Symptoms. The important symptoms are profound disturbance of general health with emaciation, such as characterize cancer in any part of the body; pain in the region of the liver, and increase in the size of the organ; jaundice of intense and lasting character; and occasionally dropsy of the abdominal cavity.
Parasitic Diseases. The most important of these is the hydatid cyst, which results from the lodgment of the embryo of the Tenia echi nococcus, a tapeworm occurring in the adult state in the intestines of dogs and some others animals. The eggs of this tapeworm are com municated by the dog to the human through drinking water or fresh vegetables. As all of the blood from the enteric canal passes through the liver the parasite embryo is generally lodged there. Fortunately this disease is rare in North America. In man the larval condi tion alone is met with. The embryo in the liver becomes surrounded by a capsule in which a light liquid collects and thus a cyst is formed. Secondary cysts (daughter-cysts) may develop within the original one and thus a large cavity filled with smaller spherical cysts may result. The liver increases in size and the cyst may be visible, or it may be felt through the abdominal walls as a resilient projecting mass. The by datid cyst may subsequently contract by absorp tion of its liquid contents or it may rupture in the same manner as an abscess. The symptoms of this disease are frequently obscure, but jaundice (from pressure on the bile ducts), dropsy of the abdominal cavity from pressure on the portal vein and other exinechanicall' symptoms may occur.
Jaundice is a functional disturbance of the liver in which the biliary coloring matter is ab sorbed by the blood and deposited in the tissues of the body. Jaundice may result from any cause of obstruction of the outflow of the bile through the biliary ducts or from any serious disease of the liver substance, such as abscess, cancer, acute yellow atrophy, etc. Various poi sons and infectious diseases cause jaundice by their destructive action on the liver.
The most frequent form of jaundice is that known as simple catarrhal jaundice, which re sults from digestive disturbances, especially such as follow great excess in eating or drink ing and exposure to cold. In this variety, the outflow of the bile is impeded by swelling of the mucous membrane of the duodenum where the common bile duct discharges, and also by swelling of the lining membrane of the larger bile ducts themselves. When the bile formed within the liver cannot find normal discharge, it is absorbed into the blood, and finding its way to various parts of the body discolors these, causing the yellow appearance of the skin and mucous membranes which characterizes the disease.
Symptoms. The symptoms of catarrhal jaundice are, in the fist place, those of intense disturbances of digestion, such as great pain in the region of the stomach, nausea and vomit ing; later, the appearance of a yellowish dis coloration of the skin and mucous membranes.
The frees becOme light-colored from the ab sence of biliary coloring matter, and in ad vanced cases they are actually a light clay color or even white. The urine becomes dark brown or greenish in color. The patient is depressed, often even melancholy. The pulse is slow; the temperature as a rule is depressed, though there may be a moderate degree of fever.
Treatment. Careful dieting is an essential in the treatment. The patient must abstain from food entirely at first, and later take the less irritating of foods, such as milk, broths and the like. Bismuth, pepsin, small doses of calomel and salines are administered to im prove the state of digestion and lessen the con gested condition of the stomach and duodenum. Drastic purgatives are harmful. Warm appli cations over the region of the liver are effica cious. The disease usually subsides in a few days or in a week or two.
Gall-stones. Gall-stones are usually formed within the gallbladder; very rarely in the biliary ducts within the liver. The gall-stone consists of biliary pigment matters, but in some cases almost wholly of one of the constituents of bile, cholesterin. On section through a gall stone, a central nucleus may be seen which is composed of epithelial detritus and inspissated mucus, together with bacteria in many cases. Around this is deposited cholesterin or biliary pigment. The gall-bladder may contain a sin gle stone or, more commonly, a number, and sometimes even hundreds are found.
Gall-stones are more common in women past middle life than in younger persons or in the male sex.
Symptoms may be wanting until a stone en ters the cystic duct and becomes lodged in the latter, or passing through this, becomes ob structed in the common bile duct, and causing what is known as biliary colic. The patient is seized with intense pain, radiating to the right and to the back, sometimes as high as the right shoulder. Vomiting and other reflex disturb ances and even collapse may occur. When the stone lodges, jaundice is the most pronounced symptom. Frequently the gall-stone passes with some effort and the paroxysm is relieved. Sometimes this relief is brought about by a recession of the stone into the gall-bladder.
Treatment. The treatment of gall-stone consists of careful diet and the use of saline waters to improve the digestive conditions and render the bile as liquid as possible. Gall stones may thus be diminished in size and enabled to pass through the ducts. During the paroxysm of biliary colic, remedies to relieve pain are imperatively necessary. Hypodermic injections of morphine and even narcosis with ether or chloroform may be required. Surgical operation for removal of the stone is often de sirable.