DISEASES OF THE LIVER. 



Of the diseases of the liver that have already been described, some, 

 such as fatty and lardaceous liver, never induce icterus, as they never 

 cause compression of the bile-ducts; others, such as cirrhosis, cancer 

 and hydatids, sometimes induce biliary obstruction, sometimes they do 

 not* Where the bile-ducts are compressed, if the retention of bile be 

 only partial, its reabsorption and the icterus do not become excessive ; 

 the unimpeded flow of bile from the bile-ducts, which are not obstruct- 

 ed, gives some color to the faeces. The case is different when the 

 ductus hepaticus or choledochus is compressed by tumors of the liver 

 or plugged up by hydatids ; then the biliary obstruction becomes ab- 

 solute, the icterus very marked, and the faeces totally discolored. 



Total retention of bile, with its results, is much more frequently 

 caused by disease or compression of the excretory bile-ducts than by 

 disease of the liver. This condition will occupy us in the next sec- 

 tion ; in this chapter we shall only speak of the changes induced in 

 the liver by biliary obstruction, and of its results. 



ANATOMICAL APPEARANCES. The size of the liver may be in 

 creased by general excessive biliary obstruction, just as by decided 

 congestion of the blood ; but the swelling rapidly subsides as soon as 

 the obstruction to the flow of bile is removed. The form of the liver 

 is not altered by the enlargement. In high grades of the affection, 

 the larger as well as the smaller bile-ducts appear dilated and dis- 

 tended with bile. The color of the liver is deep yellow, and, in the 

 highest grades, olive green ; it is not usually regular, but mottled. 

 According to Frerichs, on microscopical examination, we sometimes 

 find the entire contents of the li ver-cells pale yellow, sometimes there 

 is a deposit of fine granular pigment, particularly in the vicinity of the 

 nuclei. After the disease has lasted some time, the li ver-cells contain 

 firm collections of pigment in the form of yellow, reddish-brown, or 

 green rods, spheres, or angular fragments. The cells containing pig- 

 ment lie chiefly in the vicinity of the central veins. 



Even when the obstruction to the excretion of bile is not removed, 

 the previously-enlarged liver may become smaller, and may even be 

 reduced below its normal size ; at the same time it acquires a dark- 

 green or even black color, and loses its consistence, becoming soft and 

 capot. In such cases the nutrition of the liver-cells has been impaired 

 by compression of the afferent blood-vessels, and by pressure from the 

 distended bile-ducts, perhaps also from the pressure of the bile collect- 

 ed in the cells. On microscopical examination, we find most of the 

 cells broken down into a fine granular detritus, while some still con- 

 tain pigment. 



On autopsy of jaundiced bodies, collections of bile-pigment may bo 

 found in almost all the organs and fluids. Besides the characteristic 



