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This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1903 Excerpt: ... rise to no symptoms (Kehr); in the remaining 5 per cent, symptoms are produced which vary in intensity and importance from a slight discomfort in the right hypochondriac region to a rapidly fatal septic peritonitis. One or more stones in a healthy gall-bladder with patent ducts produce, as a rule, no symptoms, and under these conditions the only physical signs present may be those of a tumor of the gallbladder, caused by the number or size of the calculi. If, however, a calculus becomes impacted at the neck of the gall-bladder or in the cystic duct, or if the mucous membrane of the gall-bladder becomes inflamed, symptoms are produced. In the former instance, pain of a moderate, paroxysmal character may be present, due to the expulsive efforts of the organ to rid itself of the obstruction, or to a gradual distention of the viscus with mucus; in the latter, to distention of an inflamed and sensitive organ. In the first instance the pain may occur at any time; in the latter, it generally occurs during prolonged fasting, as at night, when the flow of bile is toward the gall-bladder. Kehr, however, believes that the pain in these cases is practically always the result of inflammation. It is certainly a well-recognized fact that it usually begins at night, and this circumstance seems to distinguish it from the pains of gastric ulcer or other digestive disorders, which begin, as a rule, soon after a meal. The pain originating in the gall-bladder varies considerably in intensity, but presents two fairly uniform characteristics: it is situated in the upper right quadrant of the abdomen, and generally extends through to the back and upward to the region of the scapula and shoulder. Tenderness is rarely present in the absence of inflammation; but when present it is i...
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