The clinique médicale; or, reports of medical cases / Condensed and translated, with observations ... from ... medical authors: by D. Spillan.

  • Gabriel Andral
Date:
1836
Catalogue details

Licence: Public Domain Mark

Credit: The clinique médicale; or, reports of medical cases / Condensed and translated, with observations ... from ... medical authors: by D. Spillan. Source: Wellcome Collection.

    1014/1050 page 982
    At other times, on the contrary, the cavity of the gall-bladder is found much larger than usual ; this appears to happen chiefly in cases w'here, there being an obstacle to the free passage of the bile into the ductus choledochus, this liquid flow's back, and accumulates in the gall-bladder, from which it can no longer make its exit, so as to flow' into the duodenum. This same increase of size may also exist in portions even of the biliary ducts which are situate behind an obstacle. In one case, where a calculus closed up the duodenal orifice of the ductus choledochus, we found this duct so dilated through the remainder of its extent that its diameter equalled that of the vena portæ. Every one knows that the materials of the bile may become solidified in the excretory passages, so as to form calculi, w'hich vary very much in their chemical composition, in their form, colour, dimensions, number, seat, etc. We shall not here enter into the history of biliary calculi. We shall merely call the attention of chemists to a white calculus, composed merely of phosphate of lime found by us in a gall-bladder, which contained nothing around it but a little mucus. In another case we found the gall-bladder filled with pus instead of bile. The symptoms occasioned by the different alterations in the excretory passages of the bile now considered vary according to the nature and seat of these alterations. The gall-bladder may be filled w'ith calculi, and even w'ith pus ; its parietes may be the seat of different alterations ; its cavity may have diminished con- siderably, or even have disappeared ; it may cease to receive any bile in eon- sequenee of the obliteration of the cystic duct, without any of these lesions producing during life any morbid phenomenon which could indicate them. The gall-bladder distended very much by bile or by other matter (calculi, pus, etc.) may pass beyond the edge of the liver, and form a tumour in different points of the abdomen, where it becomes sensible to manual examination. We have detected it, ist, immediately beneath the cartilaginous edge of the ribs of the right side ; 2ndly, low'er dow'n in the hypochondrium, either directly perpen- dicularly dow'nw'ards, and corresponding to the place it usually occupies, or inclined considerably backwards or forwards ; projecting, for instance, into the epigastrium ; Srdly, we have seen it touch the crest of the ileum, and even descend before it as far as the iliac fossa. This tumour thus formed by the gall-bladder may not disappear, once it has shown itself. At other times it is observed to disappear after a longer or shorter time. This disappearance comes on principally under the following circumstances : 1st, when the obstacle w'hich prevented the passage of the bile into the ductus choledochus ceases to exist ; 2ndly, when the bile, at first accumulated in its reservoir, becomes afterw'ards absorbed, and the gall-bladder, no longer receiving any additional bile, has a tendency to become atrophied ; Srdljq when the parietes of this same gall-bladder, distended, and more or less changed, come to be per- forated ; whence there is a flow of bile either into the peritoneum, or into some other hollow' organ, with whose cavity the gall-bladder accidentally communicates, or externally, in the case where adhesions are previously established between the gall-bladder and the abdominal parietes ; and the latter have in their turn become inflamed, ulcerated from within outwards, and perforated. In speaking of the different changes which may affect the hepatic parenchyma, w'e stated that jaundice might come on in all, but was not necessarily the result of any. Observation proves, on the contrary, that every time there is obliteration either of the ductus hepaticus, or ductus choledochus, jaundice is produced. This obliteration may be occasioned either by a foreign body which obstructs the cavity of the ducts, or by tumours which compress it from without inw'ards, or by a process of inflammation w'hich has ]:)roduced engorgement and thickening of the mucous membrane, or that of the subjacent tissues. It may be readily seen that
    digitised image 1
    digitised image 2
    digitised image 3