GOO 



THE LIVER. 



is sometimes uniformly and intensely congested and coated with mucus. 

 In other cases both the mucous and muscular coats are pale, but very 

 markedly thickened. 



Cirrhosis of the liver is not infrequently accompanied by chronic dif- 

 fuse nephritis. 



Hypertrophic Cirrhosis. There is a form of interstitial hepatitis in 

 which the growth of new tissue occurs not only between the lobules but 

 extends into the lobule between the liver cells (Fig. 365). Under these 

 conditions even in advanced forms of the lesion the liver may be en- 

 larged, the surface may be smooth or slightly roughened, the parenchyma 

 is often bile-stained. This form of interstitial hepatitis is called hyper- 

 trophic cirrhosis. There is a form of interstitial hepatitis, usually of the 

 hypertrophic type, in which the growth of connective tissue is most 

 marked in the vicinity of the smaller bile ducts. This often occurs in 

 connection with obstruction of the bile ducts and the lesion is called bili- 

 ary cirrhosis. In "biliary cirrhosis" marked jaundice is said to be com- 

 mon while ascites is moderate or absent. In certain cases there is a 

 marked difference in the gross and microscopic appearance in atrophic 

 and hypertrophic cirrhosis, but intermediate forms occur. The difference 

 in the conditions which lead to these two forms of cirrhosis of the liver, 

 the atrophic and the hypertrophic, is not yet clear, and the distinctions 

 which have been made between them, in part clinical, in part morpho- 

 logical, are often unsatisfactory. 



*1S ' 7 ' 





Fio. 365. HYPERTROPHIC CIRRHOSIS OF THE LITER. 

 Showing formation of connective tissue between the liver cells. 



The causes of cirrhosis are imperfectly understood. It is a disease 

 of adult life, but exceptionally occurs in children. ' Congenital cirrhosis 



'For a resume of cirrhosis in childhood see Morse, Boston Med. and Surg. Jour. 

 September llth, 1902. 



