Part 90

Characters. The biliary calculi of cattle are characterized by a faint odor of musk, which becomes stronger on the addition of potassa and the consequent disengagement of ammonia.

They are distinguished according to their color as dark green, yellowish green, and orange, brownish or white. There are also the sedimentary deposits (biliary sand).

The dark green calculi are the most frequent, and being found in the gall bladder and larger bile ducts, they attain a larger size than the others. Those in the gall bladder may be pear-shaped, and those in the ducts, round, ovoid or cylindroid. They are often rough and uneven on the surface with deep cracks and holes penetrating deeply into their substance and often filled with cholesterin. The pigments may change to a blood red when dried. The consistency of these calculi varies, some being hard, resistant and heavy, while others are soft and friable. All are composed of concentric layers around a central nucleus as in those of the horse. They vary in weight up to seven ounces in exceptional cases. They contain cholesterin, fat, resin, pigments, and lime and magnesia salts.

The yellowish green calculi are usually spherical unless moulded into polygonal shapes by mutual contact. In the last case they have flattened surfaces. These have a firm consistency and are composed of successive layers of nearly equal color and density surrounding the central nucleus. They are on an average smaller than the dark green variety but individual calculi have been found of three ounces.

The whitish or orange calculi are usually in the form of hollow casts of the bile ducts having a dull white color externally and a yellowish brown internally. They are usually thin, fragile and crystalline and contain relatively more earthy salts than the two first named varieties. From this cause also they have a higher specific gravity. One specimen weighed 8 ounces.

The biliary sand or pulp, is made up of granules of a yellowish, dark green or black color, forming with the bile a pultaceous mass but drying into a consistent mass. It may be firmly adherent to the mucosa of the gall bladder and require to be scraped off. These granules may be looked on as the first step in the formation of calculi or encrustations.

The causes of biliary calculi in cattle are mainly close confinement, dry feeding, abundant rations, the presence of trematodes in the bile ducts and finally microbian infection.

Lesions vary. With obstruction of the common bile duct or cystic duct, there are usually dilatation of the bile ducts with fibrous thickening of their walls so that they stand out as white branching lines on the back of the liver. In extreme cases the common duct may acquire the calibre of the small intestine. The gall bladder may participate in this thickening (Chassaing) or may even rupture (Proger, Shaw).

In connection with obstruction microbian infection extends upward into the liver, and in rupture of the bladder an acute, diffuse septic peritonitis follows (Chassaing). This only follows on infective inflammation of the gall bladder. Aseptic bile causes little or no irritation.

Symptoms. As in the horse, general symptoms of ill health or hepatic disorder are not pathognomonic. The presence of intermittent attacks of constipation, and colic, with icterus, tympanies and violent efforts at expulsion are the diagnostic symptoms of an acute attack. Pulsation and respiration are accelerated, and the urine dense, high colored, oily and slightly yellow. Reboul has noticed that symptoms are aggravated on exposure to cold; there are great prostration and dullness, frequent moaning and marked indications of tenderness when the right hypochondrium is percussed. Charlot has observed that the only symptoms may be persistent jaundice with scanty, high colored urine, containing some sediment.

Treatment is essentially the same as in the horse. Vanswieten and Verheyen draw special attention to the fact that whereas biliary calculi are very common in cattle during winter, they are rarely found in animals that have been for even a short period on the spring grass. Spring pasture is therefore the best therapeutic agent. During paroxysms of colic, Glauber salts, or olive oil, antispasmodics and fomentations over the liver are to be tried. In the intervals salicylate of soda, sodium and potassium carbonate, olive oil, chloroform, and ether may be used. Abundance of water and aqueous rations are essential.

GALL STONES IN SHEEP.

Calculi are very rare. One described by Morton had a brownish yellow color on its surface, and a white color spotted with green internally; it had a bitter taste, colored saliva yellow, and melted when heated, diffusing the odor of musk. It weighed twelve grains and contained 70 per cent. of cholesterin, calcic phosphate and carbonate and the usual biliary elements.

