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Cirrhosis of the Liver.
—Synonyms.—Interstitial Hepatitis; Sclerosis of the Liver; Nutmeg Liver; Hobnailed Liver.
Definition.—A chronic disease of the liver, characterized by an increased connective tissue, a reduction in the size of the organ, and a degeneration of the parenchymatous constituents.
Etiology.—In a great majority of cases the disease is due to alcohol, syphilis, highly spiced and very rich foods. Cirrhosis may result from chronic obstruction of the bile ducts, due to gall stones, or tuberculosis. Cirrhosis frequently occurs between the ages of thirty and sixty years, though it may be found in the extremes of life. Men are more liable to contract the disease, owing to greater dissipations.
Pathology.—The liver is increased in size by the increase of connective tissue, and hyperaemic. On the surface it exhibits a knobbed appearance (hobnailed liver) and these knobs present through the capsule a yellowish appearance. The granulations vary in size from a pinhead to a pea. As a rule there is a little jaundice, as there is a decrease in the production of bile, instead the skin takes on an earthy, sallow tint. There is generally ascites, swelling of the feet and legs, which increases until the abdomen and the lower extremities become of an enormous size. The nutrition of the body suffers, the skin is dry and harsh. The blood is altered in quantity, and coagulates quickly. Ecchymotic spots appear on the skin, about the face and nose.
Treatment.—There are probably not many other cases of death, which need greater skill and intelligence in their treatment than does cirrhosis. The condition that presents itself is a distended abdomen with gas and liquid. The limbs are also distended and the upper part of the body is wasted away and is greatly discolored as death was caused by asphyxia.
Place the body on the board, open the femoral vein, and insert your drainage tube. It is better to use this vein as it is larger, and there is more control of the removal of blood, and we would advise in this case the use of the flexible rubber drainage tube, which can be pushed up in the vein till it reaches the right auricle of the heart if you wish. Drain all the blood possible. Use the trocar method, see [page 255], or the direct incision, see [page 257], to remove the gases and ascitic fluid from the abdomen. Use the bandage method, see [page 339] to remove the water from the tissue of the extremities.
Raise the femoral artery and inject slowly a diluted fluid and massage the face gently toward the jugular vein, using some recognized face bleacher. Then follow with an injection of fluid of full strength until you are sure the fluid has permeated every tissue of the body. Do not be afraid to use plenty of fluid. Inject the cavities.
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