Gall Stones. Biliary Calculi.
These are brownish, chocolate colored concretions which form either in the gallbladder itself, in the duct leading from the gall bladder, or in the common duct which is formed by the union of the gall duct and the hepatic duct which leads from the liver. They are solid, generally have bodies of irregular shape and size, and have facets caused by the stones being impacted against one another. Fig. 99 shows their appearance. These concretions are formed of inspissated bile and organic salts. When they settle into the ducts their natural course is downward through the duct into the bowel where they axe naturally carried off with the feces. Their passage through these ducts is accompanied often with extreme pain and colic, the pain being the severest of any to which the system is subjected, and generally requires an opiate. . When once an attack of gallstones has occurred, the patient is liable to more, as they seldom exist singly in the gallbladder. These repeated attacks have been the subject of a great deal of thought among surgeons.
Symptoms. An almost constant uneasiness in the right hypochondriac region, with spasms of pain, coming on suddenly, and lasting for a time with great severity, and then subsiding. The pain is caused by a stone being suddenly forced into the duct and moving forward in it, and it subsides when the stone either stops, or gets through the duct. When the stone reaches the bowels, it passes off with the stools.
The patient generally has a pale, sallow complexion, a small, feeble pulse, and often suffers from nausea and vomiting, and from restlessness and hurried breathing.
Treatment. To reduce the spasm, give Dover's powder in full dose,, or chlorodine. Also, apply mustard over the right hypochondrium and stomach, and follow it with hot fomentations with hops.
If the stomach is irritable, give the neutralizing mixture until it moves the bowels. To relieve the intense pain, morphine should be administered, together with hot baths and hot cloths over the abdomen.
Sweet oil was at one time advocated as a solvent of these bodies, but experience has not proven the validity of the claim. Many practitioners, however, still insist that oil in large doses hastens the passage of the stones.
To remove the acidity on which the formation of these stones so often depends, a neutralizing preparation (338) may be given for a long time, the diet, in the mean time, being well regulated. The sponge bath with saleratus and water, should be taken daily, followed by brisk rubbing; and free exercise in the open air should on no account be omitted.
Of late years it is customary to treat this complaint surgically, operating directly on the gallbladder by incising it and removing the stones. If the ducts become obstructed, they too are incised and the stones dislodged, either by pushing them down into the bowel, or otherwise, as may be most convenient. The gallbladder is either sutured to the abdominal wall, and a biliary fistula forms, discharging the bile upon the abdominal wall; or it may be drained off into a bottle; or, as has been recently advocated, the bladder may be sewn up tightly and replaced. Sometimes communication is established between the gallbladder, or the duct, and the duodenum, by means of an ingenious device called 1, Murphy's Button." This button, invented by Dr. Murphy of Chicago, is intended to draw together the parts to be connected, retaining them in that position. After some days the walls slough away, and the button passes into the bowel, and is thus removed from the system. By this means many stubborn cases of impacted gallstone have been permanently cured.
Abscess of the gallbladder, inflammation of the surrounding tissue, and even death are not infrequent results of the presence of these foreign bodies.
For preventing the formation of gallstones, see the articles on Biliousness, Diet, etc.
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