FATTY LIVER HEP AR ADIPOSUM. 685 



the symptoms greatly resemble those of cirrhosis. In both cases the 

 obstruction to the escape of blood from the roots of the portal vein 

 leads to gastric and intestinal catarrh and haemorrhage, to haemor- 

 rhoids, enlargement of the spleen (not constantly), and to ascites. 

 Biliary retention and icterus result more frequently from compression 

 of the gall-ducts in adhesive pylephlebitis than in cirrhosis, because a 

 greater number of the liver-cells are preserved to prepare bile. The 

 continued secretion of bile and the occurrence of icterus in pylephlebi- 

 tis appear to show that the hepatic artery, as well as the portal vein, 

 furnishes the liver with material for the formation of bile. The course 

 of the disease is chronic. Recovery is impossible ; but it often lasts 

 for months before death occurs from the same symptoms as it does in 

 cirrhosis. Hence it appears that the disease can only be recognized 

 and distinguished from cirrhosis by aid of the history of the case. If 

 it be found that the patient was not given to drinking, and if the above 

 symptoms were preceded by chronic inflammation and suppuration in 

 the abdomen, the chances are in favor of adhesive pylephlebitis, par- 

 ticularly if the disease have run its course more rapidly than is custom- 

 ary with cirrhosis. 



Hitherto suppurative pylephlebitis has rarely been recognized dur- 

 ing life. Its symptoms are pain in the right hypochondrium, enlarge- 

 ment and tenderness of the liver, chills recurring at irregular intervals, 

 high fever, and almost always icterus. If these symptoms join them- 

 selves to an inflammation or ulceration of one of the abdominal organs, 

 we may, with some certainty, conclude that there is an acute inflam- 

 mation of the liver ; but we cannot yet say whether the parenchyma 

 or the portal vein be inflamed. We are only justified in the latter 

 supposition, when, besides the other symptoms, we have those of ob- 

 struction of the portal vein, particularly when there is enlargement of 

 the spleen, slight ascites, and haemorrhage from the stomach. Schorilein 

 was the first to recognize a case of suppurative pylephlebitis during 

 life, from the above symptoms ; thereby showing great diagnostic acu- 

 men and anatomico-physiological knowledge. 



TREATMENT. Concerning the treatment of adhesive pylephlebitis 

 we may refer to what has been said of cirrhosis ; while that of sup- 

 purative pylephlebitis corresponds exactly with that of suppuratrve 

 lepatitis. 



CHAPTER VI. 



PATTY LIVEK HEPAB ADIPOSUM. 



ETIOLOGY. There are two forms of fatty liver. In one, superfluous 

 fat is deposited in the liver-cells from the blood of the portal vein ; in 

 the other, the nutrition of the liver-cells is disturbed by disease of the 



