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Diseases of the Liver

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DISEASES OF THE LIVER.

Congestion of the Liver.—The structure•of the liver has been described at page 200, and the way in which it is permeated with blood vessels has been noted. Normally the liver contains about one-fourth part of the total amount of blood in the body. It can be under stood, however, that if these numerous blood vessels, instead of being ordinarily filled, were choked with blood, the liver might contain an enormous amount, and that, if it could be seen in that condition, it would appear of a deep red colour, and would feel hard and tense owing to the amount of blood contained in it.

The liver may be congested from various causes. Anything which prevents the blood, returning from the liver, passing on to the heart, and from that to the lungs, will produce an accumulation of blood in the liver. Thus heart-disease and disease of the lungs act. It may, however, result from much simpler causes —excess in eating or the use of too rich foods, excess in drink, want of exercise. It is very common in people of sedentary habits. Very hot weather occasions it. Malarial disease, ague, &c., produce it. Chronic enlargement or hypertrophy of the liver may result from long-continued congestion.

The symptoms are weight and fulness in the region of the liver. Reference to Figs. 100 and 104, pp. 190 and 198, will show the limits of that region. The organ becomes enlarged and tender on pressure. This tenderness is often well shown by giving a smart push with the fingers to the front of the belly just beyond the end of the breast-bone. As mentioned on page 200, the liver should be completely covered in by the ribs when the person lies down, ex cept at the part beyond the breast-bone. In enlargement the liver projects beyond cover of the ribs, and its firm edge may often be felt by the fingers. Physicians are in the habit of de fining its limits by percussion, as described on p. 206. The sound given out by tapping with the fingers over the liver is dull, while other parts of the belly give forth a clear sound. Thus the boundary of the liver can be ascer tained. In congestion there is also some pain, especially on coughing and when lying on the side, pains often also about the right shoulder.

Added to this are dyspeptic symptoms, a feel ing of sickness, bad appetite, often (lull head ache, and mental depression. The urine is highly coloured, and there is costiveness. Some times there is slight yellowness of the skin— jaundice, seen first in the white of the eye.

Treatment.—Let any discoverable cause of the condition be removed if possible. Thus let plain food take the place of rich stimulating dishes. Let all alcoholic liquors be abstained from, and let regular exercise be taken. Hot applications over the liver will often greatly relieve the sense of weight and the pain. As to medicines, they should be chiefly medicines that will relieve the bowels, saline medicines like seidlitz- powders, Eno's salt, &c. Stout people are liable to be troubled with this con dition of liver. They will find great relief by avoiding fatty food, sweet dishes, pastries, &c., and by taking every morning a dose—the quan tity they find most convenient—of a mineral water like Hunyadi Janos, Carlsbad, or the waters of Harrogate or Cheltenham. If addi tional purgative is required the resin of podo phyllin is preferable. One or two pills grain in each) may be taken occasionally at bed-time, or a breakfast pill of grain of podophyllin and A extract nux vomica may be taken every morning. Mineral acids, for example dilute nitro-hydrochlo•ic acid (20 drops), are valu able, and may be combined with the dandelion juice (a tea-spoonful), the dose to be taken twice or thrice daily a little time after food. In India, chloride of ammonium (sal am moniac) is largely used in doses of from 5 to 20 grains several times a day, and continued for a long period.

Inflammation of the Liver (Hepatitis) is frequent in hot climates, and is closely con nected with dysentery, in the course of which disease it often occurs. But inflammation of the liver may also occur from injury—a violent blow on the right side, &c. It may also result from the presence of poisons in the blood, such as phosphorus or the poison of syphilis, &c., or it may be a consequence of other diseases. It may be acute or chronic.

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