Bile Tract Disease

Cholecystitis; cholangitis; cholelithiasis; dyskinesia of the bile passages; a group of disorders of the bile passages which may be characterized by the inflammation of the gall bladder (cholecystitis) or of the bile passages (cholangitis) or the formation of "stones" or calculi in the gall bladder or bile ducts (cholelithiasis) in both acute and chronic forms. The origin of these diseases may be due to infection by various bacilli, e.g. streptococcus, typhoid, bile stasis, dietary upsets leading to separation of cholesterol, especially in "gallstones" (cholelithiasis). An entire science of cholecystography has been developed to visualize the stones by means of dyes opaque to Xrays, which usually contain high percentages of iodine.

Jaundice is frequently an accompaniment of biliary disease because of liver involvement. The symptoms include "biliousness" which is characterized by nausea, headaches, drowsiness, belching. Gall stones are largely cholesterol with protein inclusions. In treatment the flow of bile can be increased only cautiously. The agents used to promote the flow of bile, cholagogues or cholekinetics, are usually magnesium salts. Substances which tend to increase the amount of bile secreted, or choleretics, may be salicylates or cinchophen combined with the bicarbonates and sulfates.

Numerous tests have been developed in connection with bile tract and liver diseases besides cholecystography. Bile pigments are determined in the blood and in the urine. Various types of jaundice (hemolytic, obstructive, parenchymatous) are thus distinguished. Liver function is also tested by ability of the liver to store glycogen from galactose, blood sedimentation tests, amino acid tests to determine breakdown of tissue, and special tests on serum proteins, e.g. Takata-ara reaction.