246 DISEASES OF THE LIVER 



RUPTURE OF THE LIVER. 



i 



Ruptura Hepatw. Apoplexia Hepatis. 



Etiology. Owing to the structure of the liver being very 

 friable and easily torn and its blood supply great, it is not 

 uncommon that rupture of this organ takes place. The 

 common causes are injuries, such as being run over by 

 vehicles, penetrating rib fractures; severe exertion (running, 

 jumping, falling, etc.), or during the course of infectious dis- 

 eases when there is a severe congestion or inflammation of 

 the liver. Predisposing factors are: Degenerative processes 

 in the liver, such as fatty liver, amyloid liver, etc., or diseases 

 of the heart and vessels. 



Pathology. The postmortem lesions depend largely upon 

 the extent of the rupture. Small hemorrhages are often 

 found showing through the capsule of the liver, greater may 

 occur in the form of a large hematoma. In most cases, how- 

 ever, the capsule also becomes torn and the blood is allowed 

 to flow out into the abdominal cavity. The liver when 

 examined will reveal the rupture. The other tissues and 

 organs will be pale and anemic. 



Symptoms. Small hemorrhages in the liver will not pro- 

 duce any marked symptoms. If severe there will be all the 

 symptoms of internal hemorrhage, such as paleness of the 

 mucous membranes, general weakness, anxious expression, 

 weak rapid pulse, and dyspnea; the extremities and skin 

 become cold, trembling of muscles, and finally coma. Death 

 often takes place very suddenly or within ten or twelve hours, 

 depending upon the extent of the rupture. Small and con- 

 tinuous hemorrhages will be observed where the rupture is 

 very small or where a hematoma is forming showing symp- 

 toms of weakness, paleness of the membranes and often some 

 icteric symptoms. Such cases often recover in a few days or 

 death may occur from exhaustion in four to ten days. 



Diagnosis. An accurate diagnosis is very difficult. The 

 anamnesis may assist in arriving at a definite conclusion. 



Prognosis. Should be considered unfavorable as most 

 cases, especially where the hemorrhage is severe, terminate 



