Symptorns.—There may be none, the condition being discovered accidentally. On the other hand, they may be severe, consisting of pain, tension, and drag,ging sensation in the normal hepatic region. Jaundice, sometimes severe, has been present in a few cases, probably due to tension or kinking of the common bile duct. Ilypochondriasis is apt to de velop. The diagnosis may be difficult. Other masses—as carcinoma of the omen tum, tumors of the right kidney, etc.— have been supposed to be movable liver. Of the greatest diagnostic importance are the form of the tumor, its mobility, the possibility of reducing it to its normal position, the tympanitic note obtainable over the normal hepatic region before such reduction, and the dull note later.
Case in which diag,nosis of tumor of large intestine, with atrophic cirrhosis, was made. Laparotomy showed liver entirely prolapsed and suspensory liga ment entirely destroyed. Convex surface freshened and sutured in contact with parietal peritoneum. Two years and nine months later patient seen. Liver fixed to abdominal wall by extensive adhesions. Lanelongue and Fagnet (La. Sem. MCAL, Aug. 7, '95).
Iln a diagnosis of floating liver percus sion is of some value in determining dis placements, bnt palpation is much more important if done by using the palmar surface of the fin,g,ers of the entire hand to exert strong pressure. This should begin at the right border of the ribs, where a portion of the liver-surface is. always found. From this point it should pass downward and forward, as far as the umbilicus. Sometimes the lower border can be recognized as low as the umbili cus, and in these eases it is often possible to palpate the convex superior surface by inserting the fingers deeply between the liver and the right costal arch. The re cumbent and upright position should both be used, as in eases of highly developed mobility of the liver the organ may slip back into its normal position as the pa tient lies down. Max Einhorn (-Med. Record, Sept. 16, '99).
Etiology. — Acquired displacements may be due to pressure upward by as citic effusion, abdominal tumors, and flatulent distension, and downward by thoracic or subdiaphragmatic accumula tions. These are, however, scarcely en titled to be included among liver-dis placements. The movable or wandering, liver is of more interest. Tbe condition is not very rare.
Graham, in the Transactions of the Association of American Physicians, vol ume x, has tabulated sixty-six cases, all of which have been reported during the last thirty years. It is found chiefly
in females who have borne several chil dren. The displacement is favored by a lax abdomen, tight lacing of the lower part of the chest, and sudden muscular strain. To render these causes effective it is probably necessary that the liga ments supporting the liver be abnormally long or weak: a condition that is doubt less congenital.
Treatment. — Treatment is not very satisfactory. A suitable bandage may relieve symptoms. The liver cannot be retained in the normal position by it, but furtber prolapse may be prevented and the liver so far supported as to re lieve the pain and dragging. In a few cases the liver has been successfully sutured in position.
Case of fixation of movable liver. Lagenbucli incision was made. The serous coat of the liver and corresponding surface on the parietes behind the costal cartilages were scratched with the knife so that adhesive exudation might be en couraged. Three No. 3 silks were passed to the depth of half an inch into the sub stance of the liver, and brought out be tween the cartilages of the false ribs; finally they were tied. Three more silks were employed to fix the liver to the upper part of the incision; they included peritoneum arid muscle. A year and ten months later the patient was in good health. Blanc (Loire Med., Dec. 15. '97).
The treatment of floating liver re sembles, on the whole, that of enteropto sis, and especially that of floating kid ney. Here, also, the chief measure is the application of well-fitting abdominal bandages, whieli support the lower half of the abdomen in an upward direction, and increase the tension of the abdominal walls. A special pad for pressing, the liver still farther back is of as little service here as in floating kidney. Gen eral massage and hydrotherapentic meas ures, which have for their aim the strengthening of the organism, arc of high value. In the front rank of all these methods is an appropriate diet. The patient should be directed to take as much food as other healthy persons, and a little more. If besides the ordinary diet an additional quarter of a pound of butter is ordered daily, much will be accomplished by tbis means alone, and most of the patients will show an in crease in weight. Gymnastic exercises in the open air, and, in cases with a tend ency to constipation, special exercises for the abdominal muscles, are likewise of value. Operative procedures are per sonally opposed. Max Einhorn (CBI" Jour., Oet. 4, '99).