226 DISEASES OF THE LIVER 



etiological factors, which are: Catarrhal inflammations of 

 the mucous membrane of the stomach and duodenum, the 

 inflammation being sufficient in a number of cases to close 

 the orifice of the duct by the swelling of the mucosa; foreign 

 bodies in the duct producing irritation and swelling; parasites; 

 gall-stones; inflammatory conditions of the duct; neoplastic 

 formations in the duct; cicatricial stenosis of the duct; 

 compression of the duct from without by tumors on or in the 

 stomach, intestine, lymph glands or mesentery. Adhesions 

 after operations (gastrotomy), fecal accumulations, aneu- 

 rysms of the arteries, interference with the outflow of bile by 

 torsion of the ducts which sometimes occurs during preg- 

 nancy, tumors in the abdomen, etc.; localized inflammatory 

 processes in the liver (abscesses), and primary and secondary 

 new growths in the liver are further etiological factors. 

 Obstruction of the bile ducts causes the bile to be retained 

 in the liver, the hepatic cells continue to secrete bile and to 

 convert into bile pigments the free hemoglobin brought 

 •thither. From the resulting accumulation the pressure in the 

 smaller biliary capillaries increases causing them to rupture 

 into the lymph spaces to be. eventually carried through the 

 lymph vessels to the general circulation. 



(b) Disturbance in the function of the liver cells, diverting 

 the bile from the biliary capillaries to the lymphatics or blood- 

 vessels producing icterus by hemolysis or hemohepatogenous 

 icterus. This form of icterus occurs most commonly from 

 the following: In many infections, such as the different 

 types of infectious icterus; distemper (partly obstructive, 

 by producing a catarrhal inflammation of the duodenum); 

 pyemia; in the different forms of intoxications, poisonings 

 by ptomaines, mineral poisons (phosphorus, arsenic, coal-tar 

 products, etc.); pernicious anemia; hemoglobinemia; disturb- 

 ance of the circulation, such as passive congestion; some nerv- 

 ous diseases, whereby the function of the liver is modified. 



Pathology.— Yellow discoloration of all the organs and 

 tissues by the bile pigment with the exception of some of the 

 nervous and corneal tissue, characterizes the postmortem. 

 The discoloration varies from a slight tinge of yellow to a 

 deep greenish yellow, depending upon the amount of bile 



