184 



ABNORMAL ANATOMY OF THE LIVER. 



qui re"sulte d'un travail d'irritation dont le foie 

 est devenu le siege. Cette irritation est tantot 

 idiopathique, et tantot elle est la suite d'une 

 irritation primitivement fixee sur le tube di- 

 gestif. 



" Une seconde espece d'hyperemie, dont le 

 foie me parait susceptible, est celle dans la- 

 quelle le sang s'accumule d'une maniere toute 

 passive au sein du parenchyme hepatique, 

 comme il s'accumule dans les gencives des 

 scorbutiques. 



" Enfin le troisibme espoce d'hyperemie du 

 foie est purement mecanique ; elle s'observe 

 dans les cas ou un obstacle quelconque s'oppose 

 a la libre entree du sang dans les cavites droites 

 du cceur ; le sang stagne alors dans les veines 

 sus-hepatiques, et engorge le foie." 



Now the researches of Kiernan have proved 

 that " in consequence of its double circulation, 

 the liver is naturally in a state of sanguineous 

 congestion " after death, and that author has 

 also pointed out the various forms of conges- 

 tion which are observed in the organ. " San- 

 guineous congestion of the liver," he observes, 

 " is either general or partial." 



. General congestion affects the whole of the 

 substance of the liver, which presents a gene- 

 rally diffused red colour; the central portions 

 of the lobules having usually a deeper hue than 

 the marginal portions. 



Partial congestion is of two kinds, 

 Hepatic venous congestion. 

 Portal venous congestion. 

 Hepatic venous congestion may exist in 

 tages. " In the first and most common 

 (Jig- 42) the hepatic veins, their intra- 



b 

 two 



stage 



lobular brandies, and the central portions of the 

 lobular venous plexuses are congested. The 

 congested substance is in small isolated patches 

 of a red colour, and occupying the centres of 

 the lobules is medullary ; the non-congested 

 substance is of a yellowish white, yellow, or 

 greenish colour, according to the quantity and 

 quality of the bile it contains; it is conti- 

 nuous throughout the liver, and forming the 

 marginal portions of the lobules is cortical." 



Fig. 42. 



Rounded lobules in the first stage of hepatic venous con- 

 gestion, as seen upon the surface of the liver. After 

 Kiernan. 



" This is the usual and natural state of the 

 organ after death," and arises from arrest in the 

 circulation of the hepatic veins, while the cur- 



rent of blood in the minute branches of the 

 portal vein is still in motion. 



"In the second stage (Jig. 43) the congestion 

 extends through the lobular venous plexuses to 

 those branches of the portal vein situated in 

 the interlobular fissures, but not to those in the 

 spaces, which being larger there and giving 

 origin to those in the fissures, are the last to be 

 congested ; when these vessels contain blood 

 the congestion is general, and the whole liver is 

 red. In this second stage the non-congested 

 substance appears in isolated circular and ra- 

 mous patches, in the centres of which the spaces 



Fig. 43. 



Lobules in the second stage of hepatic venous conges- 

 tion, as seen on the surface of the liver. The dark 

 centres of the preceding stage have become conjoined 

 at the interlobular fissures, while the unconyested 

 parts encircle an intralobular space. 



and fissures are seen. This form of congestion 

 " very commonly attends disease of the heart 

 and acute disease of the lungs or pleura ; the 

 liver is larger than usual in consequence of the 

 quantity of blood it contains, and is frequently 

 at the same time in a state of biliary conges- 

 tion, which probably arises from the sangui- 

 neous congestion. Although in the first stage 

 the central portions of the plexuses, and in the 

 second the greater portion of each plexus, and 

 those branches of the portal vein occupying the 

 fissures are congested, and although the plexuses 

 are formed by the portal vein r yet as this form 

 of congestion commences in the hepatic veins 

 and extends towards the portal vein, and as it 

 is necessary to distinguish this form from that 

 commencing in the portal vein, the term of he- 

 patic-venous congestion will not probably be 

 deemed inapplicable to it." The second stage 

 of hepatic venous congestion, generally com- 

 bined with biliary congestion, gives rise to those 

 various appearances which are called dram- 

 drinkers' or nutmeg liver. 



c. " Portal venous congestion is of very rare 

 occurrence ; I have seen it in children only. 

 In this form, the congested substance never as- 

 sumes the deep red colour which characterises 

 hepatic-venous congestion ; the interlobular fis- 

 sures and spaces and the marginal portions of 

 the lobules are of a deeper colour than usual ; 

 the congested substance is continuous and cor- 

 tical, the non-congested substance being me- 



