340 T/ic Liver 



which then lodge in the liver and become infecting foci. Sometimes 

 it follows surgical operations upon the lower bowel, or simple ulcera- 

 tions of the stomach or small intestine. 



Jaundice is the result of the absorption of bile by the efferent 

 vessels of the liver. The vena portae carries up the elements of bile, 

 and the liver prepares that fluid from them. Thus, if the bile cannot 

 flow out into the intestine, as when a calculus blocks the hepatic or 

 common bile-duct, or a tumour presses upon them, the intra-hepatic 

 tension becomes so great that the blood-staining fluid has to be carried 

 away by the branches of the hepatic veins. The student is apt to 

 think that jaundice is always the prominent symptom of liver-diseases ; 

 but when the bile-secreting cells are destroyed, as in certain cases of 

 abscess and cancer, there is too little bile formed ; and if it be possible 

 to imagine malignant disease destroying all the liver-cells, it is certain 

 that no jaundice could occur, for no bile would be formed. 



The hepatic circulation and the secretion of bile are under the 

 influence of the pneumogastric and sympathetic filaments, and when 

 the central nervous system is upset, not only may digestion be im- 

 paired or lost, but jaundice may occur. As an example of this, refer- 

 ence may be made to the brief clinical report of the lady in ' Twelfth 

 Night,' who, concealing her too great love, pined in thought and was, 

 in consequence, overcome by a ' green and yellow melancholy.' 



The arterial supply is chiefly from the hepatic division of the 

 cceliac axis, whose branches pass with ramifications of the portal 

 vein, hepatic duct, and Glisson's capsule between the lobules. A small 

 quantity of blood also comes from the right phrenic. 



The blood brought by the vena porta: and by the hepatic artery 

 is conveyed into the vena cava by the hepatic veins ; the descent of 

 the diaphragm at each inspiration compresses the liver and helps to 

 empty these capacious and valveless veins. 



Of the lymphatics, some pass out by the transverse fissure to 

 glands between the layers of lesser omentum, whilst the superficial 

 ones join the anterior and posterior mediastinal glands. 



The nerves are sympathetic filaments from the solar plexus, and 

 twigs of the pneumogastric and phrenic nerves. The pain in the 

 shoulder in hepatic congestion has been explained on p. 339. 



The grail-bladder is pear-shaped ; its larger end reaches to the 

 sharp edge of the right lobe of the liver, just behind the ninth costal 

 cartilage. Its upper surface adheres to the liver ; the under surface 

 is covered by peritoneum, and overhangs the pylorus or the beginning 

 of the duodenum, and the hepatic flexure of colon. The stalk of the 

 pear extends upwards and backwards to the transverse fissure, where 

 it joins the common hepatic duct to form the common bile-duct, 

 which opens with the pancreatic duct into the second piece of the 

 duodenum. When a gall-stone blocks the cystic, or the common 

 bile-duct, the gall-bladder becomes distended, and may form a 



