Clinical manual for the study of medical cases / edited by James Finlayson.

Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Clinical manual for the study of medical cases / edited by James Finlayson. Source: Wellcome Collection.

    379/616 (page 351)
    bile in the faeces. The pale colour of the faeces may thus in doubtful cases assist the diagnosis of jaundice, but their bilious colour does not count for much as negativing jaundice. The motions in jaundice are usually costive, and if long retained in the bowel, the faeces are often highly offensive, from decomposi- tion going on within. The bile acts normally both as a purga- tive and an antiseptic. Obstructive and Non-obstructive Jaundice.—The pre- sence or absence of bile in the motions affords an important aid in classifying the cases according as they are, or are not, due to obstruction of the common bile-duct. If there be any such obstruction, the motions are pale in proportion to the depth of the jaundice ; and we find that in cases due to obstruction the jaundice is much deeper than where no obstruction exists. The obstruction may be due to something within the duct itself,—thickened walls or excess of mucus give rise to the form called catarrhal, or gall-stones may block up the channel, or the ducts themselves may be the seat of a cancerous growth. Ulcers, cicatrices, foreign bodies, and even worms have been known to interfere with the opening of the duct into the duo- denum, and catarrh or inflammation of the duodenum may like- wise do so. But the obstruction may be due to pressure from without, by a tumour (usually malignant) in the pancreas or duodenum; or by waxy or cancerous glands at the fissure of the liver; or, a tumour connected with the liver itself may, from its position, compress the duct, as in the case of a cancerous nodule, an abscess, an aneurism, or a hydatid cyst; or again an exuda- tion of lymph (perihepatitis) may by its contraction constrict the duct. Abdominal tumours connected with the kidney, ovaries, &c, may compress the bile-duct and give rise to jaundice. The pregnant uterus, or faecal accumulations in the bowels may likewise do so; and hardened scybala have been mistaken for cancerous nodules in cases of jaundice due to such a cause. In discriminating these causes we have regard to the size and form of the liver, the presence and character of the pain (if any), and the special symptoms of the various affections named, in