Part 89

According to the degree of obstruction there may be more or less acute symptoms of biliary colic, icterus, marasmus, poisoning by bile acids, etc.

Treatment must be directed toward the removal of the special cause of dilatation.

DOUBLE GALL-BLADDER.

As a congenital formation the gall bladder is sometimes divided into two at its fundus, and in other cases the division extends throughout, forming two complete sacs. This has been found in the sheep, cat, ox (Gurlt, Goubaux) and pig (Goubaux). Such a redundancy does not interfere with normal functions.

CHOLELITHIASIS. BILIARY CALCULI. GALL STONES.

In ruminants, omnivora, and carnivora, less often in horse, 1 to 1000, or more, biliary sand to marble or more, casts; nucleus, bile pigment, blood mucus, etc., with concentric layers of cholesterine, pigment, salts and lime. Causes: idleness, overfeeding, dry feeding, thickening of bile, colloids, bacteria, wintering in stable. Colloids induce globular deposits. Parasites. Inflamed biliary epithelium secretes excess of cholesterine and lime. Age. Acid bile, constipation. Diseased liver. Lack of bile salts. In solipeds: all sizes and numbers, green, brown, yellow or white. Liver disease. Symptoms: colic with depression, prostration, yellow or red urine, icterus, sudden recovery. Treatment: sulphate of soda, olive oil, antispasmodics, warm drinks, fomentations, salicylate of soda, chloroform, pasture, or succulent food, and open air exercise. In cattle: musk odor; calculi dark green, yellowish green, whitish or orange, dry red, all sizes and numbers. Causes: dry winter feeding, etc. Lesions: dilated biliary ducts and bladder. catarrh, thickening, rupture, septic peritonitis. Symptoms: relapsing colic, with icterus, prostration, and tender right hypochondrium, in stalled animal on dry feeding. Suggestive: not pathognomonic. Treatment: as in horse: succulent spring pasturage. In sheep: rare, musky odor; concretions and casts common in distomatosis. Hypertrophied ducts. Symptoms of distomatosis. Treatment: for distomatosis and calculi. In swine: rare: circular. In carnivora: round, dark green, pin’s head to hazel nut. Symptoms: colics, constipation, emesis, icterus, tender right hypochondrium, concurrent catarrh of bowels, heart disease, dyspnœa, sudden relief. Mode of relief. Treatment: olive oil, bile, sodium sulphate, or salicylate, antispasmodics, alkalies, enemata, fomentations. Laxative food, exercise, open air.

Gall stones are most frequent in animals having a gall bladder. Some medical writers say they are formed in the gall bladder only, but the soliped which has no gall bladder has in particular instances furnished hundreds of gall stones. Yet the ox, dog, sheep and pig are the common victims of biliary calculi among our domestic animals. In these the calculi appear to be mostly deposited from the stagnant bile in the gall bladder, yet concretions on the biliary ducts and hollow casts inside the ducts are by no means uncommon.

A gall stone may be single, or they may be multiple up to hundreds or even thousands, and when very numerous they are individually small, perhaps no larger than a pin’s head. They may, however, attain the size of a marble or more, and by mutual pressure and wear they assume various polygonal forms. If they lie apart in the gall ducts or bladder they are regularly rounded. They are sometimes mulberry shaped as if conglomerate. In other cases the solid masses are so small as to have secured them the name of biliary sand. Casts and incrustations in the ducts are not necessarily made up of smaller globular masses.

On section a calculus shows a nucleus, composed of bile pigment, blood, mucus, with the debris of parasites or bacteria. Around this nucleus the calculus is deposited in concentric layers, of a hard material consisting largely of cholesterine, but containing also bile coloring matter, bile salts, and lime, in short all the constituents of bile.

Causes. Various conditions contribute to the precipitation of biliary solids in the form of calculi or encrustations. The most prominent causes are: lack of exercise, overfeeding, dry feeding, concentration of the bile, the presence of colloids and bacterian infection.

Idleness is especially operative in cattle, which are quite subject to biliary calculi and concretions, when shut up in the stall on abundant, dry feeding for a long winter. They are not noticed in stalled animals, that are fed watery or succulent rations, such as green fodder, distiller’s or brewer’s swill, ensilage, brewer’s grains, mashes, roots, potatoes, apples, pumpkins, and in case a tendency to their formation is developed on the dry feeding of winter, the concretions may be re-dissolved and entirely removed by the succulent spring grass. A similar influence is noticed in the human family, as the female sex living mostly indoors, and males pursuing sedentary occupations furnish the greatest number of gall stones.

Concentration of bile results in part from muscular inactivity and hepatic torpor, but also from overfeeding which loads the portal blood and indirectly the bile with an excess of solids, and from dry feeding which lessening the secretion of water leaves the bile more dense and predisposed to precipitate its solids. The density of the liquid, however, developed from a rich and dry ration and a prolonged inactivity, may continue for a length of time, without the occurrence of actual precipitation. It usually requires some additional factor to make this predisposition a direct cause.

=Presence of Colloids.= This may be found in the presence of solid or semi-solid particles. Just as the introduction of a thread into a concentrated solution of sugar or salt will induce an instant crystallization on the filament so the presence of solid bodies determines a similar condensation in solid form of the solids of the bile. But this tendency is increased materially if the solid body is itself of a colloid or non-crystallizable material. Rainey and Ord have shown experimentally that colloid bodies like mucus, albumen, pus, blood, epithelial cells, not only determine the precipitation of crystallizable salts from a strong solution, but that they cause the precipitate to assume the form of globular or spherical particles, which by gradual accretions on their surfaces tend to grow into calculi. They found that salts which are deposited by mere chemical reaction, without the intervention of colloids, appear in the form of sharply defined angular crystals. The very fact that a precipitate assumes a spherical form suggests the presence of colloids as an active factor in the precipitation. Heat appears to intensify this action, though probably the normal body temperature operates mainly through the more active proliferation of bacteria.

