240 DISEASES OF THE LIVER 



4 



rounded on either side with sterile gauze to prevent any of 

 the pus entering the cavity while operating. A free incision 

 is made directly over the abscess its full length, the contents 

 of the cavity thoroughly washed out with boric acid solution 

 (2 per cent.) and the abscess wall thoroughly curetted to 

 remove all of the necrotic tissue and detritus. If necessary 

 some of the tissue is removed with the scissors or knife to 

 straighten the edges of the wound, and also to be sure to 

 remove all of the necrotic tissue. The wound in the liver is 

 sutured with a deep continuous suture. Should the hemor- 

 rhage interfere it should be controlled by ligating the larger 

 vessels. 



Should the abscess be suprahepatic or infrahepatic, the 

 affected parts should be carefully withdrawn, the adhesions 

 broken down and the entire wall of the abscess completely 

 extirpated. All exposed portions should be thoroughly 

 irrigated before returning to the abdominal cavity. 



When multiple abscesses are found surgical treatment is 

 rarely of value. The external wound is sutured as in gastrot- 

 omy. (See Gastrotomy.) 



ATROPHY OF THE LIVER. 



Definition. A term generally applied to a reduction in the 

 size of the liver. In most conditions where there is a reduc- 

 tion in the size of the liver it is due to degenerative changes. 



Etiology. Atrophy of the liver occurs most commonly 

 from the following: 



(a) Pressure upon the liver, by tumors, enlargement of 

 adjacent organs, passive congestion, amyloid disease, etc. 

 These causes may produce a true atrophic condition of the 

 liver with subsequent replacement fibrosis, or atrophy and 

 degeneration (fatty degeneration and necrosis) as in passive 

 congestion and amyloid disease. 



(b) From a stenosis or occlusion of the portal vein, general 

 hepatitis, advanced passive congestion, etc., a general 

 atrophy of the liver may develop. 



(c) A reduction in the size of the liver, which is not a true 

 atrophic condition, follows many degenerative processes, 



