The Role of Chronic Cholecystitis in the Production of Indigestion

THE view that chronic cholecystitis is the commonest organic cause of indigestion is widely held. In support of this contention Eusterman,l from a study of patients in the Mayo Clinic exhibiting gastric symptoms, states that there are sixty per cent. more cases associated with a diseased gall-bladder than with a peptic ulcer. To understand and estimate the value of such a statement, it is necessary to review shortly the physiology of the liver and the biliary tract if we are to appreciate the changes which arise under pathological conditions. Among the many-sided activities of the liver, we will only consider those having a bearing on the subject of this contribution. (a) The storage of glycogen. This function is possibly the most important, as in diseased conditions of the organ the blood-sugar level falls owing to shortage of dextrose. This loss of function can be temporarily restored by administration of glucose preparatory to dealing with the cause. (b) The secretion of bile salts and bile acids which assist the pancreatic ferments to split fats into fatty acids and glycerin. Failure of this function results in excess fats in stools, due to faulty fat metabolism. (c) Detoxifying powier. Opie2 concludes that the liver, by means of its peculiar eipthelium lining its sinusoids, fixes insoluble material and many kinds of organic particles such as bacteria. The value of such a function in diseases due to infection arising in the intestinal tract is apparent. Investigation into the function of the gall-bladder has been greatly assisted by the introduction of cholecystography. It is now possible to visualize the viscus and observe its size and shape, its filling and emptying, its density as illustrating' its power of absorption, and its varying reactions to the ingestion of proteids, carbohydrates, and fats. From its construction, the gall-bladder is evidently intended for the storage of only a small quantity of bile, but owing to the transference of water through its walls, concentration occurs. This concentrated bile is discharged when the neuromuscular mechanism relaxes the sphincteric action at the distal end of the common duct. A gall-bladder, therefore, to act in a normal manner, must be capable of clistension and collapse, must have an unobstructed cystic duct and a mucosa able to secrete and absorb. Following chroniic infection of the gall-blad(ler, naked-eye changes occur, such ais alterationi in its colour, inicrease in thickiness of its w!all, deposit of fat in the wall, and a geineral fibrosis. TIllese changes affect the adjacent liver through the