HEPATITIS 239 



no characteristic symptoms. The temperature is variable, 

 usually slightly elevated; chills may be present. Examina- 

 tion of the blood often reveals leukocytosis, which is not 

 always present, especially in chronic, well encapsulated 

 abscesses. The urine is concentrated, highly colored, specific 

 gravity increased, with an abundant deposit of urates and 

 uric acid. When there is much destruction of the liver tissue 

 the amount of urea is diminished, and albumin is often 

 present. 



Spontaneous rupture of the abscesses often takes place, 

 especially in those cases resulting from traumatism, causing 

 serious symptoms to suddenly develop. As in most cases 

 the rupture occurs into the peritoneal cavity, a generalized 

 peritonitis follows which soon leads to death. 



Diagnosis.— An accurate diagnosis is usually quite difficult. 

 The most suggestive signs are progressive enlargement and 

 tenderness of the liver, jaundice, chills and fever, leukocytosis, 

 and the consideration of the etiological factors. 



When an abscess is suspected an accurate diagnosis .can 

 be made with safety (especially in the dog) by making an 

 explorative laparotomy. 



Prognosis.— Abscesses of the liver even in the single supra- 

 hepatic form should always be considered unfavorable. 

 The small multiple abscesses are almost always fatal, death 

 occurring in one to two weeks. 



Treatment. — The early indications in the treatment are 

 surgical. Under general anesthesia and strict antiseptic 

 precautions, an explorative laparotomy should be per- 

 formed. The incision in the abdominal wall should be 

 made large enough to admit of a careful and free examination 

 of the liver. Should the abscess be suprahepatic, or single 

 in the liver substance, that portion of the liver is carefully 

 brought out through the incision. It is very important that 

 the liver be carefully manipulated to prevent rupturing the 

 abscess. Should the abscess be of large size, it is often 

 advisable to aspirate most of the contents before it is manipu- 

 lated to prevent rupture of the sac and also to facilitate 

 its withdrawal through the abdominal incision. When the 

 affected portion of the liver is withdrawn, it should be sur- 



