AUSS
low. black, green, or a mixture of
these; in shape they are round. oval,
polygonal; their surface is rough,
smooth. granular, shiny or dull.
In hehaviour they are equally va
riable. Generally their hehaviour
falls inte three patterns. They
are “silent” and produce no dis
tress; (2) they produce a dull type
of upper abdominal distress ralleld
biliary dyspepsia: (3) they produce
a violent type af excruciating pain
called biliary colic,
As to the silent type, little need
be said about them since they are
of no importance.
The second class gives rise to
biliary dyspepsia. Here the person
experiences a dull type of distress
associated with fullness after meals
in the middle of the upper part of
the abdomen, also belching and
Weoating: coated tongue, offensive
breath, sometimes nausea and vomit.
ing: sometimes pain under the lower
ribs on the right side and radiating
to the back: intalerance for certain
foods, as fried foods. greasy foods,
highly fat foods, onions, vinegar,
spices, peppers. alcohol, strong tea
ONES
and coffee, radishes, cucumbers,
chocolate, cabbages. brussels sprouts,
raw apples. canteloupe and some
others.
The distress usually ocenrs after
meals and conversely the person usu
ally fecls better when the stomach
is empty: sometimes he gels relief
from soda. Constipation iz common
and the stools mav be clav-cloured.
The third type of distress iz the
biliary colic. Here the person is
seized by an attack of excruciating
pain, kntfedike in character, usu.
ally along the lower horder of the
rieht ribs. The pain nenally ra dinates
to the rioht shonlder blade, how.
ever it may radiate to the pit of the
stomach ar elsewhere. The duration
of such an attack 1s variable, Tt may
last from seconds ta hours.
With an attack,
prostrated.  nsnally
doubles up in agony;
cazsionally he mav
The
nne is severely
likes to hed.
althoneh oc-
pace the floor,
WareHaax, 1648
ORIENTAL Fry
He is apt to have a chill followed by
a fever; sometimes he has nausea
and vomiting. The urine is apt to be-
come darkly stained or even jaun-
diced while the stool becomes clay-
roloured: jaundice may appear in
the skin. eyes, lips and other sur-
faces of the body. Few people can
stand the agony of a gall-stone colic
without the beneficent help of
powerful sedative.
There is no set pattern for the
number of such attacks that a person
can have. He may lave a single at
tack or repeated attacks coming on
avery few weeks, Generally speaking
the gravel and smaller type of
stones are more apt to produce colic
since their small size makes it easier
for them to enter the ducts, a posi-
tion which is the basis of the colic;
whereas the larger stones encounter
more difficulty in entering the ducts.
These accordingly are less apt to
produce colic, but they are more apt
to produce biliary dyspepsia.
IMMEDIATE AND Lonc-TiMmE
TREATMENT
Treatment depends upon the be-
haviour of the stones in the body.
During the stages of colic it is neces-
sary to give the sufferer relief from
the agonizing pain. A powerful seda-
tive is necessary. Usually morphine
is employed. External heat to the
zall-bladder region is helpful.
The appetite as a rule is lost and
nausea is usually present, hence a
very light or even liquid diet is em-
ploy ed. The use of fluids is to he en-
couraged. Bed rest is usually em-
ployed.
When the acute stage of the colic
has subsided, then a more perma-
nent programme has to be con
sidered.
When ¢all-stones are known to be
present either by the evidence of
N-rav films or by the excruciating
experience of the colic, then surgery
is generally considered. with cer-
tain specific exceptions which will
he mentioned later.
Bile duets from the liver connect
with the eall-bladder and alse with
the duodenum. where thhe bile en-
ters the dizestive tract, Normally the
bale dees not flow directly into the
duedenum bt first into the
cali-Bladder. where it becomes con-
centrated. When the gall-hbladder is
removed, the hile thereafter follows
the direct route and the ducts that
carry it dilate, possibly in partial
ermpensation for loss of the gsll-
| ladder.
passes
Most physicians agree that a gall-
bladder that contains stones and has
caused a biliary colic should be re-
moved. Gall-stanes that have caused
colic are apt to repeat the perform-
ance. Certainly few people wish to
repeat the experience of pall-stone
colic.
Following the removal of the gall
bladder with ils stones, the person
should follow the so-called “gall
bladder regime” for some time, per-
haps for vears, It must be remem-
bered that the factors which pro-
duced the gall-stones before are still
present and may produce gall-stones
again. Removal of the gall-bladder
did not remove the causes or the
mechamism for the formation of
stones.
Over-eating will certainly produce
biliary dyspepsia. Hence the need
for caution and a centrolled pro-
eramme of living after the removal
of the gall-1 ladder, in order to avoid
the recurrence of stones or biliary
dyspepsia.
Mepical MANAGEMENT
To begin with, over-weight must
be corrected if il is present, likewise
hich fat diets and sedentary life be-
vond the requirements of the per-
son's physical condition should alsa
be avoided. These all tend to rause
the recurrence of biliary dyspepsia.
Certainly there is no point to inviting
trouble.
Medical management consists of
those: procedures which experience
has shown afford the zreatest pro-
tection and the maximum romfort to
a person with an impaired biliary
system, and protect him from biliary
dyspepsia. .
First 1s body weicht. Gall-bladder
patients should not be over weight.
If they are thev should |
their proper weight level. This is
done by restricting the faod intake
to 1.000 to 1.200 calories with
proper regard to the intake of pro
tein. nunerals and vitamins. Then
they should follow the gall-hladder
dict. which consists of thos fonds
that cause the least irritation ta the
liver and wall-bladder while at the
same time maintainme the body in
a state of adedgiate nutrition.
The total energy value of the diet
should lis enough to maintain nor.
mal work and normal weizht and no
more. every additional ounce of
food imposes a needless burden npon
the liver. Hence the gall-bladder
diet consists of 1.0500 10 2.200 eal:
aries if the of normal
15
get down to
person Je