But if spherical calculi are rare, concretions and casts of the bile ducts are common, especially in distomatosis. These are of a yellowish, reddish, greenish or blackish brown, and form granular plates, or veritable cylindroid casts often firmly adherent to the mucous membrane of the duct.

In such cases the walls of the encrusted ducts are hypertrophied and stand out on the back of the liver as white bands diverging from the portal fissure.

Apart from the usual symptoms of distomatosis no special indications have been observed.

Treatment is primarily that for distomatosis, to which the general measures advised for calculi may be added.

GALL STONES IN SWINE.

Characters. The calculi are spherical, rough or on their opposed surfaces flat, clear and glistening where they have become polished by friction. They are found as a fine sand or as calculi the largest of which have been 75 grains, and of a high density (1303 to 1484). Bruckmüller found that they contained carbonate of lime and biliary mucus. Verheyen found biliary resin, mucus, pigment, and a little fat. They are rare in fat hogs in America. No diagnostic symptoms have been observed.

GALL STONES IN DOG AND CAT.

These are more or less spherical, dark brownish green, and usually found in the gall bladder or larger bile ducts. They may vary in size from a pea to a hazel nut. Their chemical analysis is wanting.

Symptoms. There may be evidence of biliary obstruction and if this occurs intermittently and is associated with colic, it becomes somewhat characteristic. Constipation, emesis, icterus, and sometimes tenderness of the right hypochondrium would indicate the source of the colic. A pre-existing and concurrent catarrh of the bowels corroborates these indications.

Cadeac explains that the obstructing calculus is called on to resist the impulse of the bile forced upon it by the spasmodic contraction of the bile ducts, which distends the bile duct immediately back of the stone to perhaps ten times its normal size. Then under a suspension of the spasm or even an antiperistaltic contraction of the duct, the calculus is forced back into the dilated portion or even into the gall-bladder, and the attack is relieved. Under repeated irritations of this kind the inflammation of the bile ducts extends into the liver and determines cirrhosis. The irritation further through the sympathetic produces a reflex constriction of the pulmonary capillaries, with the natural results of increasing tension of the pulmonary artery and right heart, and dilatation and degeneration of the walls of the latter even in the best nourished animals. Thus dyspnœa and modified heart sounds (murmurs) may be symptoms of biliary calculi.

Treatment. Three or four ounces of olive oil were found to greatly increase the quantity and fluidity of the bile in from thirty to forty-five minutes. Bile, sulphate of soda and salicylate of soda are excellent cholagogues, and the latter at the same time an antiseptic. Anti-spasmodics are especially indicated to relieve the colics, but they must be used in relatively smaller doses than in the herbivora. Potassic and sodic carbonates or tartrates (Vichy) may be used as enemas if they cannot be administered by the mouth. Fomentations may be resorted to. The food must be laxative and aqueous, and exercise must be imposed as far as the animal can bear it.

FOREIGN BODIES IN THE LIVER.

In horse: spikes of leguminosæ, barley awns. Symptoms: of internal hemorrhage, pallor, weakness, vertigo, death; jaundice, prostration, stupor, weakness, crossing of fore limbs, tender right hypochondrium. In cattle: bodies passing from rumen. In swine, sand. In dog, sharp bodies from stomach. Treatment: laparotomy.

Foreign bodies are rare in the liver in our domestic animals. Horse. St. Cyr has found the spikes of leguminosæ and Megnin the beards of barley. St. Cyr believed that he traced the passage followed by the stalk through the walls of the duodenum, and portal vein where it divided to be distributed through the liver. At the point of supposed entrance the walls of the vena portæ were thickened and its lumen filled with clots. The further course of the portal vein and its branches showed similar thickening and clots, and on the branch leading to the right lobe was a large abscess containing 4 decilitres of pus. Clots extended into the splenic, omental and mesenteric veins, and between the folds of the mesentery of the small intestine were a number of minute ruptures and blood extravasations.

Megnin found traces of the passage of the barley beards through the gastric walls and into the substance of the liver close to the portal fissure. Around the centre where the barbs were implanted there was an irregular hæmorrhagic extravasation in the liver, and in the abdominal cavity an effusion of 8 or 10 quarts of blood.