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SURGERY OF LIVER AND
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See also:SURGERY OF See also:LIVER AND See also:GALL-See also:BLADDER.—EXpoSed as it is in the upper See also:part of the See also:abdomen, and being somewhat friable, the human liver is often torn or ruptured by blows or kicks, and, the large See also:blood-vessels being thus laid open, fatal See also:haemorrhage the hepatic lobules. i, i, i, Interlobular See also:veins ending in the intralobular capillaries. c, c, Central veins joined by the intralobular capillaries. At a, a the capillaries of one lobule communicate with those adjacent to it. s, ct, Central veins receiving the intralobular capillaries. Sublobular vein. Interlobular connective See also:tissue forming the capsules of the lobules. Interlobular veins. Into the belly-cavity may take See also:place. The individual becomes faint, and the faintness keeps on increasing; and there are See also:pain and tenderness in the liver-region. The right thing to do is to open the belly in the See also:middle See also:line, See also:search for a See also:wound in the liver and treat it by deep sutures, or by plugging it with See also:gauze. Cirrhosis of the Liver.—As the result of chronic irritation of the liver increased supplies of blood pass to it, and if the irritation is unduly prolonged inflammation is the result. The commonest causes of this chronic hepatitis are alcoholism and syphilis. The new fibrous tissue which is See also:developed throughout the liver, as the result of the chronic inflammation, causes See also:general enlargement of the liver with, perhaps, See also:nausea, vomiting and See also:jaundice. Later the new fibrous tissue undergoes contraction and the liver becomes smaller than natural. Blood then finds difficulty in passing through it, and, as a result, See also:dropsy occurs in the belly (See also:ascites). This may be relieved by tapping the cavity with a small hollow See also:needle (See also:Southey's trocar), or by passing into it a large See also:sharp-pointed See also:tube. This relieves the dropsy, but it does not cure the See also:condition on which the dropsy depends. A surgical operation is sometimes undertaken with success for enabling the engorged veins to empty themselves into the blood-stream in a manner so as to avoid the liver-route. Inflammation of the Liver (hepatitis) may also be caused by an attack of micro-organisms which have reached it through the veins coming from the large See also:intestine, or through the See also:main See also:arteries. There are, of course, as the result, pain and tenderness, and there is often jaundice. The See also:case should be treated by See also:rest in See also:bed, fomentations, See also:calomel and saline aperients. But when the hepatitis is of septic origin, suppuration is likely to occur, the result being an hepatic See also:abscess. Hepatic Abscess is especially See also:common in persons from the See also:East who have recently undergone an attack of See also:dysentery. In addition to the See also:local pain and tenderness, there is a high temperature accompanied with shiverings or occasional rigors, the patient becoming daily more thin and miserable. Sometimes the abscess declares itself by a bulging at the See also:surface, but if not an incision should be made through the belly-See also:wall over the most See also:tender spot, and a See also:direct examination of the surface of the liver made. A bulging having been found, that part of the liver which apparently overlies the abscess should be stitched up to the sides of the opening made in belly-wall, and should then be explored by a hollow needle. Pus being found, the abscess should he freely opened and drained. It is inadvisable to explore for a suspected abscess with a hollow needle without first opening the abdomen, as septic fluid might thus be enabled to leak out, and infect the general peritoneal cavity. If an hepatic abscess is injudiciously See also:left to itself it may eventually See also:discharge into the See also:chest, lungs or belly, or it may establish a communication with a piece of intestine. The only safe way for an abscess to evacuate itself is on to the surface of the See also:body. Hydatic Cysts are often met with in the liver. They are due to a See also:peculiar development of the eggs of the tape-See also:worm of the See also:dog, which have been received into the alimentary See also:canal with infected See also:water or uncooked vegetables, such as watercress. The embryo of the See also:taenia echinococcus finds its way from the See also:stomach or intestine into a vein passing to the liver, and, settling itself in the liver, causes so much disturbance there that a See also:capsule of inflammatory material forms around it. Inside this wall is the See also:special covering of the embryo which shortly