In inflammation of the liver there is, as in congestion, a much greater quantity of blood in the organ. But it is not there simply be cause it is prevented flowing on quickly enough ; it is there because there is an active determina tion of blood to the inflamed organ. As a re sult of the inflammatory material which exudes from the blood-vessels, matter may be formed in the liver, and an abscess may result.
The symptoms of the acute form are similar to those described under congestion. More are pain and swelling of the organ, pains in the right shoulder, and sometimes down the arm, indigestion, sickness, hiccough, &c., and also fever, which may be slight or severe according to the degree of the inflammatory action. Jaun dice is not common, though a slight degree may be present. The movements of breathing in crease the pain felt in the side, and this leads to the breathing being short and shallow, and to a short dry cough. No special symptoms indicate the fm (nation of an abscess, though chills and fits of shivering (rigors), occurring in the course of the disease, are strongly sug gestive of it. Where the abscess forms in front, a swelling may be evident through the ab dominal walls. An abscess is a very serious complication. It may burst into the cavity of the belly, or into the lungs, and be spat up; or it may burst in other directions.
Treatment.—The patient must be kept in bed. The diet must be light and not stimulat ing—milk and light soups, fat being removed, &c. Hot applications are to be freely used over the region of the liver. Nothing special can be done for the pains in the shoulder, since with the relief of the liver they will disappear, but not till then. Saline purgatives, as recom mended for congestion, are to be employed. The addition to the saline medicine of infusion of senna (2 table-spoonfuls) will help its action. The flow of urine should be encouraged by the use of draughts of hot water, a tea-cupful at a time given 5 or 6 times a day. During re covery, change of air, proper food, and the use of dilute nitro-rnuriatic acid, as recommended for congestion, will be beneficial.
A physician will often advise the opening of an abscess which has formed, and the operation is now performed with great care and success, owing to improved methods of procedure.
The chronic form of the disease of the liver is of various kinds. The acute attack above described may end in the chronic disorder, or chronic inflammation may be due to various other diseases. Other forms of chronic disease of the liver are spoken of under entanosis.
Its symptoms are similar to those already described, but of a milder type.
Its treatment is practically the same as that for congestion—plain food, moderate exercise, saline purgatives, and the dilute nitro-muriatic acid, or the chloride of ammonium.
Cirrhosis of the Liver (Hob-nailed Liver, Gin-drinker's or Drunkard's Liver).—The word cirrhosis is derived from the Greek kirros, yel lowish, because in this disease the liver is of a grayish-yellow colour—the colour of impure bees'-wax. The phrase "hob-nailed" is applied because of the irregular surface of a liver affected with the disease ; and the term "gin-drinker's liver" points to the fact that constant spirit drinking (not necessarily of gin) is one very common cause of the complaint. It sometimes occurs, however, in people quite independently of spirit-drinking, and it has been known to occur in children. Cirrhosis. may also, and often does, arise from syphilis.
In the disease the fine connective tissue, acting as a sort of framework for the liver cells (p. 200), increases in amount. The result is slight enlargement of the liver at first, but the newly-formed tissue contracts gradually, until, in the end, the liver is much reduced in size. There is, in fact, atrophy of the liver. It is the contraction that produces the irregular surface suggesting the term " hob-nailed." One evil consequence of the growth of this tissue among the cells, and its gradual contraction, is that the cells are pressed upon, so that their normal nourishment is impaired, and they waste and disappear.
The symptoms are none of them such that any but experienced persons could trace to their proper cause — indigestion, loss of strength, growing thinness, sallow complexion. Trouble some piles are common. Sometimes there is diarrhoea, though sometimes costiveness, and the motions are usually pale. There is never serious jaundice. The occurrence of dropsy of the belly is frequent, as well as the passage of blood from the bowels, because, as the disease progresses, the contraction of the liver hinders the due return of blood to the heart, and thus causes engorgement of the abdominal blood vessels. The occurrence of abdominal dropsy in a constant drinker should lead one to suspect this disease at once. With these symptoms, percussion (p. 271) shows the liver to be dimin ished instead of increased in size. The disease may last for years before it cuts off the patient.