HYPEE.EMIC LIVER CHARACTERISTICS. Ill 



be no doubt that a granulated condition of the liver 

 may arise in other ways, and from divers other causes ; 

 but anato-pathologically there is only a superficial re- 

 semblance between such granulations and those of true 

 cirrhosis. CLINICALLY granulations of this type are to 

 be met with under the five following circumstances : 



1. THE FATTY LIVER. In this disease, segments of 

 the gland in which the cells are greatly distended with 

 fat, project in the form of yellow rounded granulations, 

 the size of a globule, or a pin's head. In all cases 

 of this kind examined by Frerichs and others, the 

 prominences were formed by the portal zones of the 

 lobules, and after injection, twigs of the portal vein and 

 hepatic artery might be seen on the top of the granulations 

 whilst the hepatic vein lay in the depressions. In true 

 cirrhosis, however, it will be observed that the relation 

 of the parts is precisely the reverse. The hypertrophy 

 of the connective areolar tissue ; the development of 

 new vascular channels; and the great firmness and 

 tenacity of the whole gland, which is never absent in a 

 case of genuine cirrhosis, are invariably absent in an 

 adiposed liver, and which is also exempt from any 

 prominent derangements of the circulation. 



2. THE HYPER^IMIC LIVER. This form of hepatic 

 derangement arises from an obstructed circulation in 

 heart and lung affections. In the first stage there is 

 considerable enlargement of the gland (hypertrophy), 

 arising from a redundancy of blood (hypersemia), but 

 after a time this enlargement is followed by an opposite 

 condition atrophy. Here also the liver becomes firm, 

 leathery, and finely "granular," which has led many 

 able practitioners to confound it with true cirrhosis. 



