CHOLELITHIASIS GALL-STONES 245 



CHOLELITHIASIS. GALL-STONES. 



Cholelithiasis is quite rare in animals. Only a few cases 

 have been reported where free concretions were found in 

 the biliary ducts and these occurred most commonly in the 

 gall-bladder and ductus choledochus. Gall-stones are the 

 result of a catarrhal inflammation of the membrane of the 

 duct or gall-bladder causing a desquamation of the epithe- 

 lium and a collection of bile salts, gradually forming con- 

 cretions. Infection or parasites gaining entrance via the 

 duct and producing irritation are common causes. 



Symptoms. Gall-stones may exist for some time without 

 producing any marked symptoms, depending upon the 

 location of the concretion. When in the gall-bladder but 

 little disturbance will be produced, but when the concretion 

 passes out into the ductus choledochus, severe colicky symp- 

 toms are observed, and by completely blocking the exit of 

 the bile, obstruction or hepatogenous icterus is produced. 

 (See Icterus or Jaundice.) A diagnosis is difficul: and, when 

 suspected, an explorative laparotomy should be performed. 



Treatment. Surgical means should be employed early. 

 Under general anesthesia laparotomy is performed, as for 

 gastrotomy (see Gastrotomy) making the incision longer, if 

 necessary. The portion of the liver containing the gall- 

 bladder and duct is brought out through the incision. A 

 careful examination should be made to determine the location 

 of the concretion. When located, an incision is made down 

 upon the concretion just large enough for its removal. Care 

 should be taken to prevent the bile from running into the 

 cavity. After all the concretions are removed the wound 

 is stitched carefully with a fine suture using a small, straight 

 needle. A continuous suture is first used to bring the edges 

 of the wound in apposition, and then a Lembert suture 

 to completely close the opening and to bring the serous 

 membranes together for rapid healing. The parts should 

 be thoroughly cleansed before returning to the abdominal 

 cavity. The laparotomy wound is sutured in the regular 

 manner. (See Laparotomy.) 



