694 



DISEASES OF THE LIVER. 



by JJuschka, almost the whole of the liver was transformed into a 

 shapeless mass of the structure of alveolar cancer. 



Still more rarely small nodules of the structure of epithelial cancer 

 are found in the liver. 



Occasionally cancer of the liver is accompanied by cancer of the 

 portal vein, the trunk, roots and branches of the latter being filled by 

 a loosely-connected thrombus of cancerous substance. I have seen 

 one case where the contrary occurred : cancer of the portal vein first 

 complicated cancer of the stomach, and the cancer of the liver found 

 on autopsy had evidently resulted from the extension of the degen 

 eration from the portal vein to the tissue of the liver. 



SYMPTOMS AND COURSE. The symptoms of cancer of the liver 

 are always obscure at first ; later they are usually quite distinctive, 

 but cases do occur where a certain diagnosis cannot be made till death. 

 The first complaints of the patient are almost always of a feeling of 

 pressure and fulness in the right hypochondrium, such as accompanies 

 all enlargements of the liver when they occur rapidly and become great. 

 When the tumors are near the surface of the liver, and hence induce 

 partial peritonitis early, there is pain in the region of the liver even at 

 the commencement of the disease ; this pain often spreads to the right 

 shoulder. Even from the first the region of the liver is usually more 

 sensitive to pressure than in any of the diseases of the organ hitherto 

 described, except suppurative hepatitis. After a time the patients 

 themselves notice that their right side is prominent, and that there is 

 a hard tumor in the right hypochondrium. If the tumors compress 

 large branches of the portal vein, there is moderate ascites ; if, on the 

 other hand, they grow on the concavity of the liver and compress the 

 portal vein itself, the ascites becomes considerable; in other cases 

 there is none, but this is rare ; for, besides the obstruction of the ves- 

 sels, consecutive disease of the peritonaeum causes ascites. Gastric 

 and intestinal catarrh, which often complicate cancer of the liver with- 

 out the stomach or intestines being affected with cancer, are to be 

 regarded as due to the obstruction of the circulation. The spleen is 

 rarely enlarged, perhaps because the hydraemia favors the early occur- 

 rence of dropsy, and the pressure of the dropsical fluid interferes with 

 the swelling of the spleen. The same is true of icterus as of ascites. 

 Compression of the large bile-ducts causes partial obstruction of bile 

 and moderate jaundice ; but, from the gall-ducts that are not com- 

 pressed, sufficient bile flows into the duodenum to color the faeces nor- 

 mally. If the ductus choledochus be compressed, however, the obstruc- 

 tion of bile becomes general, the icterus great, and the faeces are col- 

 orless. Lastly, the jaundice and discoloration of the faeces occasion- 

 ally depend on catarrh of the gall-ducts In more than half of the 



