In the past, many people considered only in cirrhosis of liver that the association of non-specific cholecysitis and cholelithiasis would exist. But, in fact, in clinical practice, not a small number of patients with abnormal margin of liver dullness (that is, chronic hepatitis patients) had already received biliary tract operations on account of cholelithiasis or biliary tract infection. It is a pity that part of these patients after operation had not been relieved from the original symptoms of chronic hepatitis (clinicians believe these are symptoms of biliary tract disease). In the previous article, we mentioned that the computer data showed that in 2455 cases of abnormal margin of liver dullness, 61 cases were recorded of cholecystitis or cholelithiasis (occupying 2.84%). These patients still sought for medical help to deal with the clinical symptoms after biliary tract operation.
It was reported that the incidence of gallbladder damage in virus hepatitis was variable according to the severity and emergency of the illness. In severe hepatitis, the incidence was nearly 100%, in acute hepatitis 56.7%, chronic active hepatitis 51.1% and chronic persisting hepatitis 33.3%.
Some reports stated that the incidence of cholecystic pathologic changes revealed within 1 week of the onset of hepatitis was 81% and after 1 week 28%. In addition, a few cases of virus hepatitis had acute cholecystitis as the first symptom.
Liver diseases often have the association of cholelithiasis. It was reported that from hepatitis to the presence of cholelithiasis, the interval in general was found to be 8 to 20 years, average 13 years. However, clinically, the patients are often in lack of typical symptoms of gall bladder stone and very few vases present biliary colic. The common symptoms are chiefly upper abdominal discomfort, poor appetite and slightly more intake of food rich in fat or protein would instantly cause diarrhea. Currently, because of the diagnosis standard of chronic hepatitis depends too much on the abnormality of laboratory examination results and also due to the lack of ideal therapy in western medicine, it is, therefore, often easily neglected by clinical physicians. So the prolonged and repeated occurrence of the symptoms of chronic hepatitis may be intermixed with the symptoms of chronic cholecystitis and cholelithiasis. If, clinically, gallbladder stone is found, it may easily be sent for operation, but after operation, the symptoms of chronic hepatitis are still present. Therefore, if gallbladder stone patients with history of hepatitis have abnormality of area of liver dullness, it is advantageous to have TCM chronic liver disease systemic treatment as the first choice, in this way, many operations would be avoided.
Furthermore, some authors insist that in liver disease complicated with gallbladder stone, especially if cirrhosis of liver has occurred, the choice of operation should be very cautious.
Introduction of cases (continued)
| Case 2
Lin (code number 2407), male, age 46 years. He first visited the clinic on March 2001 with the complaint of positive type B hepatitis antibodies and pain over both knees for 30 years. He had stomache ache for more than ten years and he took gastric drugs for long period because of repeated gastric pain and occasionally felt comfortable after vomiting of the gastric contents. Later, he was diagnosed as having sand like gallbladder stones in a hospital. He was accordingly operated for cholelithiasis. Although post-operatively colic pain was relieved, he still suffered from distensive pain of the upper abdomen, abdominal distention after meal, aversion to oily food, defecation within on hour after eating, thirst and nocturnal drinking, wetness-heat loose stools, diarrhea after taking diet rich in oil and passing stools 3-4 times a day. There was over abundance of gastric acid which frequently regurgitate to the esophagus to cause heart burn. Gastroscopy was performed in a certain hospital with no abnormal findings. Physical examination revealed percussion tenderness over hepatic region and enlargement of liver to the costal margin. After 3 parcels of TCM drugs, the liver was normal and acid regurgitation decreased. The passing of stools was once a day but tenesmus was present. TCM treatment was continued and later stomache ache disappeared. Acid regurgitation at first lessened and finally stopped. There was intervention of common cold symptoms which disappeared during the course of TCM therapy. TCM treatment was stopped at the completion of the systemic therapy and the patient was followed up thereafter. This was a case of chronic hepatitis complicated with biliary tract infection, cholelithiasis and hepatic osteal malnutrition.
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| Case 3
Wong (code number 2406) male, age 50 years. His first visit was on March 22, 2001 with the complaint of repeated nasal hypersensitivity, asthma, common cold since childhood and he had also insomnia abdominal distention after meal, flatulence, repeated dryness and itching of skin, frequent pain sensation of both plantae and the necessity of nasal spray every night presently. Physical examination last year revealed cholelithiasis, but there was no significant biliary discomfort besides some pain at the back. Two to three months afterwards he received cholecystectomy in a certain hospital in Hong Kong, but clinical symptoms did not improve after the operation. Physical examination: abdomen soft but frog like in shape, tympanites, separation of margin of labial mucosa, tongue enlarged with teeth prints, liver enlarged to costal margin, (±) edema of lower extremities. After 3 parcels of TCM drugs, sleeping was good, dry coughing was relieved and pruritus of skin lessened. The liver returned to normal after taking another 3 parcels of TCM drugs, he slept well, was free of coughing and felt no more skin itching. Continuation of TCM therapy gave him a feeling of well being; he had occasional flatulence and the edema disappeared. After taking 25 parcels of drugs, he said that a large wart (about 1.5 cm to 2 cm) , on the dorsal surface of the right big toe detached off by itself. (For this, he visited specialists and asked for all kinds of help and received cryotherapy, electrocautery, oral antibiotics, but of no avail). Systemic TCM therapy totaled 39 parcels of drugs. Treatment was stopped at the obtainment of clinical cure and thereafter, the patient was followed up. There was slight enlargement of tongue and teeth prints at the time of cessation of therapy.
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By Wong Kwok Hung
published on 15th May 2001
(translated by Professor ZHENG Hua En in December 2002)