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Unpleasant Symptoms Due to Disturbance of Digestion or Bile Secretion
The conditions grouped popularly under the terms Bilious Attack and Biliousness arise from various causes though presenting similar symptoms. These causes, which include migraine, liver congestion, consipation unsuitable diet, acidosis and reduced secretion of bile, are here examined and treatment and diet prescribed.
BILE. The formation of bile is an important function of man's largest gland, the liver. Between one and two pints of bile are produced daily. In a state of health it is continuously secreted, but the flow is more rapid after eating, especially when meat and fats are taken. The quantity of bile is also increased when water is consumed copiously, and the beneficial effects of spa treatment are partly due to free flushing of the biliary system.
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Between meals the bile is stored and concentrated in the gall bladder, whence it passes into the duodenum through a thin-walled tube known as the common bile duct. The lining membranes of the bile duct add diluting fluid to the bile, and these ducts are richly supplied with blood vessels and nerves, the latter forming specially close connexions with the nervous control of the heart, and with the sensory mechanism governing painful feelings over the lower chest and right shoulder.
The bile, as it reaches the small intestine, is a viscid, glairy alkaline and bitter tasting fluid varying from golden yellow to olive green in colour. Bile assists in the digestion of food and acts as a lubricant to the wall of the bowel and the contained food. By assisting the action of the steapsin in the panereatic juice it plays an important part in the digestion of fats. It does not itself contain much actice digestive ferment though it plays some little part in the digestion of starch and protein. It is the bile salts which help to activate the pancreatic juice. These salts act both as a stimulant to the lower bowel for elimination and as a mild antiseptic.
BILE DUCTS: HOW BILE REACHES THE INTESTINES: Throughout the liver are an immense number of minute channels, which are gathered up into larger and larger vessels until finally the common bile duct is reached, which pours the bile or secretion of the liver into the duodenum.
The conditions grouped popularly under the terms Bilious Attack and Biliousness arise from various causes though presenting similar symptoms. These causes, which include migraine, liver congestion, consipation unsuitable diet, acidosis and reduced secretion of bile, are here examined and treatment and diet prescribed. See also Acidosis; Bile; Diet; Indigestion; Jaundice; Liver.
This term has a popular rather than a scientific meaning though it denotes a fairly definite group of symptoms and in lesser or greater severity is of fairly common occurrence.
In many cases the condition is of probably purely nervous origin and should be classed under the definition of Migraine (q.v.). The principal symptoms being headache, giddiness and vomiting, symptoms also associated with a bilious atttack set up by digestive or metabolic disturbanccs, the two conditions are very apt to be confused. Migraine tends to be habitual. Attacks occur more or less frequently and are apt to be brought on by definite nervous causes rather than by dietary indiscretions. In some cases, it is true, migraine may be due to metabolic disorder, but in most cases no treatment directed to this is effective in stopping the attacks from recurring. Or a particular article of food may induce an attack of migraine. Common causes of the so-called "bilious" attack which is really of the nature of migraine are some defect of sight causing eye strain, or mental worry and strain or excitement. A still further relationship between migraine and a genuine bilious attack is that children who have been subject to the latter may suffer from migraine in later life.
The term bilious attack should therefore be reserved for the condition which is clearly due to digestive or metabolic disturbance, the result of incomplete digestion or assimilation of food. It should be regarded as an acute poisoning from one or both of these causes. Though the attack may follow immediately after some dietary indiscretion in the way of over-indulgence in unsuitable food, it may come on as the result of the slow accumulation of poisonous substances in the blood.
The liver is the organ principally at fault in setting up the attack, although in most cases it will be unfair to blame its default. One of its main functions is to act on products of digestion which are unsuitable for use by the body and are brought to it by the portal blood in such a way that these substances are rendered harmless and capable of exeretion by the kidneys. If, however, it is asked to deal with an undue amount of these substances, or for any reason, such as a chill or nervous upset, its function is impaired, some or much of this poisonous material will escape from the liver and enter the general circulation. By its influence on the nervous system the symptoms of a bilious attack are then set up.
After a night disturbed by terrifying dreams the patient wakes unrefreshed and complains of headache with a general feeling of being weak and ill. He is irritable and unduly depressed by trifles. On attempting to rise he feels giddy, and may complain of floating specks which disturb his vision. The mouth is foul, while the skin has a muddy, sallow appearance with dark rings around the eyes and a slight yellow tinge on the conjunctiva.
Appetite is lost and the patient feele sick. If he takes a meal, flatulence with discomfort in the stomach follows, and usually there is vomiting. The regurgitated matter, besidcs the breakfast food, contains part of that taken overnight, and it is mixed with mucus and a good deal of bile. The bile may be yellow or green, and it has an acrid, bitter taste. The retching or vomiting is accompanied by a cold sweat and considerable prostration. The bowels are affected either by diarrhoea or by constipation, the former being a more favourable sign. Thirst is a common symptom.
In the absence of treatment the sufferer's condition remains unsatisfactory for many days, all the symptoms tending to persist, though lessening in severity. Eventually the patient makes a slow and irregular recovery.
An excess of food or to excessive richness of food, especially fatty foods, only aggravates the recovery.
In the treatment of a bilious attack, this period no food should be allowed. Thirst may be relieved by plenty of soda water, potash water, or mineral water, to which a little fresh lemon is an agreeable addition.
On the next morning a quarter of an ounce of Epsom salts in quart of water should be taken.
The diet on the second day must depend on the degree of improvement achieved. Many cases will have virtually recovered, and these may have ordinary food, save that meat and fatty substances should be taken sparingly. If the headache and sickness have not yet subsided, it is better to give only soup with a little toast and abundance of aerated mineral water. In order to prevent a relapse dietary indiscretions, chill or constipation must be avoided.
In addition to what is said above it is only needful to point out that a tendency to such attacks, or it may be only to frequent malaise with loss of appetite, nausea, constipation, slight headache or loss of mental efficiency with chronic depression of spirits, is to be explained in similar fashion. The symptoms are much less marked and more persistent. An acute attack may or may not develop.
The indigestion and constipation which give rise to biliousness are aggravated by the defective secretion of bile due to the interference with liver function. The normal activities of the bile in promoting digestion and evacuation are lessened, and this gives rise to further indigestion and more marked constipation.
Treatment must be directed to lessening and simplifying the food, or even by a short course of fasting. Simplifying the diet should mean the exclusion of all fried, fatty and "rich" foods and all highly seasoned dishes. Sugar should be taken sparingly and never between meals for children. The diet should consist largely of dairy and vegetable produce, with white fish, wholemeal bread and fruit. Alcohol must be used sparingly, and exercise, if possible in the open air, be taken regularly. Games involving active movements of the abdominal muscles are the best, and failing these, abdominal exercises (q.v.) should be practised daily.
Any tendency to constipation must be dealt with by exercise and suitable food, with possibly the use of a mild laxative. Where, as is often the case, there is an element of nervous disturbance this must be dealt with by suitable rest and the use of a mild sedative.
One teaspoonful of aperient salts or bitters may be taken with advantage every second morning before breakfast for some days until the torpidity of the liver has passed away. Chicory, roasted, as a coffee, is most suitable.