=Definition.=—Jaundice due to inflammation of the terminal portion of
the common duct, not the result of impacted gall-stone. The disease
probably starts as a catarrhal inflammation of the stomach and upper
portion of the small intestine. The bile is retained and absorbed.
=Osteopathic Etiology= and =Pathology=.—A frequent predisposing
cause is the subdislocation of the tenth rib on the right side, thus
interfering with the innervation to the bile ducts, and causing
congestion of the mucous membrane of the common duct; although lesions
above and below this point may occur. Extension of gastro-duodenitis
into the common duct is a common source of the inflammation. Sagging of
the duodenum will disturb the bile-duct through its being a portion of
the duodeno-hepatic ligament. Duodenal catarrh usually follows errors
in diet, exposure, malaria, Bright’s disease, portal obstruction and
chronic heart disease. Infectious fevers, as pneumonia and typhoid
fever, and emotional disturbances are among the causes. Catarrhal
jaundice may occur in epidemic form.
=Pathologically=, the duodenal end of the duct is most commonly
involved. The mucous membrane is swollen and the orifice fills with
mucus. The inflammation may involve the common and cystic ducts and
even the hepatic. The liver is enlarged and the gall-bladder distended.
=Symptoms.=—The only symptom present may be simply the jaundice. There
is always tenderness upon pressure over the ducts. The patient many
times complains of a stabbing pain when pressure is exerted over the
duodenal opening. Usually the course of the bile duct can readily be
felt upon deep pressure, owing to the tumefaction. Accompanying this
condition may be general malaise, loss of appetite, nausea, vomiting,
constipation or irregular action of the bowels, pains in the back and
limbs and a slight fever.
=Diagnosis.=—Where jaundice is present without pain, it generally
indicates catarrhal jaundice. The absence of emaciation or of evidences
of cancer or cirrhosis usually makes the diagnosis easy. Good general
nutrition and a negative physical examination favor simple jaundice as
to the diagnosis.
=Prognosis.=—The prognosis of catarrhal jaundice is favorable, unless
accompanied with infectious diseases or hypertrophic cirrhosis. When
diseases are associated with jaundice the danger is usually from the
disease. The duration of the disease is generally given as from two to
eight weeks, but osteopathic treatment generally lessens that time at
least one-half.
=Treatment.=—The treatment is directed toward relieving the
inflammation of the bile ducts and increasing the flow of the bile into
the intestines. Great relief to the patient will be experienced from
thorough treatment over the bile ducts, especially at the duodenal end.
Press slowly but firmly over the region of the ducts, then execute a
downward motion with firm pressure over the course. This performance
should be repeated several times, until the tenderness in this region
is almost or entirely relieved. The idea of this treatment is, =first=,
to slowly but firmly bear down upon the abdominal muscles over the
congested tissues, so as to relax the tissues and get as close to
the ducts as possible, and =second=, with the downward movements to
reduce the congestion of the ducts and at the same time to remove any
mucus or other material from the orifice, thus allowing a freer flow
of bile. It will be recalled that the normal flow of bile is under
very low pressure. Care should be taken not to gouge or dig into the
tissues with the ends of the fingers, but to use the flat surface
of the fingers. Any gouging or severe treatment will not allow one
to accomplish his purpose, owing to the stimulus or irritation it
would give the abdominal muscles and thus cause them to contract; and
furthermore, it would more or less bruise the parts. An inhibitory
treatment should be given along the spine on the side affected to help
relax the abdominal muscles before this treatment is administered. In
all circulatory disturbances of the bile-duct and other hepatic tissues
lift the duodenum at about the second lumbar where it lies beside the
ascending colon. This tends to release portal vein, hepatic artery and
bile-duct, the duodeno-hepatic ligament.
=Direct treatment= is given to the liver by more or less kneading or
working the organ and also by raising and spreading the ribs. This
treatment is to stimulate the activity of the liver. Reaching under
the cartilages of the eighth and ninth ribs on the right side and
bearing inward and downward will empty the gall-bladder and thus be of
aid in relieving the tension in the biliary passages. It is probably
a stimulus to these cutaneous fibers that causes a relaxation of the
sphincter muscles of the gall-bladder and thus allows it to empty.
Stimulation of the tenth nerve contracts the gall-bladder. Then it
should also be noted that work over the duodenal end of the bile-duct
relaxes the orifice while through reciprocal relationship the fibers
of the gall-bladder contract. When all of the muscles of the hepatic
region have been carefully relaxed and softened, a thorough examination
can then be made of the vertebræ and ribs that might embarrass the
innervation or vascular supply of the liver. Lesions of the vertebræ
and ribs affecting the liver may occur from the sixth to the eleventh
dorsal. Lesions to the vagus and phrenic nerves may occasionally
involve the organ.
Irrigation of the large bowel with cold water may be employed. The cold
excites peristalsis of the gall-bladder and ducts. Drinking freely of
water will be helpful. A non-stimulating diet should be given. The
stomach may not be in a condition to bear solid food; and furthermore,
food on entering the duodenum will increase the local inflammation of
the common bile duct. Give diluted milk, buttermilk, light meat-broths,
clam-broth, egg albumin and pressed beef juice. After the pain,
vomiting and fever subside, the diet can be gradually increased.