Liver fluke

“ SYMPTOMS.—Cases of fluke-worms in the human liver have occurred so rarely that we are not prepared to indicate with certainty what may be the nature of the peculiar symptoms. If the parasites were numerous, they would give rise to more or less obstruction of the bile-ducts, with accumulation of bile, accompanied with jaundice and other symptoms usually attendant on functional disturbance of the liver. ”

“ Fluke.
SYMPTOMS: A sheep, when first infected with Liver Fluke, generally
thrives as the parasites tend to stimulate the process of digestion,
being located as they are in the liver, but eventually rumination
becomes irregular, the sheep becomes anemic, weak and the visible mucous
membranes of the mouth, nose and eyes become pale, bloodless, taking on
a yellowish color as the disease progresses. Swellings will also appear
under the jaw along the neck and under the lung cavity. The process of
breathing becomes feeble and temperature irregular. ”

“ The liver fluke (Fasciola hepatica) , though not very frequent in the horse, is not uncommon in the ass. In dissecting-room subjects at the Royal Veterinary College it is often encountered. In France it was originally found in the horse by Daubenton. As I learn from Sonsino, Dr Abbate Bey recently recorded a similar find at Cairo. In solipeds generally the liver fluke appears to be almost harmless, for, notwithstanding the frightful ravages produced by rot amongst a variety of animals besides sheep, we have no evidence of the destruction of horses from this cause. ”

“ The initial stage of infection with this fluke generally runs a symptomless course; in proportion as the worms multiply the following symptoms are manifested: First there is a morbid sense of hunger and irregularity in defæcation; at the same time the patient experiences a feeling of pressure and pain in the epigastrium and right hypochondrium, or just a dull pain. Pressure increases the pain considerably. The liver appears to be enlarged, sometimes the enlargement is specially perceptible over the left lobe of the liver. ”

“ 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. ”

“ 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. ”

“ 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, 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. ”

“ 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. ”

“ But if it is attended with fever and bilious evacuations from the bowels, and if there be a sense of weight in the right hypochondrium, a hot inflammation of the liver is indicated, by which the blood, being rendered bilious, is conveyed over the whole body. When there is heat in the part without a sense of weight, the affection is occasioned by a hot intemperament alone of the liver. If it is without fever, and the alvine discharges are white, an affection of the gall-bladder, or of its ducts, is indicated. ”

“ 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 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. ”

“ It is in fact the economist of the system. It excretes bile, and liver-sugar, and renews the blood. When the liver is disordered the whole body is more or less deranged and the proper nutrition of its parts arrested."
Dr. Alfred Carpenter says:—
"The liver has to do several things; a considerable part of its duty is to purify the blood from débris (waste matter) , to filter out some things, to break up and alter others, and to expel them from the body in the form of bile. There are certain diseases in which the liver suddenly declines to do any more work. ”

“ Digestion is due to the friction of the walls of the stomach. He thought that the bile is useless, as is the spleen and other viscera. He shows some acquaintance with pathological anatomy, as he describes induration of the liver in dropsy. His idea of the cause of disease is plethora and aberration of the humours. Inflammation is due to the detention of the blood in the small vessels by the pneuma driven from the heart into the arteries; fever occurs when the pneuma is crowded back to the heart by the venous blood, and blood gets into the large arteries. Dropsy always proceeds from the liver. ”

“ When the paralysis of the hepatic glands is less complete, or less universal, a schirrosity of some part of the liver is induced; for the secretory vessels retaining some of their living power take up a fluid from the circulation, without being sufficiently irritable to carry it forwards to their excretory ducts; hence the body, or receptacle of each gland, becomes inflated, and this distension increases, till by its very great stimulus inflammation is produced, or till those parts of the viscus become totally paralytic. ”

“ 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 disease usually commences towards the end of summer with an enlargement of the liver, induced by the invasion of numerous young flukes; in the autumn and winter the animals suffer from the consequences of disordered biliary secretion; they become feverish, emaciated, and anæmic, and lose their appetite. In consequence of the consecutive atrophy of the liver, œdema and ascites set in, and many animals succumb to this “liver rot.” On examination the liver is found to be shrunken, the bile-ducts are enormously dilated and in parts saccular and full of flukes. ”

“ The patient dies of dropsy but not of "liver complaint."
Some people act as if they thought bile were a poison. On the contrary, it is a very useful digestant; it aids in keeping down the number of harmful bacteria and helps to carry the food from intestines to blood. Every day the liver manufactures at least a pint of this important fluid. The body uses what it needs and stores the surplus for reserve in the gall-bladder. The flow is continuous and, despite all appearances to the contrary, there is no such thing as a torpid or an over-active liver. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ When the obstructing cause is merely local—as, for example, a gall-stone or the cicatrix of a simple ulcer—the duration of the case is determined by the mere effect of the suspension of the hepatic functions. As the eliminating action of the liver and the part played by the bile in the intestinal digestion are necessary to life, it follows that the complete cessation of these functions must lead to death. ”

“ But if the atony arise from a hot intemperament, in process of time it appears more feculent and very fetid, the bile being high-coloured and thick. Wherefore, the substance of the liver being already melted, the whole body also is melted down; and there is fever, anorexia, and vomiting of bile. When the intemperament is cold, the discharges are neither constant nor many, for the affection is a chronic one; and for several days the discharges from the belly will be more abundant, but less fetid, like the lees of thick blood, approaching to black bile. ”

“ 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. ”

“ Besides these dangerous bacteria many other harmful substances pass from the stomach down into the intestines, whence they are taken up by the portal vein and brought to the liver. When the latter is in good condition so much the better for us, but when they arrive in too large quantities, or when the liver is more or less degenerated, as in old people, drunkards, gourmands, etc., then trouble arises. ”

“ 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. ”

“ When diarrhœa has been marked and persistent, the digestive mucous membrane is hardened, indurated, and appears as though tanned. This is due to chronic inflammation, probably to the gastro-enteritis with which the condition begins. The liver appears as if cooked; the fat, the majority of the tissues, and especially the conjunctiva, exhibit a light yellow tint, pointing to hepatic disturbance.
The diagnosis is generally easy in all three forms, provided that the food be examined.
262The prognosis varies; the acute and nervous forms are usually fatal. ”