108 DISEASES OF THE DIGESTIVE APPARATUS 



Stagnating hypcripmia of the liver may be caused by defective 

 valvular action of the heart or a weakened condition of that organ; 

 in the later stages of acute diseases, such as the lungs; in cases where 

 large numbers of the lung capillaries become atrophied and useless; in 

 great pleuritic exudations; in extensive induration of the lungs, with 

 emphysema; and also in dropsy of the pericardium. 



Pathological Anatomy. — The liver is greatly enlarged and very hard; 

 when a section is cut in it, the blood seems to run out of it in large quanti- 

 ties. This blood generally is dark colored, especially if the stagnation 

 has been prolonged. The liver tissue may be spotted, the spots cor- 

 responding with the central veins which are located in the centre of the 

 lobules; or we may notice peripheric zones (nutmeg liver) alternating 

 with lighter colored spaces. The liver gradually becomes smaller and its 

 surface dull, and later on the parenchyma finely granular. 



Clinical Symptoms. — It is not possible to make a positive diagnosis 

 of this disease, we can only suspect it by great tenderness on pres- 

 sure in the region of the liver, and perhaps slight icterus, ascites may 

 accompany hyperaemia of the liver; but as these symptoms may all be 

 caused by catarrh of the bowels, it is well to be very cautious before 

 making a positive diagnosis. 



Therapeutics. — Remove the cause if possible, regulate the diet and 

 administer saline laxatives. 



Inflammation of the Liver (Hepatitis). — This disease appears in 

 three forms — parenchymatous, interstitial and purulent. 



1. Parenchymatous hepatitis accompanies various infectious dis- 

 eases, probably in the same way that we see congestion of the liver. 

 It is seen as a symptom of acute phosphorus-poisoning, also as an ac- 

 companiment of certain infectious diseases. 



The pathological-anatomical alterations are as follows: Enlarge- 

 ment, softening, and a friable condition of the tissue, which breaks 

 easily to the touch. At first it is dark red, but later on it becomes a 

 yellowish clay color, due to the enlarged acini; the capsule is dull and 

 thickened, due to a certain amount of perihepatitis. If the disease 

 lasts any time, the volume of the liver is greatly lessened. 



The clinical symptoms are, evidences of catarrh of the stomach, 

 pain on pressure in the region of the liver, icterus, and the liver is found 

 on palpation to be enlarged. 



2. Interstitial Hepatitis (Cirrhosis of the Liver) (Hardening of 

 the Liver). — This disease originates from causes that are at present un- 

 known. There is no doubt that certain chemical or bacterial poisons 

 which originate in the intestines have some part in causing this disease. 

 Friedberger and Frohner surmise that it is caused by valvular disease 

 of the heart. 



