Liver disease

“ In any such cases it is proper to look for other indications of liver disease,—pale color and offensive odor of the fæces, muco-enteritis, indigestion, icterus or yellow patches on the mucous membranes, tenderness on percussion over the asternal ribs, muscular neuralgia, nervous disorder, the passage of bile, hæmoglobin, albumen, sugar or other abnormal elements in the urine, etc.
TREATMENT OF SECONDARY AND FUNCTIONAL DISEASES OF THE LIVER. Diet. Many hepatic disorders, and especially those that are exclusively or mainly functional may be corrected by diet alone. ”

“ THE subject of liver disease is everywhere a difficult and complicated one. It is especially difficult in tropical countries; for not only is the resident there liable to all the forms found in temperate climates, but he is exposed, in addition, to various potent predisposing and exciting causes of liver disease not present, or only present in a very mild degree, in more temperate latitudes. These additional causes of liver disease, inseparable from the tropics, are heat, malaria, and, especially, amoebic dysentery. ”

“ If such a diet be beneficial in cases where the tissues of the liver are degenerated, it appears reasonable to assume that it will be equally efficacious when the liver has not yet been altered by disease. We must realize that the various unwholesome matters we eat or drink are carried to the liver to be dealt with, and that the end-products of the decomposition of the meat, and other elements contained in preserved meat which may not be perfectly sound, may injure the liver-tissue, or, at any rate, throw more work on this organ than food in the nature of vegetables or milk. ”

“ Any abnormal activity of the liver in the production of sugar—more than can be burned up in the circulation—overstimulates the kidneys and produces increased flow of a heavy urine with a sweetish taste. This increased production of sugar may be primarily due to disease of the brain, which, in its turn, determines the disorder of the liver. Disease of the right side of the heart or of the lungs, by obstructing the onward flow of blood from the veins, increases the blood pressure in the kidneys and produces disorder and excessive secretion. ”

“ 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. ”

“ I urge the people of the United States and educational, philanthropic, scientific, medical, and health care organizations and professionals to learn more about the liver, to support appropriate efforts to discover the causes and cures of all types of liver disease, and to aid those who suffer from the crushing physical, psychological, and financial burden of a liver disease. ”

“ The fatty liver is well known to be a liver containing in its substance more than the normal amount of fat; a morbid condition intentionally induced in certain animals for the purpose of gain. In man the liver often becomes surcharged with fat, giving rise to obstruction of the liver. The term, obstruction, conveys an idea of the disease arising from this cause. The liver secretes bile, which, in order to reach the duodenum, flows through a small duct. ”

“ It is a common mistake to suppose that malaria causes the suppurative liver disease of the tropics; the two concur geographically to a certain extent, but are in no way etiologically identical.
Morbid anatomy.— It may be inferred from the symptoms that in the early stages of suppurative hepatitis there is general congestion and enlargement of the liver; in some instances this condition may be more or less confined to one lobe or even part of a lobe. ”

“ Horses that have suffered from chronic liver disease for years eventually present symptoms of colic and die quite suddenly. Upon post-mortem examination we discover that the liver has ruptured. The cicatrices, or scars, that are often found upon the liver indicate that this organ may suffer small rupture and yet the horse may recover from it. This can not be the result, however, if the rent or tear is extensive, since in such cases death must quickly follow from hemorrhage, or, later, from peritonitis. Enlarged liver is particularly liable to rupture. ”

“ Cirrhosis of the liver is a disease that is almost invariably fatal in from one to two years—although, if the process is not far advanced, and the cause is removed, the patient may recover tolerable health.
It is absolutely necessary that further irritation of the liver, caused by the drinking of alcohol, be stopped. Close attention should be paid to the catarrhal condition of the stomach and bowels, which is usually associated with cirrhosis. ”

“ Recent physiological study has shown how closely the intestine and the liver are associated in health and in disease. When the liver is implicated in indigestion the symptoms which follow are due either to a deficiency of the secretion of bile, and the resultant disturbance of digestion in the intestine, or to a derangement in the transformation in the liver of the products of albuminoid digestion. When the disorganization of the peptones is imperfectly performed in the liver, instead of urea there is a production of lithates and lithic acid, constituting the condition called lithæmia. ”

“ 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. ”

“ There is a chronic congestion, and there is very frequently various forms of degeneration in the hepatic cells, and in many cases an increase in the connective tissue to such an extent as to cause the disease known as cirrhosis of the liver.
Alcohol may also under certain circumstances produce such excessive fatty degeneration in the liver, as in itself to be a menace to existence, for if the liver ceases to do its proper work, the whole minute nutritive chemistry, the metabolism of the body, breaks to pieces. ”

“ The secretion of the liver is always a waste product, but, even as such, it has its use as a digestive fluid in health. When the fast is in progress, however, this product of elimination is discharged into the intestines, and is nothing more than poisonous refuse excreted from tissue, blood, and organs, which must be at once removed from the body lest it be reabsorbed into the circulation. ”

