CIRRHOSIS OF THE LIVER. 



The patients complain of loss of appetite, of a feeling of pressure and 

 fulness after eating ; they suffer from flatulence and constipation. The 

 nutrition may be already affected and the appearance cachectic ; but 

 the same is true of these appearances as has been said of several of the 

 accompaniments of simple hyperaemia of the liver, that, although they 

 accompany the disease, they are not symptoms of it. The habitual use 

 of liquor almost always causes chronic catarrh of the stomach, and the 

 symptoms depend on this, not on the interstitial hepatitis. 



The symptoms of the second stage depend almost entirely on me- 

 chanical conditions. Compression of the branches of the portal vein 

 must cause symptoms of congestion in those organs from which the 

 portal vein conducts the blood to the liver ; the compression of the 

 bile-ducts (as long as the liver-cells to which they belong prepare bile) 

 induces absorption of bile and icterus. 



Symptoms of congestion are seen soonest and most frequently in 

 the gastric and intestinal mucous membrane. The chronic gastric 

 catarrh accompanying the second stage of cirrhosis is not, as in the first 

 stage, a complication, but is a necessary result of the disease. The 

 symptoms it causes have already been described. Intestinal catarrh, 

 which is just as frequent an accompaniment of cirrhosis, rarely leads to 

 excessive transudations of fluid into the intestines, but, like most chronio 

 catarrhs, to a copious production of cells and to the secretion of tough 

 mucus. We have learned that constipation, tympanites, cachectic 

 appearance, etc., are among the symptoms of this form of chronic in- 

 testinal catarrh, hence we readily understand why they should take a 

 prominent part among the symptoms of cirrhosis of the liver. Not un- 

 frequently the capillaries of the gastric and intestinal mucous mem- 

 brane become so full as to rupture. Hence, next to ulcer of the 

 stomach, cirrhosis of the liver is the most frequent cause of gastric and 

 intestinal haemorrhages ; and as the obstructed evacuation of the portal 

 vein causes overfilling of the inferior mesenteric artery and the haemor- 

 rhoidal plexus, it is to be mentioned among the causes of haemorrhoids, 

 and these form one of the most frequent symptoms of cirrhosis. 



As the splenic vein also empties into the portal vein, compression 

 of the branches of the latter will impede the escape of blood from the 

 former ; hence symptoms of congestion of the spleen unite with those 

 of the gastric and intestinal congestion. In the later stages of inter- 

 stitial hepatitis the spleen has so often been found enlarged to two or 

 three times its natural size, or even more, that Oppolzer, Bamberger, 

 and others, give enlargement of the spleen as one of the most important 

 symptoms of cirrhosis of the liver. Out of thirty-six cases, Freriehs 

 found the spleen enlarged eighteen times. We cannot agree, however, 

 in referring the enlargement of the spleen solely to obstruction of the 

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