Cholecystitis.
Definition:—An inflammation of the structure of the gall bladder, including its mucous membranes. It must be distinguished from an inflammation of the lining membrane of the biliary passages, which is designated as cholangeitis.
Cholecystitis may be a simple catarrhal inflammation, it may be -pseudo-membranous, or suppurative, and in extreme cases, gangrenous, involving a part only or all of the coats of the gall bladder. When the peritoneum covering the gall bladder alone is involved it is designated as pericholecystitis.
Cholangeitis is an inflammation of the mucous membranes only, which become greatly thickened and secrete a thick, tenacious mucous, which occludes the ducts, and results in an accumulation of bile and consequent jaundice. This latter inflammation may terminate in suppuration, which may produce infection of the entire structure of the organ, and a suppurative form of cholecystitis, with more or less constitutional infection, accompanied with chill, hectic fever, night sweats, emaciation, debility and anemia.
Etiology:—Cholecystitis results from the persistency of stone in the gall bladder, from the presence of those micro-organisms which are designated as the cause of cholelithiasis, or it may be induced by direct infection from those infectious fevers which may terminate in ulceration or pyemia. The commonest of the micro-organisms which produce this condition is probably the typhoid bacillus, although the tubercular bacillus and the various cocci are common causative factors.
Symptomatology:—Among the first symptoms are chill and fever. Usually the fever does not exceed 101.5° or 102° F., except in the suppurative forms, when it becomes remittent in character, and in the exacerbations may reach 104° or 104.5° F. If the onset is abrupt, there will be nausea, with violent pain in the right hypochondrium, which may be mistaken for that of gall stones. This pain is apt, however, to be paroxysmal, to vary greatly in severity and to be frequently located in the epigastrium. Shortly after the abrupt appearance of the pain, soreness develops, which may become exquisite and may involve the peritoneum (pericholecystitis), or ultimately become diffused over the abdomen (general peritonitis). With this there is usually prostration and threatened collapse. The pulse, at first full, soon becomes small, rapid and feeble, the walls of the abdomen become hard and rigid and are greatly distended.
Diagnosis:—The symptoms of cholecystitis are similar to those of acute appendicitis; it also resembles intestinal obstruction. In that disorder, however, paralysis of the walls of the intestine is apt to be present. It must be distinguished from gastric ulcer, from diaphragmatic pleurisy and from gall stones. Jaundice occurs in about one-third of the cases.
Prognosis:—This disease is classed among the fatal disorders. It runs a rapid course and is apt to terminate in death, either directly or from its complications, within a few days.
Treatment:—The most active measures must be instituted at the onset. A very large mustard poultice may be applied over the entire side. This should be allowed to remain for eight or ten minutes, but no blistering must be induced. When removed the skin should be dried and covered with vaseline, and over this libradol should be applied for a period of from eight to twelve hours. A rubber water bag containing a small quantity of hot water should be kept over the libradol. The administration of from two to five drops of the aqueous extract of opium, with one drop of the tincture of aconite and one drop of specific bryonia, should be administered every hour until there is some relief of pain and a slight abatement of the soreness. The opium should then be discontinued and the other two remedies persisted in. When the libradol is removed, hot applications should be continued over the liver. The bowels should be thoroughly flushed, but it is only in those cases where there has been obstinate constipation that physics should be permitted. Very early in the treatment intestinal antiseptics must be introduced, and echinacea will serve an important purpose in anticipating suppuration and purulent infection.
