Diseases of the liver, gall-bladder and bile-ducts.

  • Humphry Rolleston
Date:
1905
Catalogue details

Licence: In copyright

Credit: Diseases of the liver, gall-bladder and bile-ducts. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    Penrose * records this in acquired syphilis and Lazarus-Barlow f in tardive congenital syphilis. Dwarfing of the left lobe is occasionally seen; it may be merely repre- sented by a little flap of hepatic tissue. In these cases the left lateral ligament is correspondingly small and the falciform ligament arises from the left margin of the liver. The stomach is thus abnormally ex- posed, and the whole of the gall-bladder is visible from the front and projects from the left lateral margin of the liver. Owing to the dis- turbed relation of the lobes the gall-bladder may be so displaced as to lie with its long axis in the transverse axis of the body. (Vide Fig. 3.) There is seldom any very manifest reason why the left lobe should be so atrophied, and it may again be suggested that it is due to some disturbance of the circulation in foetal or in early life. The change may be associated with other congenital defects. In a case reported by Garrod J extreme dwarfing of the left lobe was associated with lobulation of the right lobe of the liver and the presence of two instead of three aortic valves. In other instances atrophy of the left lobe may be due to syiDhilis or to other pathological changes taking place later in life. I have seen atrophy of the left lobe in a case where a large intra-hepatic cal- culus pressed upon the vessels entering the left lobe of the liver. MINUTE ACCESSORY LOBES. Small projections of liver substance—about the size of the terminal ]ihalanx of the forefinger—which in miniature imitate the caudate lobe, are c^uite common and of no importance or pathological significance. Their usual situation is the under surface of the right lobe, near the por- tal and longitudinal fissures. When markedly pedunculated, they may form accessory livers. The Spigelian lobe is sometimes curiously pedunculated. There is a cast in the Anatomical Museum at Cambridge of a pedunculated lobe attached to the left border of the left lobe; the pedicle is composed of hepatic tissue. Lawrence and Nabarro § described an abnormal process from the left lobe of the liver in association with absence of the inferior vena cava in a female child aged fourteen weeks. Accessory Livers.—Isolated fragments of hepatic tissue or rests have been found in the suspensory ligament; but it is noteworthy that they are very rarely seen. This contrasts with the frequency of accessory suprarenal bodies and of splenunculi. Pepere || has recently described a remarkable case in which there were innumer- able small nodviles of hepatic tissue or accessory livers scattered over the peritoneum and great omentum. One with a diameter of 7 cm. formed a solitary adenoma in the liver. Thirty-one years previously Wagner** described a number of nodules * Penrose; Trans. Path. Soc, vol. xl, p. 133. t Lazarus-Barlow: Trans. Path. Soc, vol. 1, p. 158. % Garrod, A. E.: Ibid., vol. xlviii, p. 42. § Lawrence and Nabarro: Journ. of Anatomy and Physiology, vol. xxxvi, p. G3. !l Pepere: Archiv per le Sc. Med., 1902, vol. xxvi, p. 117. ** Wagner: Archiv dcr Heilkundc, 1861.