Gall-stones and diseases of the bile-ducts . dice. Such cases are oftenmistaken for pyloric stenosis or indigestion. Vomiting is also one of the most prominentsymptoms when a gall-stone is impacted in thesmall intestine, and the amount of fluid ejected bypatients in such circumstances sometimes amountsto pints in the course of twenty-four hours. (3) Jaundice associated with cholelithiasis.—Con-trary to popular opinion, jaundice is not a commonsymptom of gall-stones, for when they are containedin the gall-bladder there is no impediment to thefree escape of bile along the main duct. When gall-st
Gall-stones and diseases of the bile-ducts . dice. Such cases are oftenmistaken for pyloric stenosis or indigestion. Vomiting is also one of the most prominentsymptoms when a gall-stone is impacted in thesmall intestine, and the amount of fluid ejected bypatients in such circumstances sometimes amountsto pints in the course of twenty-four hours. (3) Jaundice associated with cholelithiasis.—Con-trary to popular opinion, jaundice is not a commonsymptom of gall-stones, for when they are containedin the gall-bladder there is no impediment to thefree escape of bile along the main duct. When gall-stones lodge in the hepatic or the common bile-duct,and when the mucous membrane of these ducts isinflamed as a sequence of cholelithiasis, then the freeflow of bile is hindered and jaundice is produced, itsintensity depending on the extent and completeness SIGNS OF CHOLELITHIASIS 153 of the obstruction. It is the custom to state thatjaundice is absent in these cases, but this is a randomstatement; for a critical examination of the skin and. Fig. 44.—An obstructed cystic duct which caused severe vomiting. conjunctiva will often reveal an icteric tinge in caseswhere the notes state the absence of jaundice. Under common conditions it may be stated that astone in the cystic duct does not cause jaundice,but occasionally a stone in this duct will be largeenough to interfere with the main duct and lead to 154 DISEASES OF THE BILE-DUCTS jaundice. When a gall-stone is the cause of markedjaundice it is usually associated with local pain andoften with colic. Moreover, jaundice caused by agall-stone usually varies in intensity; at times it willseem to be on the point of clearing up, then arenewed attack of pain or colic occurs, and the colourdeepens. When a stone is firmly impacted in theampulla the jaundice is deep and does not vary. There are several unpleasant effects connectedwith jaundice which it is necessary to consider apartfrom the cause. Variations in the degree or intensityof
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