Pathological Anatomy.—Two forms of cir rhosis of the liver are recognized. One known as the atrophic, in which the liver is decreased in size; the other, hypertrophic, in which the organ is increased in size. In atrophic cirrhosis (hob-nail liver, granular liver), the organ has an irregular nodulated or granulated surface, the irregularities being caused by the contrac tions of the connective tissue 'which forms the basis of this pathological state of the organ. It is very firm, and on section the increased connective tissue can be recognized in the form of more or less distinct septa interlacing the lobules or groups of lobules of the liver sub stance. The lobules and groups of lobules are compressed by the contracting connective tis sue, and as a result undergo atrophy and de generative change. The connective tissue formation which is characteristic of this form of cirrhosis is found in the interlobular tissues surrounding the terminal branches of the portal vein. Consequently the portal circulation is ob structed, and congestion of the various abdom inal organs whose blood is discharged through this circulation results. When cirrhosis has proceeded for some time, new channels of cir culation may be established, by which the con gestion of the abdominal organs is relieved. There results from this visible enlargement of the veins of the abdominal walls an increased size of the veins in the lower end of the oesophagus and in the rectum.
Hypertrophic cirrhosis of the liver is a form in which the liver is increased in size. The surface is usually smooth and the substance of a uniform character. This is due to the fact that the new connective tissue is uniformly dis tributed within as well as between the liver lobules. This form of disease may be the result of the same causes as the atrophic variety, but is more commonly due to obstructions of the flow of bile. Very commonly interference with the discharge of bile is found in this form, as interference with the circulation of blood is characteristic of the other variety.
Symptoms.—The symptoms of cirrhosis of the liver in earlier stages are very obscure and uncertain, but frequently include a pallor and sallowness with peculiarly muddy complexion. Later interference with the portal circulation causes congestion of the mucous membrane of the stomach and intestines, with resulting dis turbances of digestion, such as dyspepsia, vomiting, constipation and even hemorrhages from the stomach or bowel. There is also a thinness and emaciation with drawn and oc casionally bloated face, sunken eyes with dis colored whites. The spleen is enlarged from congestion of its substance, the abdomen is distended forming a marked contrast to the fleshless face and limbs, and the last phase of the disease is marked by dropsical effusion in the abdominal cavity (ascites). Cirrhosis of
the liver is a chronic disorder which may ex tend over a period of many years and which may be arrested even after it has reached an advanced stage. Among the symptoms of hy pertrophic cirrhosis-are tenderness and increase in the size of the liver, the development of jaundice, and sometimes the occurrence of fever. The disease is more rapid in its course than the atrophic variety.
Treatment.—The treatment of this condition is preventative rather than curative. When due to alcohol it may be arrested if not too well advanced, by a control of the habit of drink ing; and a restitution of normal conditions may be favored by careful diet, including mainly the avoidance of stimulating or irritating food, and of general excesses of diet. The use of saline waters may be beneficial. When advanced to the stage of dropsy of the abdominal cavity, depletive measures, such as are used for the relief of dropsies in general, may be useful; or it may be necessary to remove the liquid by tapping.
Abscess of the Liver may result from dysen tery and other ulcerative conditions of the in testines, in which cases the abscess is likely to be solitary; or it may accompany a septicaemia originating in the abdominal cavity from some local disease like appendicitis or puerperal in fection, in which case multiple small abscesses are found throughout the substance of the liver. Another variety of multiple abscess is that in which obstructions of the biliary ducts by gall stones occasion retentions of bile and the for mation of local foci of suppuration. Abscess is more common in tropical countries, probably on account of the greater frequency of dysen tery in such localities.
Pathological Anatomy and Symptoms.— The liver is enlarged, and sometimes a project ing mass can be seen in the upper right portion of the abdomen. The abscess may be of small size, but frequently reaches very considerable proportions, containing perhaps a pint or more of thick pus. It may discharge externally through the skin, into the abdominal cavity or some of the abdominal organs, and even through the diaphragm, into the lung and bronchi. Occasionally a spontaneous cure re sults in this way. More commonly the patient perishes before the abscess ruptures, from gen eral infection or from prostration. The disease is frequently attended with great pain, with jaundice and with irregular fever.
Treatment.— The only effective, treatment of abscess is surgical operation.
Tumors.—Among the tumors of the liver, the most important is cancer. This is usually secondary to cancer of the stomach or intes tines. It may, however, be primary in the liver. The liver is found enlarged and its surface irregularly studded with nodules vary ing in size from that of a pea to that of an apple, or even larger masses.