GENERALIZED FIBROID PERIIIEPATITIS may, with great difficulty, be distinguish able from true portal cirrhosis. If the organ can be felt, the rounded character of the edge, the absence of roughness of fine nodulation on palpation, the pres ence of a thickened ()mental mass below the liver, all are in favor of a diagnosis of perihepatitis. As already stated, ac cording to IIale -White, if a patient is able to stand a long series of tappings of the ascitic fluid, the diagnosis is against the existence of an uncomplicated portal cirrhosis, and is in favor either of chronic peritonitis associated with perihepatitis or of portal cirrhosis complicated by chronic peritonitis.
The i-nain points elicited in the pre ceding pages with regard to portal cir rhosis and its diagnosis are the follow ing:— 1. That the small size of the organ is by no means the main diagnostic feature of this condition. Only in advanced cases, and by no means always then, is the organ markedly atrophied. Of far greater diagnostic importance is the de termination of progressive diminution in size of the organ.
2. If the organ be palpable, the recog nition of a finely-nodular, firm surface indicates with relative certainty the ex istence of this condition.
3. Contrary to general opinion, in only about 50 per cent. of the cases in which the autopsy reveals a well-developed con dition of portal cirrhosis is there ascites.
4. Enlargement of the spleen is a much commoner symptom, and this is present in more than SO per cent. of the
cases.
5. Jaundice is present in about 30 per cent. of cases. Such jaundice tends to be transient and to develop after other symptoms have been present some little time.
6. From the very onset of the condi- , tion gastric and intestinal disturbances form a prominent feature in the disease.
1 7. The progressive emaciation and weakness are also characteristic, and with this may be associated a peculiar, sallow, slightly-earthy complexion.
8. A urine free from sediment (mainly of urates) is against the diagnosis of cir rhosis; while the presence of increased qnantities of urobilin is, in the presence of other symptoms, in favor of such a diagnosis.
Of other conditions affecting the liver which may be confounded with cirrhosis are to be mentioned cancer, thrombosis of the portal vein, senile or marantic atrophy of the liver, and cyanotic indura tion.
Of these, PORTAL THROMBOSIS may oc cur as a complication of cirrhosis. Mere this occurs in the absence of cirrhosis the main distinguishing feature is the rapid development of the ascites and its rapid. return after tapping. At the same time, such thrombosis is secondary to disease of other abdominal organs, more fre quently of the intestinal tract, and the symptoms proper to such disease will have preceded the development of ascites.