Hepatica

“ Knowing, as we do, every plant and its place,—having taken just pride in its summer bloom,—having preserved this by cares and trimmings and proppings to a picturesque and florid autumn, though wild-flowers have long been shrivelled and shapeless,—having tidied it up and put a little something comforting round it when bloom and outline were absolutely no more: what must we feel when we first detect the ruddy young shoots of our favourite pæonies, or perceive that the brown old hepaticas have become green and young again and are full of flower-buds? ”

“ In severe cases there occurs copious and generally bloody diarrhœa, also icterus. The next stages are anæmia, emaciation, epistaxis, ascites, enlarged spleen, and cachexia, to which the patient finally succumbs. In general the course of the disease is very chronic and irregular; in winter and spring there is generally improvement, in the summer and autumn the patient gets worse. At post-mortem the bile-ducts are enlarged and thickened, there is interstitial hepatitis with enlargement of the liver, but not to such an extent as in hypertrophic cirrhosis. ”

“ Sometimes hepatick inflammation is entangled with that of some contiguous organs of the lungs or abdomen, and with their respective features. The acute hepatitis, but not the chronic, is usually terminated in a few days, at the utmost fourteen or twenty-one, by discussion, suppuration, or gangrene. Critical resolution may be variously accompanied with bilious diarrhœa and urine, nasal or hemorrhoidal hemorrhage, copious bilious sweats. Suppuration is not an unfrequent termination: after which many survive, but with difficult and slow recovery. ”

“ Hepat′ica, medicines which affect the liver and its appendages; Hepat′icæ, the liver-worts, a sub-class of bryophytic or moss-like plants.—n. Hepatisā′tion, consolidation of tissue, as of the lungs in pneumonia, resulting in a liver-like solidification.—v.t. Hep′atise, to convert into a substance resembling liver.—ns. Hep′atīte, a variety of barium sulphate or barite, with a characteristic stink; Hepatī′tis, inflammation of the liver; Hep′atocele, hernia of the liver; Hepatol′ogist, a specialist in diseases of the liver; Hepatol′ogy, the science of, or a treatise on, the liver ”

“ Liver disorders affect thousands of American children from infancy to adolescence. More than 100 different types of liver diseases, which attack these young people, have been identified. These diseases can be inherited or acquired from infection, poisons, injury, or such diseases as cystic fibrosis, anemia, leukemia, kidney or intestinal disease and glandular disorders. Infants can be born with a damaged liver or with biliary atresia, a disease characterized by abnormally-formed bile ducts. Some disorders can result in cirrhosis of the liver. ”

“ If, for example, we closely examine cases of acute hepatitis without jaundice, we find they are those in which only a portion of the liver is affected. It matters not whether it be one lobe or two, the surface or the centre of the organ, the disease is invariably circumscribed; and there is enough hepatic tissue left in a sufficiently normal condition to prevent the constituents of the bile accumulating in the blood, and producing jaundice. ”

“ A disorder of the liver by itself, i.e. unassociated with diseases of other organs, is comparatively uncommon. A failure in the secretion of bile is evidenced more or less by the well known icteric symptoms. Jaundice is often caused by an obstruction in the hepatic ducts. In such cases it is worse than useless to urge the liver to an extra formation of a secretion which can find no outlet. But other cases, in which the discoloration of the skin is in general incomplete, may be due to torpidity, congestion, or chronic inflammation of the organ. ”

“ Though both liver and gall-bladder must be very much affected in this disease, yet Dr. Moseley is of opinion that nothing can be depended upon from an inspection of them after death. Some symptoms there are in common with inflammations of the liver, but none of those which distinguish it from other diseases. It never terminates in suppuration of the liver as the hepatitis sometimes does, though it is frequently carried off by an enormous secretion of bile. ”

“ Hepatic enlargement.—— Like the spleen, the liver in malarial cachectics becomes enlarged during accessions of fever. Under the influence of a succession of acute attacks, hepatic congestion may gradually acquire a more or less permanent character. After death from such fevers the capsule of the liver is found to be tense; on section the highly vascular tissue of the organ is seen to be reddish-brown or almost black, according to the degree and kind of pigmentation. ”

