Cholecystography

Abstract

THE amount of free hydrochloric acid in the gastric secretion of a subject for cholecystography after the method of Graham, Cole and Copher,1 but by oral administration of the sodium tetraiodophenolphthalein, is a factor in the intestinal reaction to the chemical, and influences the resulting cholecystogram. Organic acids present in the stomach and small intestine will act in the same manner. The free hydrochloric acid is, however, the usual and chiefly effective acidity. Carman2 noted catharsis, rarely after oral sodium tetrabromphenolphthalein, usually after enteric-coated pills of sodium tetraiodophenolphthalein, but less often after plain gelatin capsules of the latter salt. Palefski3 noted the alimentary reaction with duodenal administration and gave morphine and atropine to counteract it. Whitaker, Milliken and Vogt4 in forty-four instances of oral administration of the sodium tetraiodophenolphthalein noted vomiting five times, slight nausea seven times, and mild diarrhea five times. Menees and Robinson5 noted in thirty-seven instances of oral administration of the sodium tetrabromphenolphthalein slight looseness of the bowels seven times and vomiting ten times. Stewart6 noted after duodenal administration in three cases vomiting once and a slight diarrhea once. Among sixty-five cases receiving orally sodium tetraiodophenolphthalein, there occurred thirteen instances of an alimentary reaction, with diarrhea, with from two to six liquid stools, and all of these showed an achlorhydria. In five of these cases there was associated nausea and vomiting. Four cases showing free hydrochloric acid had vomiting only, no diarrhea. One case of clinical diarrhea showing an hypochlorhydria gave no definite increase in the diarrhea. All cases having an achlorhydria gave but a faint or no gall-bladder shadow, and by opacities in the alimentary canal gave little or no X-ray evidence of undissolved dye. X-ray evidence of undissolved capsules or dye has appeared in only one case which showed no free hydrochloric acid, and in those having free hydrochloric acid has appeared, roughly, in direct proportion to the degree of acidity. These observations were made in a series of private cases. Cholecystography, by oral administration of the dye, has been recently incorporated into the office routine of the clinical, laboratory and roentgen examination of gastro-intestinal patients. Five one-gram, salol-coated (single coat) capsules of sodium tetraiodophenolphthalein are taken with water by the patient, following the evening meal, and the first film is exposed at eleven or twelve hours, just prior to starting a barium study of the gastro-intestinal tract. The relation of the free hydrochloric acid in the stomach to the alimentary tolerance of the dye soon becomes apparent from the co-relation of the data on each patient.