336 The Liver 



overlaps the stomach. Suppuration in it is apt to find escape by way 

 of the stomach, duodenum, or colon. 



The posterior border, thick and rounded, lies against the aorta and 

 the crura of the diaphragm. The two layers of the coronary ligament 

 which pass from* the upper and lower surfaces on to the diaphragm 

 leave this border destitute of peritoneum, and there, in a deep notch, 

 ascends the vena cava. 



The hepatic tissue is extremely friable, and may be ruptured by a 

 blow which leaves no mark upon the surface of the body. As the result 

 of the injury, fatal haemorrhage may occur into the peritoneal cavity, 

 especially from the tributaries of the hepatic veins, which rest wide open, 

 on account of their intimate connection with the surrounding tissue. 

 The portal and hepatic veins are destitute of valves. 



On account of the intervention of the pouch of peritoneum between 

 the liver and the abdominal parietes, leeches applied to the hypo- 

 chondriac region do not abstract blood directly from the liver, but in- 

 directly through the communication between the hepatic and phrenic 

 veins. 



From the front and back of the transverse fissure the peritoneum 

 descends to the stomach as the lesser omentum, and between its layers 

 pass the portal vein (posteriorly), the hepatic duct (to the right), and 

 the hepatic artery (from the left) ; pneumogastric and sympathetic 

 filaments, and lymphatics, also enter the liver through this fissure. 

 These structures are loosely invested with fibrous tissue (Glisson's cap- 

 sule) which, sending offshoots between the lobules, makes a lattice- 

 work throughout the substance of the liver ; the threads of this lattice- 

 work eventually reach, and are connected with, the fibrous capsule of 

 the liver itself, which lies just beneath the peritoneum. 



Cirrhosis. As the result of chronic alcoholic irritation the fibrous 

 lattice throughout the liver becomes swollen, the liver itself growing 

 large and hard, and perhaps tender (hepatitis]. The patient is sick 

 and dyspeptic, and, on account of the flow of the bile from the 

 lobules being obstructed, the colouring matter is absorbed, and he 

 becomes jaundiced. If the irritation be still continued, hypertrophy of 

 the fibrous tissue results, and the subsequent contraction of this tissue 

 entails compression of the lobules and a puckering of the hepatic cap- 

 sule, rendering the surface nodular. Thus the liver becomes contracted, 

 hard, and fibrous, its surface growing rough and irregular. This is the 

 gin-drinker's, or hob-nailed liver ; it is hard and fibrous, and its surface 

 rough or tuberculated. (For the anatomy of the symptoms see p. 337.) 



The substance of the liver consists of polygonal lobules the size of 

 millet-seeds which are composed of closely-packed hepatic cells. 

 The lobules are separated from one another chiefly by the inter- 

 lobular plexus of the vena portae, and by lattice offshoots from 

 Glisson's capsule ; in the contraction which follows the hypertrophy of 

 the fibrous tissue, the peripheral cells of the lobule are the first to 



