=Cholecystitis= is an inflammation of the gall-bladder caused
by infection. Stagnation of bile due to obstruction (especially
gall-stones) of the bile ducts, or a slowing of the bile flow owing
to deranged innervation from osteopathic lesions or sagging bowel,
are predisposing factors. Fibrotic changes in the appendix are fairly
common sources that derange the nervous reflexes of the biliary
function. The disorder may be associated with specific fevers.
Exciting factors are the colon bacilli, streptococci, staphylococci,
typhoid bacilli, and pneumococci.
=Symptoms.=—The gall-bladder feels hard and full. There is inflammation
and thickening of the mucous membrane, with considerable increase of
mucus. Owing to the infection there may be ulceration and suppuration,
with possible perforation and peritonitis. When the inflammation
extends outside of the bladder there are usually adhesions.
The onset is commonly sudden, with pain and tenderness in the right
hypochondrium. Great care should be taken in deciding the location of
the inflammation, for the pain and tenderness may be over the stomach,
or along the duodenum or ascending colon as low as the cecum. Nausea,
fever, constipation, and possibly jaundice, are other symptoms.
=Treatment.=—Exercise special care in treating these cases. Although in
many instances the inflammation will rapidly subside, still owing to
suppuration there is danger of aggravating the condition. It is better,
in doubtful cases, to confine the treatment to spinal work, and to
influence drainage by placing the patient in knee-chest position and
carefully raise cecum, ascending colon and duodenum. Rest, restricted
diet, plenty of water, and hot fomentations will be beneficial. In
severe cases surgical interference is indicated.