228 DISEASES OF THE LIVER 



portion to the completeness of the obstruction to the ducts 

 and to the extent of the rupturing of the biliary capillaries. 

 The symptoms develop on the external membranes, as a rule, 

 in a few hours, although in some cases of slow development 

 three to four days may be required depending upon the degree 

 of infection or obstruction of the ducts. 



The Urine.— This is changed in color to a yellowish-green, 

 dark green, yellowish-red, or greenish-brown, depending 

 upon the amounts of bilirubin, biliverdin (oxidation prod- 

 ucts), or urobilin (reduction product). These bile pigments 

 are often observed in the urine before any discoloration takes 

 place in the tissues, therefore the urine furnishes an early 

 important symptom. The urine when it comes in contact 

 with organic matter will stain it the color of bile, or upon 

 shaking or agitating the urine it will form a foamy liquid, 

 which is quite characteristic. Gmelin's test- may also be 

 used for recognition of icteric urine. In addition to the bile 

 pigments the urine often contains a number of hyaline casts 

 (indicating nephritis) and desquamated epithelial cells. 



Gastro-intestinal Tract. — The absence of bile from the 

 intestinal tract results in most cases in the passage of pale, 

 grayish, clay colored, or slate gray feces, having a fetid odor, 

 and containing undigested fat, and hydrobilirubin. The 

 pale color is due partly to the absence of bile, and partly to 

 the imperfectly digested fat which may be increased from the 

 normal 20 to 50 per cent. The fetid odor of the feces is 

 ascribed to the absence of bile which when present limits 

 fermentation of the intestinal contents. Constipation is 

 the rule in the majority of cases. However, diarrhea may be 

 present in some cases due to the imperfect digestion of the 

 fats and to the laxative action of free fatty acids which are 

 formed. The constipation is due no doubt, when present, to 

 defective motility of the muscular walls of the bowels, from 

 lack of the normal stimulating properties of the bile. In- 

 creased acidity of the stomach is observed in many cases, the 

 obstruction to the flow of bile apparently causing an increase 

 in the activity of the gastric secretion. 



Nervous System.— Serious nervous symptoms are often 

 observed. The bile salts present in the circulation are at 



