Diseases of the The diseases of the liver may be classified under the following heads: Derangements of the Circulation; Nu tritional and Inflammatory Disease of the Sub stance of the Liver; Tumors; Parasitic Dis eases; Functional Disturbance.
Circulatory Disturbances.— Congestion of the Liver is an increase in the volume of blood in the organ. This may be transient or more or less permanent.
(a) Transient congestion follows the inges tion of food and drink, especially when these are of stimulating quality such as alcoholic beverages, spiced and rich foods. It is also occasioned by circulatory activity, such as ac companies malarial and other fevers and other conditions of systemic excitement. In these cases the increase of blood in the liver is the result of an excessive supply of blood to the organ.
An excess of blood in the liver frequently occurs after a flow of blood, such as that of menstruation, has been stopped, or when, through catching cold or even because of some nervous condition, such flow of blood, or a blood flow that has been caused by hemor rhoids, has been stopped.
(h) Passive congestion is the form in which the outflow of blood from the liver is interfered with. This form is likely to be more or less durable or permanent. Among the causes, most important are diseases of the heart and the lungs, or any other cause of obstruction to the circulation in the thorax.
It is said that malaria is the most frequent occasion of an attack of congestion of the liver and that it occurs most frequently in autumn and in persons of middle age.
Pathological Anatomy.— In active or acute congestion no marked alteration is observed on examination of the organ. In passive conges tion the liver becomes enlarged, and the cen tral veins within the lobules are seen to be in creased in size, while the peripheral parts of the lobule often become light-colored from degen eration of the liver cells. This gives the sur face of section of the organ a peculiar appear ance that this has been well designated ((nutmeg liven)} When passive congestion is long con tinued, the hepatic cells, compressed by the di lated blood-vessels and otherwise disturbed in their nutrition, undergo atrophy, while at the same time some fibrous tissue growth replaces the degenerated hepatic cells, and' the whole organ becomes darker in color from deposit of pigment from the stagnated blood. The result
is that the organ decreases in size, becomes harder and of a darker color than normal. The term cyanotic or red atrophy is given to this condition.
The symptoms of congestion of the liver vary with the kind, the degree and stage of the disease. In acute congestion, such as follows over-indulgence in stimulating food and drink, a sense of heaviness in the region of the liver, and perhaps slight disturbances of digestion with general malaise constitute the symptoma tology. In chronic or passive congestion, such as accompanies heart disease, the symptoms are quite distinctive. The organ increases in size so much that it is easily felt in the upper part of the abdominal cavity and it becomes tender or even acutely painful. Digestive disturbances are very common, partly as the result of the condition of the liver itself and partly as the result of the underlying condition which occa sioned the congestion of the liver. Among these digestive symptoms, loss of appetite, diffi cult and painful digestion, nausea and vomiting are the most conspicuous. When the conges tion of the liver is pronounced, more or less jaundice occurs. This results from the thicken ing of the walls of the biliary ducts and the compression of the finer biliary channels by the swollen state of the organ. In marked cases, the jaundice may be intense; usually it is slight.
In the last stages of congestion of the liver when the organ has undergone cyanotic indura tion, the symptoms may be similar to those of cirrhosis (q.v.).
Treatment—The treatment of congestion of the liver is directed primarily toward the relief of the condition which causes the congestion. In heart diseases, cardiac tonics are important. Sometimes a prompt relief is obtained by vene section. Depletion from the portal circulation by brisk purgation may also be efficacious, and regulation of diet is important as the congested organ is less able to withstand injurious effects of stimulating foods or drink than the healthy liver.