As a consequence of chronic inflammation, the serous membrane is sometimes thickened and opaque and dense in its consistence ; at other times it is less resisting than natural and easily broken.
Depositions are occasionally found in the subserous tissue of the liver as a result of chronic inflammation of the serous membrane. They consist most frequently of an athero matous substance, and occasionally of thin plates, having a cartilaginous density and appear ance. The gall-bladder is not unfrequently thickened in its coats by the deposition of fat, of tuberculous, or of calcareous substance. The latter has been described as ossified gall bladder.
2. Diseases of the mucous membrane.—In flammation of the mucous membrane of the liver is acute or chronic, and is more frequent than that occurring in the serous membrane.' Being continuous with the mucous membrane of the duodenum, the lining of the biliary ducts and gall-bladder is constantly subject to sources of irritation from disorders of diges tion, improper aliment, and stimulating sub stances taken into the alimentary canal, or from any cause giving rise to undue action in the intestinal mucous surface. Almost all the chronic diseases of the liver are to be referred to this prolific source, and it is also by means of this direct continuity that many of the thera peutic remedies exert their alterative influence. The effects of inflammation on the mucous membrane, are a. Thickening.
b. Softening.
c. IImmorrhage.
d. Suppuration.
e. Deposition.
a. Thickening of the submucous tissue is the most frequent consequence of irritation of the mucous membrane ; the calibre of the ducts is in this way diminished ; actual stricture and obliteration of the tubes occurs, and the bile, at first hut partially impeded, becomes alto gether obstructed. The gall-bladder is some times enormously thickened, particularly where the irritation is kept up by the presence of se veral or a single large gall-stone. The coats are usually very much condensed and con tracted, and their structure appears lost ; occa sionally they are dilated. In a case which occurred to Amussat,* wherein the ductus corn munis choledochus was obliterated, and the gall-bladder and ducts were very much distend ed, the middle coat presented all-the characters of muscular fibres.
b. Softening of the mucous membrane may occur in the biliary ducts, but more particularly in the gall-bladder, and from the same causes which produce it in other mucous surfaces. I have seen two instances in the gall bladder in which patches of the surface were converted into a softened pulp, which gave way upon the distension of the sac with air.
c. Hrmorrhage.—The gall-bladder has been observed filled with blood, having its source in the capillaries of the mucous membrane. In these cases intestinal had occurred before death, and upon examination, no conges tion or lesion could be found in the mucous membrane other than that which was seen in the gall-bladder.
d. Pus has likewise been found in the gall bladder, and in the larger hepatic ducts, some time pure, but generally mingled with the bile.
e. Abnormal deposits in the submucous cel lular tissue are occasionally seen. They are most frequent in the Tall-bladder, and consist generally of calcareous accretions.
3. Disorders of the venous circulation. Under this head I have to describe the various forms of congestion of the liver. It has been customary hitherto to consider hepatic con gestion as a pathological condition, and in compliance with that custom I have given it a place under the above title, although I shall have occasion to shew that it is not in itself a disease, but the mere result of diseased actions occurring in other parts, and wholly dependent upon the peculiar anatomical structure of the organ. Andral, in his excellent work on pa thological anatomy, observes, " L'hyperemie du foie est un des etats morbides que presente le plus frequemment cet organe. Tante:it cette hyperemie est generale, alors he foie est partout d'un rouge uniforme ; son volume est aug mente et sa consistance peu change, lorsque l'hyperernie est simple. Cette hyperemie est souvent partielle ; alors, en un certain nombre de points, on trouve comme des taches rouges variables en forme et en grandeur, qu'entoure un parenchyme plus pale.