724: DISEASES OF THE LIVER. 



nosis ; for in closure of the portal vein the liver never acquires the 

 size and hardness it does in the first stage of interstitial hepatitis, 

 while it subsequently shrinks in both diseases, but a great and sud- 

 den decrease in size renders cirrhosis probable. Frerichs insists on 

 the more sudden occurrence of symptoms of congestion in obstruc- 

 tion of the portal vein ; ascites becomes very marked in a few days, 

 and after tapping returns quicker than in other diseases. 



Where the trunk of the portal vein is obstructed there is no 

 certainty of a collateral circulation ever being established ; and 

 when death results, it may be after some months, from dropsy, in- 

 testinal hemorrhage, peritonitis, cholemia, etc. 



The suppurative form is rare, and resembles suppurative hepa- 

 titis ; it is usually secondary to peritonitis, perityphlitis, splenitis, 

 ulceration of the intestines, etc. ; it is mostly accompanied by fever, 

 repeated chills, and sweating. There are usually emboli in the liver, 

 and often in the lungs ; these quickly cause suppurative hepatitis, 

 and compression of the gall-ducts often causes icterus. Enlarge- 

 ment of the spleen, which is rarely absent, may be due to splenic 

 congestion or to general blood-infection. This form is always more 

 quickly fatal than the first. 



Diagnosis of suppurative pylephlebitis is only possible under 

 very favorable circumstances and prolonged observation. If there 

 are pain and swelling of the liver with icterus, we may be doubtful 

 whether they are duo to disease of the portal vein itself, or to an 

 embolus in it from some peripheral suppuration. It is then impor- 

 tant for the diagnosis to find some certain signs of portal conges- 

 tion, such as ascites, gastric or intestinal hemorrhages ; when we 

 conclude that the portal vein is implicated, we have to decide 

 whether it has caused the hepatic abscess or the reverse. Physical 

 examination of the abdomen gives no reliable sign of disease of the 

 portal vein, nor can we rely on the so-called characteristic pain be- 

 tween the ensiform cartilage and navel. 



5. P. 689, 



Even normally there are deposits of fat in the liver-cells, which 

 vary with the nourishment and consequent amount of fat in the 

 blood. Complete absence of fat-globules, as occurs in diabetes, may 

 be regarded as morbid. 



Fatty liver, from its slighter resistance, escapes recognition on 

 palpation more readily than livers enlarged from hyperemia, amy- 

 loid degeneration, cirrhosis, cancer, etc. 



The prognosis as well as the symptoms of fatty liver depends 



