HYPERTROPHIC OR BILIARY CIRRHOSIS. 397 



the organ may be noted ; a network of connective-tissue bands, 

 running in all directions extensions from the thickened 

 fibrous capsule of Glisson is seen, which divides the paren- 

 chyma into small islets corresponding in size to the surface- 

 granulations. The yellow bile-stained groups of lobules and 

 pink interlobular fibrous tissue gives the cut surface a mot- 

 tled and granular appearance. 



Microscopically, the chief characteristic is the chronic diffuse 

 inflammatory hyperplasia of the interstitial connective tissue, 

 and resulting atrophy of the parenchyma of the liver, at least 

 a numerical atrophy, as the hepatic cells which remain in the 

 projecting granulations or nodules frequently undergo a com- 

 pensatory hypertrophy to twice their normal size. As long 

 as the hyperplasia is in excess of the atrophic changes the 

 organ is enlarged. As the newly formed connective tissue 

 becomes more sclerotic, compressing the cells of the lobules 

 and the vessels from which they obtain their nourishment, 

 the atrophy which is produced, both by direct pressure and 

 interference with the blood-supply, sooner or later results in 

 a reduction in the size of the organ. The yellow appearance 

 of the nodules is in part due to the obstruction, produced by 

 the hyperplastic connective tissue, to the discharge of bile 

 from the bile-capillaries into the interlobular ducts; and in 

 addition there is generally an excessive accumulation of fat 

 in the liver-cells, resulting not only from the lessened blood- 

 supply, but also probably from the fact that there are fewer 

 cells in which to store the fat normally present in the liver. 



The pathological changes begin as a round-celled infiltra- 

 tion of the interlobular connective tissue. Through the fur- 

 ther development of these migrated and proliferating cells 

 dense fibrous tissue is formed, the cellular character of which 

 is finally almost entirely lost, so that it comes to resemble 

 cicatricial tissue (Fig. 185). The result of the obliteration of 

 the portal capillaries is engorgement of the portal circulation, 

 the most important aspect of which clinically is the enormous 

 serous transudation into the peritoneal cavity, which is called 

 ascites. 



Hypertrophic or biliary cirrhosis differs from the ordinary 

 atrophic variety, in that the connective-tissue hyperplasia, 

 which is interlobular or monolobular, does not have the same 



