CHAPTER VIII. 



THE LIVER. 



Malformations. 



Congenital malformations of the liver are not common and are of little practical im- 

 portance. The organ may be entirely wanting ; the lobes may be diminished or in- 

 creased in number ; its form may be altered, so that it is rounded, flattened, triangular, 

 or quadrangular. The gall bladder or gall ducts may be wanting; the ductus choled- 

 ochus may be double, both ducts emptying into the duodenum, or one emptying into 

 the duodenum, the other into the stomach. The single ductus choledochus may also 

 empty into the stomach. Owing to abnormal openings in the diaphragm or the abdomi- 

 nal parietes, the liver may suffer displacement upward or forward. In congenital 

 transposition of the viscera the liver is found on the left side, the stomach and spleen 

 on the right side. 



Small, isolated bodies, having the same structure as the liver, have been a few times 

 found in the suspensory ligament and in the lesser omentum. 



Acquired Changes in Size and Position. 



As a result of tight lacing very marked changes are sometimes produced in the 

 shape of the liver. By the narrowing of the base of the thorax the organ is compressed 

 from side to side, and its convex surface is pressed against the ribs. In consequence 

 of this there are found ridges and furrows on its convex surface. In consequence also 

 of the circular constriction, a part of the right, and usually of the left lobe also, be- 

 comes separated by a depression. Over this depressed and thinned portion of the liver 

 the capsule is thick and opaque. In extreme cases the depression and thinning reach 

 such an extent that there is only a loose, ligamentous connection between the separated 

 portion and the liver. 



A series of depressions are sometimes found on the upper surface of the right lobe 

 of the liver, running from front to back, apparently caused by folds of the organ. 



Structural alterations in the liver may induce changes in its size and shape. It 

 may be increased in size by tumors, hydatid cysts, abscesses, fatty and amyloid degen- 

 eration, by congestion, and sometimes by cirrhosis, etc. 



It may be diminished in size by atrophy, by cirrhosis, by acute parenchymatous 

 degeneration, etc. 



Changes in the position of the liver are produced by alterations in its size, by press- 

 ure downward from the thoracic cavity and upward from the abdomen, by the con- 

 striction of tight lacing, by tumors or circumscribed serous exudation between the liver 

 and diaphragm, by curvature of the spine. 



The liver is readily turned, by pressure from above or below, on its transverse axis. 

 The transverse colon may be fixed above the liver so as to push it backward, downward, 

 and to the right. There are a few cases recorded of dislocated and movable livers. 

 These occurred in women who had borne children and whose abdominal walls were lax. 

 With ascites it is not uncommon to find the liver quite movable. 1 



'See Graham, "Displacements of the Liver," Trans. Assn. Am. Phys., vol. x., p. 

 258, 1895, bibliography. 



