Volume 1

Diseases of the liver, gall-bladder and bile-ducts / by Humphry Davy Rolleston.

  • Humphry Rolleston
Date:
1912
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Diseases of the liver, gall-bladder and bile-ducts / by Humphry Davy Rolleston. 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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    Graham's^ 70 cases 56 were in women. Max Einhorn ^ in private practice noted 21 women and 9 men. As already mentioned, Gl6nard's own observations, which include minor degrees of hepatoptosis, were to the effect that hepatoptosis is really more frec^uent in men, its apparently greater incidence in females being exjjlained by cases of partial hepato- ptosis (Riedel's lobes, constriction lobes) erroneously regarded as complete hepatoptosis. Age.—The majority of patients with hepatoptosis are over forty years of age. Treves ^ jouts the age at between thirty-five and sixty. In exceptional instances it is met with in children. Freeman,* in 496 autopsies on children, met with four examples of hepato- ptosis due to relaxation and elongation of the suspensory ligament; the right lobe came down into the pelvis, the left lobe being the only part of the liver touching the diaphragm, while the upper surface was turned to the right. Factors responsible for the Normal Position of the Liver.—As bearing on the causation of hepatoptosis it will be well to refer to the factors which maintain the liver in its normal position. These are : (1) The healthy tone of the abdominal muscles which keeps up the intra- abdominal pressure and makes the intestines, act as an elastic pad or support for the liver. In the rare cases of congenital absence of the muscles of the abdominal wall the liver has been extremely movable (Guthrie 5). (2) The attachment of the liver by the inferior vena cava to the diaphragm. This, according to Faure,'^ is the most important agent in retaining the liver in its place, and by itself is capable of sustaining weight of 27 kilograms, as against 20 kilograms which the other suspensory ligaments can support. (3) The peritoneal ligaments, the falciform, coronary, and lateral, and the connective tissue uniting the right lobe of the liver to the diaphragm. Graham's observations on the dead body shewed that they can support the liver independently of the abdominal walls, and both he and Button Steele^ found that cutting these ligaments led to a condition which was much the same as that in hepatoptosis. These observations shew that in spite of Symington's ^ statement that under ordinary conditions the suspensory ligaments are not tense, they can, when intact and healthy, prevent any abnormal or excessive descent of the liver. Intrahepatic hlood-])ressure may possibly play a part in keeping the liver in its normal position. Injection of water into the vessels of the liver was found by Gldnard and Siraud not only to increase its size, but to straighten out its ^ J. E. Graham. Canadian Practitioner, 1895, xx, 399. 2 Max Einhorn. Med. Rec, N.Y., 1899, Ivi, 397. Treves, F. Lancet, 1900, i, 1339. * Freeman. Arch. Pediat, 1900, xvii, 81. ' Guthrie, L. G. Trans. Path. Soc, 1896, xlvii, 139. Faure. These de Paris, 1892. Graham, J. E. In Loomis and Tliompson's System of Practical Med., iii, 414. 8 Button Steele. Univ. Penn. Med. Bull, 1903, xv, 424. Symington. Trans. Med.-Chir. Soc, Edin., 1887, vii, 53. Glenard et Siraud. Lyon mid., 1895, Ixxix, 171.