Gall-stones and diseases of the bile-ducts . flammation, especiallywhen we remember that congenital obliteration ofthe main bile-ducts, and even of the gall-bladder,is attributed to ante-natal inflammation (see Chap. in). Small bilirubin-calcium concretions not infre-quently play the part of foreign bodies and establisha cholelithiasis. Nauiryn writes that he has severalsets containing twenty or thirty stones out of onegall-bladder; in the centre of each stone there is abilirubin-calcium concretion (see p. 93). Facetting.—A solitary gall-stone, free to swim inthe bile or contained in the gall-
Gall-stones and diseases of the bile-ducts . flammation, especiallywhen we remember that congenital obliteration ofthe main bile-ducts, and even of the gall-bladder,is attributed to ante-natal inflammation (see Chap. in). Small bilirubin-calcium concretions not infre-quently play the part of foreign bodies and establisha cholelithiasis. Nauiryn writes that he has severalsets containing twenty or thirty stones out of onegall-bladder; in the centre of each stone there is abilirubin-calcium concretion (see p. 93). Facetting.—A solitary gall-stone, free to swim inthe bile or contained in the gall-bladder, is usuallyovoid and smooth on the surface. When a stone istightly embraced by the walls of the gall-bladder itssurface is nodular, the nodules being casts of the GALL-STONES 55 pits in the mucous membrane lying in contact withthe gall-stone; thus a large gall-stone is often a castof the interior of the gall-bladder. A very largestone in a greatly distended gall-bladder may havea smooth surface, as in the gall-stone Fig. 17, which. Fig. 17.—A solitary gall-stone successfully removed from aninflamed gall-bladder. Nat. size. (Museum of the MiddlesexHospital.) is the largest specimen I have removed: it measures13 cm. round the base and 19 cm. round the majoraxis. The patient, a woman aged fifty years, hada gall-bladder so large that this big calculus couldfloat about in the bile it contained. When the gall-stones are multiple, and especially 56 DISEASES OF THE BILE-DUCTS when gregarious, facets are usually present; theseare produced by pressure when the calculi are soft,Fig. 18.
Size: 1259px × 1985px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1900, bookpublishernewyorkwilliamwood