“ Circulation in the liver is disordered, gastro-duodenal catarrh results, with accompanying jaundice, that is sometimes intense. A sense of fullness and pain over the hepatic region is not uncommon. Small, brownish patches upon the skin, known to the laity as “liver spots,” are frequently seen. The bowels are constipated, the stools lacking in bile, and, consequently, clay-colored, hard, and sometimes coated with mucus, here and there streaked with blood. ”

“ In catarrhal jaundice it is in most cases the bowel that is at fault, the liver acting properly, but unable to get rid of all the bile produced. The liver suffers, however, from several diseases of its own. Its fibrous or connective tissue is very apt to increase at the expense of the cellular elements, destroying their functions. This cirrhotic process usually follows long-continued irritation, such as is produced by too much alcohol absorbed from the bowel habitually, the organ gradually becoming harder in texture and smaller in bulk. ”

“ Obstruction to the flow of blood from the liver leads to dilatation of its blood-vessels, consequent pressure upon the hepatic cells adjoining them, and their gradual loss of function, or even atrophy and degeneration. In addition to the results of such passive congestion exhibited by the stomach and bowel as noted above, passive congestion of the liver is often accompanied by varicose enlargement of the abdominal veins, in particular of those which surround the lower end of the oesophagus, the lowest part of the rectum and anus. ”

“ The great majority of intestinal diseases, as also of chronic blood-disorders, are associated with a torpidity or derangement of the function of the liver. We find this to be the case with diarrhœa and constipation, with dysentery and cholera; as well as with ague and remittents,—gout, and rheumatism,—Phthisis, and scrofula. In all of these diseases it is of great importance to attend to the state of the liver. ”

“ The second form of fatty degeneration, in which the liver-cells undergo actual and destructive metamorphosis, accompanied by the production of fat, is of a much more serious character. It appears to constitute the stadium ultimum of various forms of interstitial hepatitis, and is manifested by symptoms of the gravest character, in many particulars much like those met with in acute yellow atrophy—namely, visceral congestions, hemorrhages from mucous surfaces, serous effusions, profound and rapidly developing anæmia, nervous depression, and coma. ”

“ Monotony of food should be guarded against. Wonderful results are sometimes got from a sea- voyage.
Hepatitis.—During the whole course of an attack of dysentery, and for months thereafter, the condition of the liver must receive the most careful attention. We may not be able to prevent abscess of this organ; but if pain and swelling seem to suggest it as threatening we can try by means of full and repeated doses of ipecacuanha, emetine, saline aperients, rest, low diet, fomentations, dry cupping, and similar measures to avert what, to say the least, is a very grave complication. ”

“ The toxic effects are chiefly borne by the liver and endothelial linings of the capillaries. The cloudy swelling of the liver cells obstructs the bile canaliculi, causing jaundice, and the more advanced fatty degeneration of these cells brings about disturbances caused by interference with the important liver functions. The degenerative changes in the endothelial cells lining the capillaries bring about the haemorrhages so much a feature of yellow fever.
The icterus is apt to be more marked after death, and is especially prominent about the neck and eyelids. ”

“ Ictrogen has the unusual property of acting much like phosphorus. It causes yellow atrophy of the liver, and produces the following symptoms:—Intense jaundice; at first enlargement of the liver, afterwards contraction; somnolence, fever, paralysis. The urine contains albumen and the constituents of the bile. After death there is found to be parenchymatous degeneration of the heart, kidneys, muscles, and liver. If the animal has suffered for some time the liver may be cirrhotic. ”

“ Treatment.— Nature sometimes effects a cure in these cases of hepatic congestion by establishing a smart diarrhœa. In the treatment of such cases we cannot do better than to imitate Nature, and even to supplement her efforts. A few doses of the sulphates, in the shape of some kind of bitter water or of Carlsbad salts, generally give prompt relief. But if the subject of such attacks does not profit by experience and mend his ways, very likely his liver, in time, will become chronically hyperæmic and extremely liable to intercurrent attacks of congestion of a character more or less acute. ”

