394 DISEASES OF THE GASTRO-TNTESTINAL TRACT. 



rapid diminution of the liver to one-half, even one-quarter its 

 natural size, as the result of extensive degenerative changes 

 of the parenchyma. This reduction in size affects mainly its 

 vertical diameter, the organ being flattened out against the 

 spinal column to a few centimetres in thickness, and almost 

 concealed by the diaphragm and superimposed coils of intes- 

 tine. It is ochreous-yellow in color, soft and flabby, in 

 places almost pulpy ; or the yellow alternates with relatively 

 firmer red patches so-called red atrophy giving the surface 

 a mottled appearance, especially on section. The capsule is 

 wrinkled to such an extent that it can be picked up by the 

 fi ngers. 



Microscopically, the outlines of the lobules are indistin- 

 guishable. The liver-cells are in various stages of degenera- 

 tion or necrosis ; in the yellow areas their outlines may be 

 preserved, but their protoplasm contains numerous fat-globules 

 and granules of yellow pigment ; or the cells may be entirely 

 replaced by a detritus of yellow pigment ; and irregular col- 

 lections of fat- globules, only the connective- tissue framework 

 of the liver remaining. In the red areas the cells are entirely 

 wanting, the tissue being colored by an infiltration with hema- 

 togenous pigments. 



INFLAMMATIONS. 



Acute purulent inflammation (Fig. 184) of the liver results 

 in the formation of one or more circumscribed collections of 

 pus. The avenues open to infection by the invasion of va- 

 rious micro-organisms are numerous : the hepatic artery, 

 portal vein, bile-duct, arid the patent umbilical vein in infants ; 

 or infection may extend from neighboring organs through the 

 lymphatics. The bacillus coli communis, staphylococci, and 

 streptococci are the organisms which have been most frequently 

 found associated with these purulent inflammations of the 

 liver; in cases following dysentery the amoeba coll is fre- 

 quently found in the pus. 



The single large so-called tropical abscess is a very common 

 affection in the torrid zone, often as a sequela of dysentery. 

 It may be associated with the presence of tumors or parasites 

 in other cases. The abscess is generally situated in the right 

 lobe, and varies in size from a man's fist to that of a child's 



