Bile duct

“ If the main hepatic duct or the common duct were obstructed, there would of course be paleness of the feces, as the bile would be prevented from entering the duodenum. But when a large amount of highly-colored bile is being secreted, as in relapsing fever, it seems clear that the obstruction of a certain number of minute ducts would cause sufficient resorption of the bile to induce jaundice of varying degrees of intensity, while at the same time allowing a flow of bile through the patulous ducts. ”

“ If this ingurgitation of spirituous liquors has been daily continued in considerable quantity, and is then suddenly intermitted, a languor or paralysis of the common bile-duct is induced; the bile is prevented from being poured into the intestines; and as the bilious absorbents are stimulated into stronger action by its accumulation, and by the acrimony or viscidity, which it acquires by delay, it is absorbed, and carried to the receptacle of the chyle ”

“ The intestine also goes right through the liver, doubling backwards and forwards several times: and thus the digestive tube supplies itself with bile from the cask (to borrow a commercial expression) ; and this saves the expense of a bile-duct (choledochian canal) , which would be an unnecessary mode of conveyance in this case. The animal lives in water; consequently, instead of lungs he has gills: [Footnote: The land-snail has lungs.] ”

“ The passage of a calculus along the duct excites an inflammation of the mucous membrane, which by contiguity of tissue invades the peritoneal layer if the stone is retained for a sufficient time, and especially if it is immovably lodged. The stoppage in the flow of bile leads to dilatation of the ducts, and a change takes place in the character of that fluid, [p. 1077] owing to the admixture of mucus with the bile and to the pouring out of a pathological secretion: it loses the bilious appearance and becomes a merely sero-purulent fluid. ”

“ Rapid Relief From Colon Cleansing
During fasting the liver is hard at work processing toxins released from fat and other body deposits. The liver still dumps its wastes into the intestines through the bile duct. While eating normally, bile, which contains highly toxic substances, is passed through the intestines and is eliminated before too much is reabsorbed. (It is the bile that usually makes the fecal matter so dark in color.) However, reduction of food bulk reduces or completely eliminates peristalsis, thus allowing intestinal contents to sit for extended periods. ”

“ Cholelithiasis, that is, stone in the bile duct, may not only cause severe pain, but may lead to rupture of the duct and a rapidly fatal termination. Owing to the practice of wearing corsets, gall-stones occur much more commonly in women than in men. Twenty-five per centum of all women over 60 years of age are found to have gall-stones. While these cases suffer from intense pain they are very seldom fatal. But it must not be forgotten that a fatal issue can take place either from collapse and stoppage of the heart, because of the intensity of the pain, or from perforative peritonitis. ”

“ Without one, the bile duct takes over as a bladder but its capacity is much smaller so the person's ability to digest fats has been permanently crippled, leading to increased toxemia and earlier aging if fats are not eliminated from the diet. These days the medicos have a new, less invasive procedure to eliminate stones; they are vibrated and broken-up by ultrasonics without major surgery. Inflamed gallbladders are usually removed because gallbladder inflammations resist treatment by antibiotics. ”

“ If the stone happily finds its way into the intestine the distress suddenly ceases. In the meanwhile relief may be afforded by fomentations, and by morphia or chloroform, but if no prospect of the stone escaping into the intestine appears likely, the surgeon will be called upon to remove it by an incision through the gall-bladder, or the bile-duct, or through the intestine at the spot where it is trying to make its escape. Sometimes a gall-stone which has found its way into the intestine is large enough to block the bowel and give rise to intestinal obstruction which demands abdominal section. ”

“ The most usual, and for very obvious reasons the most important, of the sites where occlusion occurs is the common duct and at the termination of the duct in the small intestine, the intestinal orifice. Just behind and to the right of its orifice the duct is dilated into a fossa—the diverticulum Vateri; and here concretions of a size to pass along the common duct are stopped. It is not essential that the stone fit the canal: it may do so and prevent any bile passing into the duodenum ”

“ Such waste materials as the liver cannot burn down so that the kidneys and skin can handle them, it pours out through its duct into the intestine as the bile. The bile is a yellowish-brown fluid, which assists the pancreatic juice in the digestion of the food, and helps to dissolve the fats eaten, but is chiefly a waste product. It turns green when it has been acted upon by acids, or exposed to the air. So that the bile which you throw up when you are very sick at your stomach, is green because it has been acted upon by your gastric juice. ”