becomes distended with clear hydatid fluid. The cyst should be treated like a liver-abscess, by incision through the abdominal or thoracic wall, by circumferential suturing and by exploration and drainage. Tumours of the Liver may be See also:innocent or See also:malignant. The most important of the former is the gumma of See also:tertiary syphilis; this may steadily and completely disappear under the See also:influence of iodide of See also:potassium. The commonest See also:form of malignant See also:tumour is the result of the growth of cancerous elements which have been brought to the liver by the veins coming up from a See also:primary See also:focus of the large intestine. Active surgical treatment of such a tumour is out of the question. Fortunately it is, as a See also:rule, painless. The Gall-bladder may be ruptured by See also:external violence, and if bile escapes from the See also:rent in considerable quantities See also:peritonitis will be set up, whether the bile contains septic germs or not. If, on opening the abdomen to find out what serious effects some severe injury has caused, the gall-bladder be found torn; the rent may be sewn up, or, if thought better, the gall-bladder may be removed. The peritoneal surfaces in the region of the liver should then be wiped clean, and the abdominal wound closed, except for the passage through it of a gauze drain. Biliary concretions, known as gall stones, are See also:apt to form in the gall-bladder. They are composed of crystals of bile-See also:fat, cholesterine. Sometimes in the course of a See also:post-mortem examination a gall-bladder. is found packed full of gall-stones which during See also:life had caused no inconvenience and had given rise to no suspicion of their presence. In other cases gall-stones set up irritation in the gall-bladder which runs on to inflammation, and the gall-bladder being infected by septic germs from the intestine (bacilli coli) an abscess forms. Abscess of the Gall-bladder gives rise to a painful, tender swelling near the See also:cartilage of the ninth See also:rib of the right See also:side. If the abscess is allowed to take its course, adhesions may form around it and it may burst into the intestine or on to the surface of the abdomen, a biliary See also:fistula remaining. Abscess in the gall-bladder being suspected, an incision should be made down to it, and, its covering having been stitched to the abdominal wall, the gall-bladder should be opened and drained. The presence of concretions in the gall-bladder may not only See also:lead to the formation of abscess but also to invasion of the gall-bladder by See also:cancer.
Stones in the gall-bladder should be removed by operation, as, if left, there is a See also:great See also:risk of their trying to See also:escape with the bile into the intestine and thus causing a blockage of the common bile-duct, and perhaps a fatal leakage of bile into the peritoneum through a perforating See also:ulcer of the duct. If before opening the gall-bladder the surface is stitched to the deepest part of the abdominal wound, the biliary fistula left as the result of the opening of the abscess will See also:close in due course.
" Biliary See also:colic " is the name given to the distressing symptoms associated with the passage of a See also: In the meanwhile See also:relief may be afforded by fomentations, and by morphia or See also:chloroform, but if no prospect of the stone escaping into the intestine appears likely, the surgeon will be called upon to remove it by an incision through the gall-bladder, or the bile-duct, or through the intestine at the spot where it is trying to make its escape. Sometimes a gall-stone which has found its way into the intestine is large enough to See also:block the bowel and give rise to intestinal obstruction which demands abdominal See also:section. A See also:person who is of what used to be called a " biliary nature " should live sparingly and take plenty of exercise. He should avoid fat and See also:rich See also:food, See also:butter, pastry and sauces, and should drink no See also:beer or See also:wine—unless it be some very See also:light See also:French wine or Moselle. He should keep his bowels See also:regular, or even loose, taking every See also:morning a dose of sulphate of soda in a See also:glass of hot water. A course at See also:Carlsbad, See also:Vichy or See also:Contrexeville, may be helpful. It is doubtful if drugs have any direct influence upon gall-stones, such as sulphate of soda, See also:olive oil or oleate of soda. No reliance can be placed upon See also:massage in producing the onward passage of a gall-stone from the gall-bladder towards the intestine. Indeed this treatment might be not only distressing but harmful. (E. Additional information and CommentsThere are no comments yet for this article.
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