534 THE LIVEE. 



WOUNDS, RUPTURE, AND HAEMORRHAGE. 



Wounds of the liver may induce haemorrhage, which, if life continue, 

 is followed by inflammation. Serious wounds of the liver are usually 

 fatal, but recovery may occur even after the destruction of a consider- 

 able portion of the organ. 



Rupture of the liver may be produced by severe direct contusions or 

 by falls. It may be produced in children by artificial delivery. The 

 rupture usually involves both the capsule and a more or less consider- 

 able portion of the liver tissue. It is commonly accompanied by large 

 haemorrhage, and is usually fatal. 



Haemorrhage. Extravasations of blood in the substance of the liver, 

 or more frequently beneath the capsule, may be found in new-born chil- 

 dren after tedious or forcible labors. In adults, haemorrhage, except as 

 the result of injury, is uncommon. Extravasations of blood are some- 

 times seen in malignant malarial fevers, especially in tropical climates ; 

 in scurvy, purpura, and phosphorus poisoning ; and bleeding may occur 

 in and about soft tumors, abscesses, and echinococcus cysts. It may 

 also occur as a result of thrombosis of the hepatic vein. 



ANEMIA AND HYPERJEMIA. 



Ansemia of the liver may be general or partial. It may be due to 

 general anaemia or to local disturbances of the circulation, such as swell- 

 ing of the cells in parenchymatous or other degeneration, pressure of 

 tumors, etc. The organ appears pale, often of slightly yellowish or 

 brownish color. It may be harder than usual, and smaller. 



Hypersemia of the liver is either an active or a passive process. In 

 health the amount of blood in the liver varies at different times, being 

 regularly increased during the processs of digestion. When the diges- 

 tive process is unduly influenced by the iugestion of spirits, spices, etc., 

 the hyperaemia assumes abnormal proportions, and when this is often 

 repeated it may lead to structural changes in the organ. Severe contu- 

 sions over the region of the liver sometimes cause a hyperaemia, which 

 may result in suppurative or in productive inflammation. In hot cli- 

 mates and in malarious districts active and chronic hyperaemia of the 

 liver are frequent and often incite structural lesions. In scurvy, also, 

 the liver is sometimes congested. Cessation and suppression cf the 

 menses and of haeniorrhoidal bleeding may be followed by hyperaemia of 

 the liver. In all these varieties of active congestion the liver is enlarged, 

 of a deep red color, and blood flows freely from its cut surface. 



Passive congestion of the liver is produced by an obstruction to the 

 current of blood in the hepatic veins. Valvular diseases of the heart, 

 emphysema and fibrous induration of the lungs, large pleuritic effusions, 

 intrathoracic tumors, angular curvature of the spine, aortic aneurisms 

 pressing on the vena cava, and constrictions of the vena cava and of the 