“ The number of parasites varies greatly: sometimes there are but few, and they are only discovered on post-mortem examination; in other cases the bile ducts are crammed with them, as many as six or seven hundred or even a thousand being present. The distended bile ducts always show chronic peripheral inflammation, which steadily becomes aggravated, producing pericanalicular atrophying sclerosis. This condition is followed by change in and disappearance of a certain quantity of hepatic tissue, and by various forms of vascular and secretory disease. ”

“ The tissues of the body are more or less deeply stained with bile. The pathological change on which the jaundice depends has been variously stated, but the most probable explanation is that which refers it to mechanical obstruction of the bile-ducts, either by catarrhal swelling or fatty degeneration of the epithelium. Notwithstanding the prominence of the hepatic symptoms, acute atrophy of the liver is probably only one element in a constitutional morbid complexus. ”

“ Causes.—The liver does not perform its function well, or there is a retention of bile in the bile ducts. Most of the symptoms do not depend directly upon the changes in the bile, but upon failure of proper digestion in the stomach and intestines. Certain poorly prepared foods or improper food for stomach digestion, quickly cause the development of active fermentation and its results irritate the stomach mucous membrane bringing about a faulty stomach secretion of mucus, which causes further trouble. It may end in a sick headache. ”

“ Whether the liver be enlarging or diminishing in size, its functions are impaired, or indeed entirely suspended. As the digestive canal receives the bile immediately on its production, it will be best to begin with the gastro-intestinal disorders which accompany occlusion of the bile-ducts. The appetite is either wanting entirely and food is loathed, or an excessive or canine appetite is experienced. The latter belongs rather to an early stage of the disorder, and comes on after the first disturbance of the stomach belonging to the immediate effects of the occlusion. ”

“ It may also result from constipation and a resultant absorption of toxic matter as described above.
Many cases of billiousness are occasioned by obstruction of the opening of the bile ducts into the intestines, which is often occasioned by an excess of mucus in the duodenum. In such cases exercise for the intestines is clearly indicated.
In the bending, twisting and squirming movements which the infant in the cradle makes, the liver is regularly squeezed and relaxed. The same is true in the free movements of an active child at play. ”

“ When red cells are present settling takes place on standing. Rupture of gall-bladder or bile-ducts may lead to presence of free bile in the peritoneal cavity. Postmortem diffusion of bile through the gall-bladder wall should not be mistaken for a pathologic condition. In normal conditions there is just enough fluid in the peritoneal fluid to make the surfaces moist, and about a teaspoonful in all may be collected from the flanks and pelvis. The amount may be greatly increased just before death in all cases of slowly progressive cardiac weakness. ”

“ Again reabsorption of bile may be determined by a lessening of the normal fullness and tension of the hepatic capillaries as when the aorta is mechanically compressed by abscess, neoplasm, ingesta, or otherwise, just behind the diaphragm (Heidenham, Brunton) . The cause is the same in both cases, namely, the want of balance between the fullness and tension of the bile ducts, and the hepatic blood vessels. There is increased fullness of the hepatic biliary ducts, or decreased plenitude of the hepatic capillaries and lymphatics. ”

“ A similar explanation is equally applicable to the biliary secretion; and just as it happens in the case of the kidney, that it is exceedingly rare for a total suppression of its functions to take place, so with the liver it seldom happens that the congestion is sufficiently severe to induce complete arrest of the biliary secretion. We find, therefore, that although there may be yellowness of the skin and high-coloured urine in such cases, pipe-clay stools are frequently absent, sufficient bile to tinge the fæces still finding its way into the intestines. ”

“ What is it but a full foul condition of the digestive canal, a complete blockade of the canal from the rectum or colon to the stomach, making the victim feel that there must be something done in the way of cleaning out? He fears that the condition will be followed by fever—not infrequently this is the case. Biliousness is usually supposed to be occasioned by hindrance to the flow of bile, and the conclusion is drawn that the liver requires stimulating. ”