequently accompanies gastric catarrh, or cold in the stomach.
Its symptoms are indistinguishable from those described as belonging to gastric catarrh (p. 233); they are disordered stomach, loss of appetite, flatulence, pain or uneasiness across the belly and towards the right side, sickness, vomiting, white-coated tongue, and fever. The only additional thing is that after some days, perhaps a week or more, jaundice comes on, and there is tenderness or pain over the liver. The first appearance of the yellow tinge of jaundice is to be looked for in the whites of the eyes. The jaundice and pain are both due to the same cause. The bile-ducts are not very wide chan nels, and the inflammation causes swelling of the lining membrane, and thus blocks the pas sage. The bile is therefore prevented from flowing into the bowel, and, being dammed up in the liver, causes swelling and tenderness. The absence of bile in the bowel produces cos tiveness, flatulence, and clay-coloured or white stools, &c. After a time the bile, failing to escape from the liver, is picked up again by the blood-vessels, gets into the blood, and causes the yellowness of the whites of the eyes and of the skin, and a dark colour of the urine, in which the presence of bile may be detected.
For treatment, consult what has been said about gastric catarrh (p. 233), and add to it that hot applications are useful over the liver.
Obstruction of the Bile-duets may be pro duced by inflammation, the swelling and ening blocking the channels. It is often due to gall-stones, which pass down some distance and finally stick altogether, and to various other causes, a growth for instance pressing upon the bile-duct from outside. Reference to Plate XIV.
will show how any growth at the small end of the stomach or the commencement of the small bowel might easily do this. Some of the smaller ducts in the liver only may be obstructed, or it may he the duct from the gall-bladder. The worst case, of course, is where the hepatic duct (p. 201), or the common bile-duct, is obstructed, since then the bile cannot flow out of the liver at all. In such cases the bile gets pent up in its channels, unable to escape, and as the liver goes on producing bile the liver speedily comes engorged with bile, and all the channels become widened with the pressure of the fluid. The liver, therefore, gradually enlarges. This goes on for a certain time till the pressure of fluid in the bile-channels becomes so great as to act back on the liver-cells. The cells come degenerated in consequence, and the liver gradually ceases to form fresh bile. That which has accumulated becomes changed in character by materials being absorbed, picked out of it, and passed back into the blood. In the end, after several months, the liver shrivels, wastes, and becomes flabby. Death may result from complete obstruction in a few weeks, though life may be prolonged for several years.
The symptoms are chiefly intense jaundice, costiveness from the absence of bile in the bowel, the motions being of the colour of clay, inability to digest fat, and various other symp toms described under JAUNDICE (p. 274). Pain, biliary colic, due to the attempt of the bile passages, by contraction of their muscular walls, to force the stone along, occurring in spasms, of a very agonizing character, beginning in front on the right side and between the navel and the margin of the ribs, and thence radiat ing downwards, upwards, and through to the back, is very typical of obstruction by gall stone. The enlarged liver may be felt by the fingers, projecting from under cover of the ribs. It is needless to detail symptoms or treatment here, since the case will tax the powers of a skilful physician. The stone can be removed by operation.
The treatment consists mainly in attending to the general health, avoiding fatty foods and alcohol, taking moderate exercise, &c.