Bacteridian infection. In connection with the action of colloids it has been observed that when such bodies are in a condition of fermentation they are much more potent as precipitants than if inactive and sterile. But as all fermentations are the work of microörganisms we are at once brought to the conclusion that bacterial infection is one of the most potent causes of calculous formations. The invading microbes operate upon the dissolved solids, causing changes in their condition which reduce their solubility, and thus determine the separation of calculi and concretions in a manner allied to the precipitation of nitrates in the soils.

But the same microbes operate in producing the colloids which coöperate so effectively in the formation of calculi. The catarrhal biliary ducts, or bladder, shed their epithelium, and transude white and red globules, and form pus and an excess of mucus, all tending to the separation of the biliary solids or forming nuclei on which these solids may condense. The calculi and concretions tend in their turn to maintain and advance the inflammation.

The access of the microbes to the biliary duct or bladder may be effected through the blood of the portal vein or hepatic artery, or in the new-born, through the umbilical vein from an infected navel. As other modes of access may be named, a gradual advance from the duodenum through the common bile duct, or more speedily on or in the bodies of parasites (ascaris, strongylus, stephanurus, tænia, echinococcus, distoma, fasciola, coccidia), etc.

Changes in the chemical composition of the bile have been invoked as a cause of gall-stones, and Naunyn has found that the inflamed biliary epithelium secretes an excess of cholesterine and salts of lime. Thomas has also observed a great increase of cholesterine in connection with a catarrhal angiocholitis in the dog.

Among other alleged causes of biliary calculi are advanced age (Rigot, Hering), acidity of the bile (Zundel), constipation, and any organic disease of the liver and bile ducts which interferes with excretion of bile.

Age is supposed to act by inactivity, lessened secretion, hepatic torpor, and the greater presumption of liver disease, acidity by the precipitation of cholesterine and the dissolving of lime present in the tissues, and constipation through hepatic inactivity, obstruction of the flow of bile, and the tendency to infection through intestinal fermentations.

It may be added that any diminution of glycocholate or taurocholate of soda or potash, decreases the solubility of cholesterine and bile acids and favors their precipitation.

GALL STONES IN SOLIPEDS.

Characters. The biliary calculi of solipeds are of all sizes and shapes. When numerous they are mostly the size of a pin’s head (Lucet). Birnbaum found in one animal 400 like peas. Dieckerhoff has repeatedly found four or five of the size of a hazelnut. Verheyen found one as large as an apple and says one exists at the Berlin Veterinary College which weighs several pounds. Rigot found 90 in the biliary ducts of an old horse, and Zundel records the death of a stallion of twenty-six years from multiple gall stones.

The calculi may be little larger than grains of coarse sand. When larger and solitary they are mostly globular or mulberry shaped; if many are together they have become polygonal by friction. In other cases notably with distomata they form hollow tubular incrustations on the bile ducts, and contain a thick grumous bile. They are usually of a green color, but may be yellowish brown, yellow, or whitish. When cut across they present a nucleus enclosed in successive layers, each successive one often differing from the last in color. Their specific gravity is low, some will even float in water when taken from the ducts, and all float when dried. Their composition is variable but chiefly cholesterine, bile acids, resin and pigments, an albumoid matter, with lime salts, etc. The nucleus may be the remains of a dead parasite, epithelial cells, blood, pus, mucus, etc. The outer layers are usually the hardest.

There may be attendant hypertrophy of the liver, cirrhosis, amyloid and other degenerations, catarrh of the biliary ducts, and distension or (according to Birnbaum) rupture of the portal vein.

Symptoms. There are no reliable diagnostic symptoms apart from the colics which accompany the obstruction of a bile duct by a passing calculus. These in the main resemble the colic of ordinary indigestion, but they may be complicated by unusual depression and nervous prostration. There may be drooping of the head, ears and eyelids, watery eyes, resting the head on the manger or pushing it against the wall. The urine is liable to be red or reddish (Jobelot), and if it or the mucosæ show a yellowish tinge it is strongly suggestive. There may be constipation or diarrhœa. The colics are severe and may last for several days (Seaman, Lucet, Burgoin) without fever and recover abruptly when the stone passes into the duodenum. They recur, however, with the impaction of another stone, and this intermittent feature, with the marked prostration, and the access of slight jaundice with each colic furnishes the best means of diagnosis.

Treatment. During the access of colic give a full dose (1 to 2 lbs.) sulphate of soda in warm water along with some active antispasmodic (belladonna, lobelia, chloroform, ether), and foment the loins and hypochondriac regions. Olive oil in large doses (1 to 2 quarts) has been found effective. Salicylate of soda in full doses is beneficial in stimulating the biliary secretion, diluting the bile, and securing some measure of antisepsis in both bowels and liver.

In the intervals between the colics, sodium salicylate, sodium or potassium carbonate, or olive oil in continuous doses may assist in disintegrating the calculi or passing them on. Chloroform tends to break them up by dissolving the cholesterin. But any such treatment must be accompanied by the abundant ingestion of water, and this is often best secured by a run in a rich green pasture. In the absence of pasturage, succulent fruits, and roots, ensilage, mashes, and gruels may be advantageously substituted, and conjoined with systematic exercise in the open air.

GALL STONES IN CATTLE.