SECONDARY OR REMOTE RESULTS OF LIVER DISEASE.
In gout: Arrest of oxidation of proteids into urea. Deposits of biurate of lime on joints, and other disorders. Urinary calculi containing urates, cystine, xanthine, etc., also from imperfect oxidation of albuminoids. Oxalic acid represents a similar arrest. Kidney degenerations from irritating urates and oxalates. Fatty kidney from excessive glycogenesis. Digestive disorders from excess or deficiency of bile or torpid liver. Nervous disorders, dullness, lameness, vertigo, spasms, irritability from hepatic inactivity and resulting poisons. Sore throat and bronchitis from hepatic derangement. Skin eruptions in tardy or imperfect action of the liver. Treatment: Abundant water, succulent vegetables, ensilage, fresh grains, balanced ration, in carnivora and omnivora oat meal, buttermilk, clear meat juice, avoid sweets, gravies, spiced animal food. Dangers for pampered horses, dogs, and old improved meat producing animals. Open air exercise. Laxatives with alkalies, salines, mercurous and mercuric chloride, pilocarpin, chlorides, iodides, bromides, nitro-muriatic acid, ipecacuan, euonymus, bitters.
Among the many secondary results of hepatic disorder, and which are habitually described as affections of other organs a few may be mentioned as indicating the wide range of influence exercised by the liver in disease as well as in health.
Gout as it appears in fowls and omnivora is directly due to the arrest of the transformation of the albuminoids into urea. Circulating in the system in the form of the less perfectly oxidized and less soluble uric acid, it determines deposits of biurate of lime around the joints, with local inflammations, and disorders of circulation and innervation, and altered spirit, temper, etc.
Urinary calculi in the same animals, are composed largely of urate of lime, cystine, xanthine and other nitrogenous products representing various stages of oxidation short of the final transition into urea and ammonia. Recognizing the active rôle which the urinary bacteria fill in this respect we must still acknowledge the great importance, as causative agents, of an excess in the urine of these comparatively insoluble products.
The oxalic acid found in certain calculi points in the same direction, as this acid, both in the body and in the laboratory, is found to result from the oxidation of uric acid (Wohler, Schenck, Hutchinson).
Degenerations of the Kidneys are to be largely traced to the same hepatic source. The uric acid diathesis, and the oxalic acid diathesis, both the result of imperfect liver function, are among the most frequent causes of irritation of the kidneys, by which channel they are eliminated from the body. Hence acute and chronic nephritis, as well as nephritic calculi result from morbid conditions which have their starting point in the imperfect function of the liver. Again fatty degeneration of the kidney is very liable to result from derangement of the glycogenic function of the liver, the tendency to the formation of fat and the constant irritation caused by the passage of the sugar contributing to the tissue degradation. In such cases albuminuria is a not uncommon accompaniment.
Derangements of the Digestive Organs may be said to be a necessary result of hepatic disorder. Excessive secretion of bile stimulates peristalsis and may induce diarrhœa, while diminished secretion tends to constipation, light colored, fœtid stools, intestinal fermentations and poisoning by the irritant products. A torpid hepatic circulation means congestion of the whole portal system, indigestions, colics, chronic muco-enteritis, intestinal hemorrhages, hemorrhoids, etc.
Derangements of the Nervous System. In this connection may be named the lameness of the right shoulder which accompanies certain disorders of the liver, the extreme dullness and depression that attends on others, the sluggish pulse that appears in certain types, the unsteadiness of gait (giddiness) in others, the muscular cramps, and irritability in still others. These appear to be due in some instances to the nervous sympathy of one part with another, whilst at other times they as manifestly depend on the circulation in the blood of partially oxidized and other morbid products of hepatic disorder which prove direct poisons to the nervous system.
Derangements of the circulation, like extreme rapidity, or slowness of the pulse, irregularities in rhythm and intermissions, may be charged more directly on the nervous affection, though primarily determined by hepatic disorder.
On the part of the Respiratory Organs, affections of a chronic type, like sore throat and bronchitis may often be traced to hepatic torpor or disorder.
Skin Diseases are notoriously liable to come from inactive or disordered liver, the irritant products circulating in the skin or sweating out through it, giving rise to more or less irritation. The result may be a simple pruritus, an urticaria, an eruption of papules, vesicles or even pustules. In any such cases it is proper to look for other indications of liver disease,—pale color and offensive odor of the fæces, muco-enteritis, indigestion, icterus or yellow patches on the mucous membranes, tenderness on percussion over the asternal ribs, muscular neuralgia, nervous disorder, the passage of bile, hæmoglobin, albumen, sugar or other abnormal elements in the urine, etc.