(b) Disturbances affecting the autonomic innervation of the biliary
(c) Infection produced by blood or flowing back from the duodenum.
Bacteria sometimes invade the gallbladder.
(d) Vitamin A deficiency. Stones have been found in experimental
animals when a Vitamin A deficiency has been created.
(e) Waste materials of altered bile metabolism. Such materials are the
beginning of calculi crystals.
(3) Signs and symptoms. There may be no symptoms, or the patient may
experience symptoms similar to those for acute cholecystitis. If the gallbladder is
obstructed and cannot empty normally, pressure increases, and the patient may have
intense pain (biliary or gallstone colic). The pain may radiate to the right shoulder or
lower back. When fluid which should leave the gallbladder cannot, bacteria increases,
and the action of the bacteria causes the patient to have a fever. Patients with gallstone
colic may experience severe pain during these attacks and then be free of pain.
(4) Treatment. Medical treatment includes dietary control. The patient
should eat foods low in fat and high in proteins and carbohydrates. Surgery is usually
indicated but only if the physician is sure the problem is cholelithiasis.
The symptoms of many of the diseases and disorders of the gastrointestinal
system are similar. Look at your patient as a whole person. Treat the most life-
threatening or potentially life-threatening problems first. Many of the other illnesses
discussed here will require only supportive care in order to allow the soldier to return to
duty as quickly as possible.