96 THE ALIMENTARY TRACT. 
Describe acute hepatitis. 
It is a suppurative inflammation with the production of immense 
numbers of pus-cells in cireumscribed areas. The abscesses formed are 
small but may coalesce, forming larger ones. The exciting cause may 
be the pressure of tumors, or injury, or the presence of bacteria. 
What are the changes in cirrhosis of the liver ? 
It is a productive inflammation. There is an increased growth of 
connective tissue especially along Glisson’s capsule between the hepatic 
lobules. There may be an increased growth of connective tissue 
between the cells composing the lobules, and also there may be numer- 
ous leucocytes in the bloodvessels. Cylindrical ducts are frequently 
found in the new connective tissue which resemble bile ducts. The 
hepatic lobules are compressed and there may be an amyloid or fatty 
degeneration of the liver cells. ‘The most common secondary change 
is an ascites. The hemorrhoidal and vesical as well as the cutaneous 
veins about the umbilicus are frequently dilated. The spleen is fre- 
quently enlarged, and the stomach and intestines are sometimes the seat 
of hemorrhages. 
What are the changes in syphilitic hepatitis ? 
The growth of new connective tissue may be more diffuse, or 
may appear the same as in the preceding form. In some cases small 
gummata are scattered through the liver. 
Describe tubercular hepatitis. : 
This inflammation follows the same general type as do other tuber- 
cular processes, and may occur as miliary tubercles or as larger nodules. 
These foci of inflammation undergo the same degenerative changes as 
other tubercular inflammations. The affection is usually secondary 
and may be associated with a cirrhosis. 
What tumors have been found in the liver? 
Fibromata, lipomata, adenomata, angiomata sarcomata and car- 
cinomata, 
PANCREAS. 
What inflammatory changes are seen in the pancreas ? 
Parenchymatous pancreatitis with a swelling and degeneration of the 
cells of the parenchyma. Chronic interstitial pancreatitis or cirrhosis, 
tubercular and syphilitic pancreatitis. These inflammations cause the 
usual changes, each of its own particular type. 
