CONGESTION OF THE LIVER. 689 



CHAPTER XLV. 



CONGESTION OF THE LIVER. 



Definition. — Engorgement and distension of the liver frorn 

 over-repletion of the blood or bile conduits. 



Pathology, a. Nature and Varieties. — The very extensive 

 and differently distributed vascular relations of the liver 

 render the condition of hyperasmia or excess of blood in 

 its capillary system a rather frequent and to be looked for 

 occurrence. This excess of blood, we find, is probably the 

 earliest and most steadily occurring disturbance connected 

 with the various structural changes to which the viscus is 

 liable. 



The most commonly appearing form of this is that which is 

 recognised as imssive congestion, associated with obstructed 

 blood-flow in the hepatic and portal veins, as distinct from 

 turgescence resulting from increased afHux of blood. 



This condition seems largely connected Avith retrocession of 

 blood from external organs and surfaces, and with disease of 

 other viscera, particularly the heart and lungs. The state of 

 valvular disease, especially of the right side, and impediments 

 to the blood-flow in the pulmonary artery, intimately related to 

 pulmonary emphysema and collapse, are markedly powerful in 

 inducing this form of hepatic congestion. 



Another form of turgescence and hyperaemia, known as 

 active congestion, arises from an increased or excessive supply 

 of blood to the gland, appearing in the form of distension of 

 the capillaries, probably of the hepatic artery. This, as 

 respects the production of hepatic disease, is of itself of rather 

 less importance than the former manifestation. We are aware 

 that active hypersemia of the liver to some extent accom- 

 panies the regular process of digestion, also that over-feeding, 

 or feeding upon highly stimulating materials, together with 

 enforced idleness, tend to intensify this regularly occurring 

 condition. 



From either or both of these states arises the third form of 

 turgescence, termed biliary congestion, in which the minute 

 bile-ducts become loaded and surcharged with the glandular 

 secretion. 



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