Licence: In copyright
Credit: Aids to surgery / by Joseph Cunning. Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
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![bottles and fluid diet. Where there is reasonable evidence to suspect rupture, the abdomen is opened in t]:e mid-line high up. An attempt may be made to close a tear l)y stitches; and failing this, the bleeding is stopped by plugging tightly with gauze. The cautery may also be used to stop haemorrhage from shallow tears. Abscess of the Liver has several causes. I. Tropical Abscess occurs in patients who have had dysentery. The abscess is usually single, loculated and situated in the posterior part of the right lobe. Strepto- cocci, Bacillus coli and the Ainceba coli are found in different cases. The pus is thick and reddish-brown in colour, and has a foul smell. Syrnpto)iis.—There is usually pain and tenderness over the whole hepatic region. The temperature is usually raised, and in acute cases is high and accompanied by rigors. Loss of appetite and wasting are present, while slight jaundice may come on. The liver is usually found to be enlarged upwards, but if the abscess projects below the costal margin a fluctuating swelling may possibly be felt. If left alone, the abscess may point through the abdominal wall in the epigastrium, may burst into the general peritoneal cavity, some part of the intestine, the lung, or the pleural cavity. In some cases it may remain encysted, the abscess walls becoming much thickened. Treatniettt.—If the abscess is pointing tlirough th? abdominal wall, it only needs incision and drainage. If a swelling is attacked from the abdomen, and there are no adhesions to the abdominal wall, gauze packing should be inserted till adhesions have been formed. The abscess is then incised and a large drainage-tube inserted, or, in urgent cases, the abscess is opened at once, and the packing is trusted to prevent soiling of the peritoneal cavity. When the abscess is in the posterior part of the right lobe, a piece of the ninth or tenth rib is removed behind the mid-axillary line, the costal and diaphragmatic pleura are stitched together, and the diaphragm is incised over that portion of the liver which is not covered by peri- toneum. The abscess is opened and a large drainage- tube is inserted. The diagnosis is confirmed during the operation by](https://iiif.wellcomecollection.org/image/b21510891_0326.jp2/full/800%2C/0/default.jpg)
