Literature contains 9S cases of mov able liver. An injury, a ,=...evcre fall, or heavy lifting, or, in a few instances, the development of a malignant growth in the liver, is the usual cause. The prom inent symptoms are distress and feeling of weight in the region of the liver, often considerable tympanites and in testinal indigestion, alternating consti pation and diarrliort, and marked nerv ous symptoms (headaches, restlessness, hypochondriasis, etc.). Tight bandaging with proper tonic treatment usually af fords relief. Few attempts at operative interference have been made. J. H. Carstens Pour. Amer. Med. Assoc., May 17, 1902).
Congestion of the Liver.
This pathological condition does not constitute a disease of itself, but is always associated with disease elsewhere, especially of the gastro-intestinal tract and the heart. The liver is particularly prone to disturbance of its circulation, because, in the first place, of its large blood-supply and, in the second place, on account of its relationship to the gas tro-intestinal tract on the one side and to the heart on the other. As the bull: of its blood-supply is conveyed to it by the portal vein, it will share in all the conffestive disturbances of the orffans drained by ale portal system. The in creased inflov, of blood resulting from these disturbances constitutes an active congestion of the liver. On the other ferent directions gave only blood, and this was allowed to flow till two or three ounces had been abstracted. The wound was then closed with iodoform gauze and collodion. There was no after-hmorrhage. From the next day the patient was greatly relieved, the liver decreased in size, and the patient was cured. Personally considered as a simple and innocuous procedure. Beni linger (Brit. Med. Jour., Feb. 2, 1901).
Passive Congestion of the Liver.
—Passive congestion of the liver (nutmeg liver, cardiac liver, red or cyanotic atrophy of the liver), is a pathological condition caused by ob struction to the outflow of blood from the liver.
SYMPTOMS.—The symptoms are chiefly those of the condition of the heart and lungs causing the hepatic congestion. There may be a sense of weight and full ness in the right hypochondrium, ag gravated by external pressure, deep in spiration, and by lying on the left side.
Enlargement of the liver is one of the chief signs and is usually best demon strated by palpation. When large, the liver can often be delimited by inspec tion. Percussion is usually unreliable on account of distension of the intestines.
Pulsation of the liver is often present in severe cases; it disappears when the induration develops and the heart be comes weak. I have seen it persist in cases of initial stenosis until within a few weeks of death.
Gastro-intestinal symptoms are always present. They result from the portal congestion induced by the hepatic ob struction. They consist in disturbed digestion, and, often, hfcmorrhoids.
Ascites is frequent. In the early stage it occurs as a part of general dropsy. Later, when the liver becomes indurated it is increased by the portal obstruction. Jaundice is usually present, and is a definite symptom in the advanced cases. It is probably secondary to the gastro duodenal catarrh. It is usually most marked in the cardiac cases, and, with the cyanosis existing in such cases. it causes a peculiar dusky-green tint, of tne face especially.
ETIOLOGY.—The causes leading to this condition are such as lead to interfer ence with the free flow of blood through the heart, and include, therefore, all changes in the heart and lungs which tend to render the right ventricle in competent. Of the cardiac conditions the most common is mitral disease, espe cially stenosis; but all heart-lesions, whether of the valves or of the sub stance of the heart, tend to impede the venous flow by ultimately overtaxing the right heart. Such diseases of the lungs as emphysema, asthma, chronic bron chitis, etc., are also frequent causes of dilatation of the right heart, and thus lead to obstruction to the outflow front the liver.
Deformity of the spine, pleuritic effusion, aneurism, and intrathoracie tumors may obstruct the flow of blood through the heart and lungs or press upon the vena cava directly.
Occasionally a local lesion, as peri hepatitis, may compress the hepatic veins themselves or the vena cava and ob struct the outflow from the liver.
Monnin ANATom-Y.—In the early stage there is great engorgement of the hepatic veins and their intralobular branches and capillaries. The liver may become much enlarged, its lower border extend ing in time to, or even below, the um bilicus. If the obstruction be removed before organic changes have occurred in the liver, the vessels rapidly empty them selves, and the liver returns to its nor mal size. Even after long-continued congestion the liver may be much smaller afttr (loth. unit.ss escape of the blood from the hepatic veins is prevented by ns.on of the right ventricle.