CIRRHOSIS OF THE LIVEE. 405 



sixth rib in the nipple line, the eighth rib in the axilla, and the 

 tenth dorsal spine posteriorly. In the recumbent position the 

 liver only comes from under cover of the ribs in the epigastrium, 

 its edge passing from the ninth right to the eighth left costal 

 cartilage. The edge can rarely be felt unless the organ is 

 enlarged, but when felt can readily be recognised by its sharpness 

 and the notches corresponding to the fundus of the gall bladder, 

 and the position of the round ligament. A tendinous intersection 

 in the rectus is apt to be mistaken for the liver, so it is well to 

 keep to the outer side of this muscle when seeking for the liver 

 edge. The position of the liver in the dome of the diaphragm 

 causes it to move freely with the respiratory movements. 



Infarction of the liver is rare. The organ is practically supplied 

 with blood from two sources, the hepatic artery and the portal 

 vein, and the capillaries of both these vessels communicate freely 

 with the hepatic veins. When infarcts do occur they are small 

 and present a nsevoid appearance. They have been met with in 

 thrombosis and embolism of the portal vein, embolism of the 

 hepatic artery and retrograde embolism of the hepatic veins. 



Cirrhosis of the liver is believed to be due to the action of 

 some toxic or infective agent. Most of the blood which traverses 

 the liver is brought from the digestive tract by the portal vein, 

 and this vessel is supposed to be the common track of invasion. 

 The hepatic arteries afford another means of access to the liver 

 and may be responsible for the production of interstitial cirrhosis 

 in certain of the infectious fevers. The pigmentary cirrhosis of 

 bronzed diabetes is often associated with endarteritis of the 

 hepatic arteries, which has led to the belief that infection by 

 this route may cause the disease. The bile ducts afford a third 

 means of invasion, and by some authors the form of cirrhosis 

 designated monolobular or biliary is held to arise in consequence 

 of an infection which ascends these from the duodenum. In 

 multilobular cirrhosis of the liver, which is the common form of 

 the disease, the new fibrous tissue spreads from the portal canals. 

 Branches of the hepatic artery, portal vein and bile duct lie in 

 company in these spaces, but the vein chiefly suffers compression 



