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Cirrhosis of the Liver

tissue, fibroid, hepatic, child, sometimes and portal

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of the liver, although not one of the more common diseases in the child, cannot be said to be very rare. In some children, even at a very early age, there appears to be a peculiar tendency to the formation and proliferation of fibroid tissue. Sometimes the fibroid overgrowth is a general one ; sometimes it is more local, and is limited to particular organs —the lungs, the liver, or the kidneys. Fibroid induration of the lungs occurring as a-result of catarrhal pneumonia and pleurisy, is a sufficiently familiar experience ; but a similar pathological change in other internal organs is much less frequently met with.

Causation.—The causes of hepatic cirrhosis in early life are obscure. Intemperance in alcohol, to which the disease in the adult is usually attrib uted, is of course exceptional in the case of a child. It is possible that, as some writers are disposed to believe, this vice may be one of the sins of the fathers which are upon their offspring, and that cirrhosis in the child may be clue to intemperance in the parent ; but this, at present, at any rate, is no more than hypothesis. Congenital deficiency of the bile ducts is often—always, according to Dr. Wickham Legg—accompanied by an early stage of hepatic cirrhosis. Syphilis may sometimes produce it ; and _III. &mil and Ranvier have described an interstitial hepatitis as ac companying cases of general tuberculosis. Hepatic cirrhosis has been seen at a very early age. Weber has found the atrophic form in a new-born infant ; and in cases of malformation of the bile-ducts, it is always an early change, as death usually takes place in the course of a few months. The hypertrophic form is sometimes, also, met with in very young children. Wettergren has seen it in a boy of five ; and Dr. S. West has reported a case in a boy of six. It is curious that in each of these instances the child had been in the habit of drinking largely of coffee.

_Morbid Anatonly.—Cirrhosis of the liver may be atrophic or hypertrophic, and these two conditions have very distinct pathological characters.

In atrophic cirrhosis (the hobnailed liver, cirrhosis of Laennec) there is abnormal development of new fibroid tissue which permeates the organ, fol lowing the branches of the portal vein. The new development appears to originate in a chronic inflammatory condition of these vessels. It produces great thickening of the capsule of Glisson, the prolongation of which en velopes the portal branches, and extending from it into the interlobular spaces, forms meshes which embrace portions of the hepatic substance. These portions vary in size, but all comprise several lobules. The process consists in a rapid proliferation of embryonic cells which undergo conver sion into cicatricial fibroid tissue. After a time, contraction takes place in the new material, and the liver becomes small and shrunken, with an ir regular- granular surface and a dense substance. Its enveloping capsule is much thickened. On section, the surface is of a dirty yellow colour, and is seen to be divided into irregular meshes by the fibrous network.

The contraction of the dense interstitial tissue compresses the lobules so that the liver-cells become flattened and atrophied, and causes great ob struction to the portal circulation. Consequently, the whole portal system is congested. Its blood, unable freely to escape, has to find a new channel ; and a collateral circulation becomes gradually established by enlargement of the principal veins in the suspensory ligament passing to the umbilicus.

The nutrition of the liver, and the formation of bile, are kept up by the de velopment of new vessels, which permeate the new fibrous tissue and convey blood from the hepatic artery to the intra-lobular vessels. The smaller bil iary ducts are but little affected by the changes which take place, so that there is seldom retention of bile or jaundice. In this form of cirrhosis, the organ is somewhat enlarged in the early stage, but afterwards becomes very small and contracted.

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