“ Sometimes, by a slow chronic action, it is enlarged to double its usual size, and totally disorganized, and yet the person suffers comparatively little. The disease frequently arises in tropical climates, from warmth and other natural causes, but an excess in spirituous liquors is more frequently the cause than is generally imagined.
The consequences which follow chronic inflammation of the liver, are very extensive. The bile, in general, is not secreted in due quantity or quality, consequently digestion is defective, the bowels, from want of their usual stimulus, become torpid. ”

“ In view of the occurrence of morning diarrhœa of dark bilious stools as a frequent first step in the development of sprue, hyperactivity of the liver might be assumed to be a first step in the development of the disease, an activity which in time ends in exhaustion of the chologenic functions of the gland. It might be further suggested that concurrently with this hepatic disturbance there is a similar initial hyperactivity of all the other glands appertaining to digestion, a hyperactivity which also ends in a corresponding exhaustion. ”

“ DIAGNOSIS.—The mild form of chronic catarrh of the intestines associated with constipation has been confounded with hepatic disorders, and the obscure symptoms attending it have been attributed to excess or diminution of bile, and medicines to regulate the liver have been given accordingly. In the absence of lesions in the liver, in cases where symptoms such as have been described have preceded death, the opinion is not justified that disease of this organ has existed. ”

“ The disease is frequently though not always of a bilious character—that is an abundance of bile is found floating in the stomach or intestines. There seems to be neither torpor nor enlargement of the liver which have characterized the diseases of this country for 21 years past ”

“ When overworked by overfeeding or other abuse, the liver cannot perform its function of inspection successfully, and more or less of the poison retained, absorbed from fermenting refuse in the intestines, is carried into the circulation. Excess of bile is manifested, and with it the headache, the cold, or the bilious attack appears, all warnings of further disease. ”

“ All habits having a tendency to cause digestive disturbance, such as the use of tobacco or alcohol, careless eating and overeating, hinder the functioning of the liver. Any clogging or interference with its duties prevents the blood from receiving the benefit of its inspection, and an impure product is the result. All parts of the body will show distressing symptoms of fatigue and of exhaustion if the cells of the liver become diseased or useless through intemperate living or through ignorance of the specific duty belonging to it as an organ of the human machine. ”

“ Lesions. In fatty degeneration the liver is enlarged, pale, bloodless, yellowish, its cut surface exudes an oily fluid which smears the knife, and it is so light that it floats on water. If scraped and the material drawn across a sheet of paper it forms a transparent oily stain. Under the microscope the liver cells are seen to be enlarged and to have their protoplasm and nuclei replaced by fat or oil. If due to obstruction in the heart or lungs the degeneration is greatest toward the centre of the acinus, if due to an infectious disease it is usually greatest towards its periphery. ”

“ Lesions: nutmeg liver, degeneration, cirrhosis. Symptoms: pampered idleness, obesity, pulmonary or cardiac disease, intestinal catarrh, piles, ascites, slight icterus, percussion tenderness of right hypochondrium, lying on right side, increase of percussion flatness. Treatment: saline purgatives or laxatives, antiseptics, restricted laxative diet, open air exercise, derivatives, etc.
Physiologically the liver undergoes hyperæmia in connection with an abundant meal and active digestion. Within the limits of health it may increase one-third in bulk and weight. ”

“ In cattle: obstruction to circulation or the flow of bile; advances from the vessels, causes absorption, caseated foci, adhesions, enlarged liver. Symptoms: jaundice, yellow, red, albuminous urine, chronic indigestion, tends to fatal though slow advance. Treatment: green food, open air life, saline laxatives, alkalies. In dog: common following heart disease, parasites, bacteria. Lesions: Congested brownish red liver, fibroid increase from Glisson’s capsule, compression of acini, their elevation above surface, fatty and pigmentary degeneration of hepatic cells, increasing sclerosis. ”

“ 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. ”

“ Fatty degeneration of the Liver is common in many disorders. A liver may be very fatty, and yet give rise to no symptoms, as in cases of consumption. The symptoms in any case come on very gradually, so that the organ is generally much diseased before any notice is taken of the mischief. The disease is often very chronic, and will last for years unless there be much mischief in other organs; dropsy is a bad symptom, and, when general, will frequently point to disease in the kidneys. ”

“ When wasting is very marked, and particularly when there has already been a number of deaths, diagnosis becomes extremely easy. It is sufficient to find flukes in any form (Distoma hepaticum rel lanceolatum) to be assured as to the cause of disease.
Prognosis. In severely infested cases the prognosis is extremely grave, because no efficient method of treatment exists. Embedded in the liver, the parasites resist the action of all drugs, and we know of no anthelmintic eliminated by the bile which in any way affects their vitality. ”

“ The novice in tropical practice is some time in realizing that grave disease of so important an organ as the liver may, for a long time, be unattended with urgent symptoms, whether local, or constitutional, or both.
The most common mistakes in diagnosis are: (1) Failure to recognize the presence of disease of any description, even when an enormous abscess may occupy the liver. (2) Misinterpretation of the significance and nature of a basic pneumonia— a condition so often accompanying suppurative hepatitis. (3) Attributing the fever symptomatic of liver abscess to malaria. ”