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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    Stiller * records a case where a pneumothorax developed as the result of sneezing in a healthy man and the liver was depressed so as to form a large abdominal tumor. A pleural effusion or pneumothorax on the left side may give rise, if excessive, to downward displacement of the left lobe of the liver. Malignant Disease of Lung.—Very extensive malignant disease affecting the lung and greatly increasing its volume may displace the liver downwards. This displacement was very marked in a boy witlj an enormous calcifying sarcoma in the thorax, secondary to sarcoma of the thigh, who died in St. George's Hospital under the care of Dr. Penrose in April, 1898. The growth pressed the right leaflet of the diaphragm down so that its under surface was convex, the liver was depressed, and its lower border was on a level with the umbilicus. It was not more freely movable than normal. In mediastinal growths the liver is not displaced unless, as not in- frequently occurs, there is a large pleural effusion at the same time. In emphysema the downward displacement of the liver is often easily detected, but the increased downward extent of the liver is not extreme unless there is, in addition, chronic venous engorgement due to failure of the right side of the heart. Pneumonia.—Bright f thought that pneumonia was the direct phy- sical cause of the liver being below the costal arch. But the cloudy swelling of the liver is in part responsible for the projection of the liver downwards. When the whole lung is solid, the diaphragm may be in the position of maximum inspiration, and as a result the liver is some- what depressed. I have seen downward displacement of the right half of the diaphragm and of the liver at the autopsy of a child with extensive tuberculous pneumonia of the right lung. Pericardial Effusion.—A large pericardial effusion will depress the diaphragm and with it the liver. In a case figured by Sibson,t where the pericardium contamed 3J pounds of fluid, the right lobe of the liver was displaced and tilted just in the same manner as in a right-sided pleural effusion. Abdominal Conditions Leading to Displacement of the Liver.— Generally speaking, abdominal conditions which displace the liver do so in an upward direction, but occasionally the liver may be depressed, while in other cases it may be pushed, drawn, or rotated laterally. Growths arising from the retrojjeritoneal space may push the liver for- wards and, conversely, gas free in the peritoneal cavity or under certain conditions tympanitic distension of the intestines may separate the liver from the anterior abdominal wall. Abdominal Conditions Displacing the Liver Downwards.—A subdia- phragmatic or subphrenic abscess on the right side may pass between the diaphragm and the convexity of the right lobe and dis])lace the liver downwards. A right-sided subphrenic abscess may be the result of a gastric ulcer situated near the pylorus, of a perforating duodenal ulcer, * Stiller: Wien. med. Wochen., May 4, 1901. t Bright, R.: Abdominal Tumours, p. 255, Now Sydenham Society. X Sibson: Russell Reynolds' System of Med., vol. iv.