Abstract
This article is the second of a series of 3 studies designed to test the reaction of the human gall bladder to different pathological states of the stomach, i. e., to gastric ulcer, gastric carcinoma and pernicious anemia—diseases in which there are characteristically varying amounts of free hydrochloric acid.
In the first of these 1 it was shown that the gall bladder empties significantly faster in patients with gastric and duodenal ulcers than in normal individuals of comparable age. Although such patients have a high titer of free acid, to which the more rapid emptying of the gall bladder might be attributed, it was found that the curve of emptying in ulcer patients could be duplicated in normal individuals merely by injecting one egg-yolk directly into the duodenum. This would seem to explain the more rapid response of the gall bladder to food in ulcer patients, for it is known that in this disease the hypermotility of the stomach usually results in a greater initial rush of food into the duodenum. Incidentally, these observations remove any apprehension that peptic ulcer may be an antecedent factor in gall bladder disease.
The present report is based upon cholecystographic studies of 22 male patients with carcinoma of the stomach, 13 of them made just prior to gastro-enterostomy or partial resection of the stomach, and 9 of them after one of these operations. In 5 out of the 22 patients (22.7%) the gall bladder failed to visualize, notwithstanding the fact that the dye was administered intravenously. This is a higher negative incidence than occurred in 33 peptic ulcer patients, among whom only 3 (10%) failed to visualize; but this may be explained on the basis of the greater age of the cancer group for, in a previous study, 2 it was found that out of 23 apparently normal men of the 7th and 8th decade, 5 of them (21.6%) failed to become visualized.
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