“ The symptoms and signs of secondary carcinoma or sclerosis of the liver may be present, but the most commonly observed indications of impaired hepatic function depend upon pressure-obstruction of the common bile-duct. These are jaundice, fatty and clay-colored stools, and the appearance of a tumor in the region of the gall-bladder. Jaundice is a very common symptom. It occurs late in the disease as a rule, is progressive and persistent, resisting all treatment, and is extreme in degree, the skin becoming deep-yellow or greenish in color. ”

“ A remarkable symptom, which is very well explained by an active destruction of the blood, is the strong predisposition to liver-disease. The liver is an organ the relation of which with the physiology of the blood is very intimate, and the troubles of which have the most influence upon the constitution of that liquid; and that is the organ which is the first object of the attacks, not only of malaria, but of the common diseases of acclimatization. ”

“ Although the digestive functions are occasionally deranged, the appetite is at some periods remarkably keen. The action of the intestines is sometimes regular, but a state of costiveness [35] is common. The liver is often enlarged, probably from accumulation of blood. This distention is attended with pain, varies much, and, in all the cases I have seen, has subsided before death, leaving the coats of the liver wrinkled, flaccid, and marked with appearances of inflammation, caused by the distention and pressure against the surrounding parts. ”

“ The urine is diminished, high coloured, contains bile pigments, albumen, blood, and casts. There are great prostration, a quick weak pulse, sleeplessness, coldness of the surface, gradually increasing weakness, apathy, convulsions, and coma, followed by death about the fifth or sixth day.
The liver may diminish in size before death. It is rare for recovery to take place after enlargement of the liver and jaundice have supervened. It is by no means always easy to diagnose acute yellow atrophy of the liver or malignant jaundice from phosphorus poisoning. ”

“ HEPATITIS, OR INFLAMMATION OF THE LIVER.
This disease may be general or local, and may assume an acute or chronic form.
Symptoms.—The symptoms of acute hepatitis are: Dullness; the horse is suffering from some internal pain, but not of a severe type; constipated and clay-colored dung balls; scanty and high-colored urine; and general febrile symptoms. If lying down, he is mostly [Pg 88] found on the left side; looks occasionally toward the right side, which, upon close inspection, may be found to be slightly enlarged over the posterior ribs, where pain upon pressure is also evinced. ”

“ There is cough, oppressed breathing, and often vomiting of bilious matter. The urine is scanty, and of a saffron-yellow colour, and the skin and eyes are also tinged yellow. The treatment consists chiefly in purging with salines accompanied with mercurials, the use of antimonials, and a blister applied over the region of the liver. Bitter tonics, as calumba, cascarilla, and gentian may afterwards be had recourse to; and if the patient resides in a hot climate a change to a temperate one should be made, if possible. Chronic hepatitis requires similar treatment, but of a less active character. ”

“ Lung obstruction in the trouble called Emphysema, Chronic Pneumonia, etc., may cause it. The cut section of a liver shows an appearance like a nutmeg, due to a deeply congested central vein and capillaries. In a later stage the liver is contracted, central liver cells are shrunk and the connective tissue is increased.
ACUTE YELLOW ATROPHY. (Malignant Jaundice) .—This is fortunately a rare disease. There is rapid progress, and it is fatal in nearly all cases. The liver is very small and flabby. The symptoms are many and are hard to differentiate. You must depend upon your physician. ”

“ The tissues of the body are more or less deeply stained with bile. The pathological change on which the jaundice depends has been variously stated, but the most probable explanation is that which refers it to mechanical obstruction of the bile-ducts, either by catarrhal swelling or fatty degeneration of the epithelium. Notwithstanding the prominence of the hepatic symptoms, acute atrophy of the liver is probably only one element in a constitutional morbid complexus. ”