Morbid Anatomy.—The liver is large, smooth, and soft. It may weigh ten or twelve pounds. The edge is thick and rounded. The deposit of fat begins in the cells at the periphery of the lobule, and in time distends them. It can be extracted from the cell with ether, leav ing the cell shrunk.
The specific gravity of the liver is re duced, so that the whole organ floats when placed in water.
Prognosis.—This will depend on the cause. If the condition that leads to the deposit of fat in the liver is relieved the further deposit of fat will cease and the hepatic cells will gradually be restored to their normal condition.
Treatment.—Treatment should, there fore, be directed to the cause of the con dition. In the obese there should be a careful regulation of diet, with a view to lessening the formation of fat while sus taining the strength. Habits of early rising and active exercise should be en couraged, care being taken not to induce overfatigue, especially if the heart shows signs of weakness, as it often does from fatty infiltration or degeneration. Water should be freely taken on an empty stom ach, and occasional purging resorted to.
Little, if any, alcoholic stimulants, espe cially beer, should be allowed. If suffi cient active exercise cannot be taken, massage and resistance movements will, to a great extent, supply its place.
In the ancemic form of fatty liver, such as occurs in pulmonary phthisis, the treatment should aim at improving the general condition without regard to the liver.
Fatty Degeneration. — This results from poisoning of some form, as in acute yellow atrophy, in which the liver changes are typical of fatty degeneration.
Inflammation of the Bile-passages and Gall-bladder (Angiocholitis or Cholan gitis and Cholecystitis).
Definition.—This consists in an in flammation of the biliary tract. It may affect the common bile-duct and all its branches or any part of them, the cystic duct, or the gall-bladder.
Symptoms. — Since catarrhal cholan gitis nearly always follows gastro-enteric catarrh, the usual acute dyspeptic symp toms precede those due to the disease of the bile-ducts; such as anorexia, belch ing of gas, epigastric distension, nausea, vomiting, and constipation. These symp toms may, however, be very mild, or most of them may be absent, and jaun dice be the first symptom noticed. The
jrundice deepens rapidly, but is always of a bright-yellow tint, never the green or bronzed hue of that due to malignant disease. The stools are clay-colored and the urine contains bile-pigment. The temperature may be slightly ele vated. The pulse is usually normal, but may be slow, being only 40 or 50 to the minute. A dull, heavy, sleepy condition may be present. The liver is sometimes enlarged and palpable below the costal margin.
If the catarrhal inflammation is con fined to the gall-bladder the cystic duct usually beconics obstructed by pressure of the bladder-contents on the outlet. No jaundice occurs, or any of the fore- II going symptoms, except a sense of presz tire and sensitiveness at the scat of the gall-bladder. When distended, it may, if the abdominal wall is lax and not too thick, be felt as a pear-shaped mass ad herent to the liver and moving with it.
In suppurative cholangitis the symp toms are usually severe, but may be latent, especially if the disease occurs in the course of an acute infectious disease. There is, in most cases, a previous his tory of gall-stones. The patient nsually suffers from irregularly recurring chills, with fever and sweating, the temperature rising to 104° F. or more. There is swelling and tenderness of the liver. Jaundice is always present, but more variable than in the catarrhal variety; it may be intense. Leucocytosis occurs and is suggestive of the condition. Later the case presents the appearance of a well-marked general pyTmia with ema ciation and weakness.
In chronic catarrhal angiocholitis the symptoms may be very characteristic. The jaundice may vary if the degree of obstruction alters, as it often does when a (rail-stone is situated in the diverticu lum of -Veer, where it may act as a •'ball-valve," producing complete ob struction as it moves into the outlet of the duct, and, again, allowing bile to pass as it moves back into the diverticu lum. In chronic angiocholitis there are often recurrent attacks of fever with chills and sweating, the so-called inter mittent hepatic fever. Such cases may have a history extending through some years. It is probably to this class belong the cases regarded as suppurative cho langitis with a prolonged history and ultimately terminating in recovery.