The most important pathologic conditions of the liver are acute and chronic passive congestion, thrombosis of portal veins, atrophy (simple and brown), fatty infiltration, cloudy swelling, fatty degeneration, acute yellow or red atrophy, amyloid, phosphorus-liver, abscess (metastatic, tropical, purulent cholangitis), cirrhosis (Lænnec’s or atrophic, Hanot’s or hypertrophic, fatty, biliary, cardiac), pericarditic pseudocirrhosis, tuberculosis, syphilis (very common: gummata, interstitial hepatitis, cirrhosis, hepar lobatum), actinomycosis, leukæmic infiltrations, glycogen infiltration (diabetes), pigmentations (hæmosiderosis in pernicious anæmia, malaria, hæmolytic poisons, etc., hæmatoidin in atrophy, bile-pigment in icterus, anthracosis, argyrosis, malaria pigment, melanin), neoplasms (most common tumor is the cavernous angioma, usually in old people, rarely of clinical significance; primary carcinoma and sarcoma rare; secondary very common [melanotic sarcoma, lymphosarcoma, metastases from carcinoma of gall-bladder and duct, stomach, pancreas and intestine, metastases of malignant syncytioma], adenoma and cystadenoma are rare), cysts, congenital cystic liver, parasites (echinococcus hydatidosus, granulosis and multilocularis, cysticercus, distomum hepaticum, pentastomum denticulatum, coccidium oviforme).
8. Gall-bladder. Note size (length 8-17 cm., diameter 3 cm., thickness of wall 1-2 mm.), amount and character of contents (clear and watery in hydrops, seropurulent or purulent in inflammation, excess of mucus in catarrhal inflammation), calculi, bile-sand, thickening and indurations of wall, œdema, character of mucosa, carcinoma (adenocarcinoma, squamous-celled). Note size, contents, thickness of wall and character of mucosa of ducts.
9. Portal Vein. Note contents, character of wall, occurrence of stenosis, thrombosis, pylephlebitis, thrombopylephlebitis, syphilitic changes, calcification, pressure from without.
10. Mesentery. Amount of fat, color, condition of vessels, blood-content, occurrence of œdema, inflammation, abscesses, hæmorrhages, infarction, gangrene, fat-necrosis, aneurism, embolism, thrombosis, cysts, parasites (bilharzia hæmatobia), tumor-infiltrations and primary tumors (lipoma).
11. Mesenteric Glands. Size, appearance on section (rose-red in acute inflammation, grayish-white in chronic), occurrence of tubercles, secondary tumors, calcification, abscesses, pigmentation, typhoid necrosis, primary lymphosarcoma, leukæmic hyperplasia, Hodgkin’s, etc.
12. Adrenals. Weight 4-7.5 grms. measurements are 5-6 cm. long, 2.5-3.5 cm. broad, 0.5-1 cm. thick. Normally the consistence is firm; it is increased in amyloid degeneration, tuberculosis, syphilis, fibroid induration and atrophy; diminished in hæmorrhage, soft caseating tubercles, degenerating tumors. Postmortem autolysis of the medulla takes place very quickly, the cortical portion remaining as a hollow capsule. On section note the relations of the grayish-white cortex (more yellow and opaque in adults from the amount of fat contained in the cells), the intermediate brown zone and the central grayish, translucent portion of the medulla. The most important pathologic conditions are tuberculosis, syphilis, atrophy, compensatory hypertrophy, hæmorrhage, infarction, thrombosis of adrenal vessels, secondary tumors (melanotic sarcoma, carcinoma), primary neoplasms (hypernephroma, accessory adrenals typical and atypical, lipoma, glioma, neuroma, sarcoma), parasites (echinococcus).
13. Kidneys. Right kidney weighs 110-145 grms., and measures 10-12 cm. long, 4.5-5.0 cm. broad, and 3-4.5 cm. thick. Left kidney weighs 150-180 grms. and measures 12 cm. long, 5-6 cm. broad, 3-4.5 cm. thick. The left kidney is usually larger and heavier than the right. Note position and movability of kidneys, thickness and color of fatty capsule (increased in lipomatosis, atrophy of kidney), purulent infiltrations and fibroid thickenings of the perirenal fat. Normally the fibrous capsule is thin and translucent, easily stripped off, the inner layer remaining attached around the blood-vessels passing from capsule into cortex. The capsule is adherent in chronic inflammations and over healed infarcts and localized inflammatory processes, tubercles, tumor-nodules, etc. Note alterations in shape and size (“horse-shoe kidney,” “hog-back,” round, fœtal lobulations, fissures; enlarged in acute parenchymatous nephritis, pyelonephritis, hydronephrosis, chronic passive congestion, etc.; diminished in atrophy, chronic interstitial nephritis, etc.). Character of cortical surface (normally smooth, grayish-brown in color; a fine or coarse, regular or irregular granulation of the surface occurs in chronic nephritis, the elevations corresponding to the preserved portions of the parenchyma, the depressed portions to the areas of connective-tissue increase; localized depressions or fissures may be caused by old or recent scars of infarcts, abscesses, rupture, etc. Distinguish fœtal furrows from pathologic depressions. Flat, puckered or radiating scars point to syphilis. Elevations of the surface may be due to fresh infarcts, tubercles, abscesses, neoplasms, etc. Accessory adrenal tissue (resembles adipose tissue) and small papillary adenomata are very common on the cortical surface. Retention- and degeneration-cysts are also very common, particularly in the kidneys of adults). In atrophic kidneys the glomeruli can be seen through the cortical surface. Note condition of superficial vessels (stellate veins). The color of the cortical surface depends essentially upon the blood-content and the condition of the parenchyma. In acute or chronic parenchymatous nephritis the color is whitish or grayish-white. Localized fatty degeneration and cloudy swelling cause pale, grayish-yellow, opaque spots or streaks. Hæmorrhages appear as red or brown-red spots. In extreme passive congestion the kidney may be a dark purplish-blue (cyanotic kidney). In hæmorrhagic nephritis the surface may be covered with pin-point or pin-head hæmorrhages. In pyæmia or acute ascending pyelonephritis the surface may be dotted with gray or yellowish pin-head abscesses. Metastatic abscesses are uniformly distributed; others are arranged in groups. In miliary tuberculosis the surface may contain numbers of grayish translucent miliary tubercles, with opaque centers when caseation has taken place. They cannot be so easily scraped out with the knife as the abscesses. Calcified glomeruli may also appear as white spots. Proliferations of the interstitial tissue cause large, red kidneys. Anæmic infarcts are yellow, brick-red or rusty, with a deeper red zone about them. Pseudomelanosis (usually postmortem) gives a gray-green color to the kidney. In icterus the color may vary from brownish-yellow to deep bronze. The consistence of the kidney is increased in chronic passive congestion, atrophy, interstitial nephritis and amyloid degeneration; decreased in acute degenerations and inflammations.
On section note color, blood-content and consistence of cut-surface, relations of cortex and medulla. The cortex is normally 0.5-1.0 cm. broad (increased in acute degenerations and inflammations, diminished in chronic inflammation and atrophy). Note number, size and color of the glomeruli. They appear as red pin-head points in congestion; in anæmia as small colorless granules; in the normal kidney as small reddish points against the lighter color of the labyrinths. In amyloid disease they are enlarged and glassy. Calcified glomeruli are white and opaque. In venous congestion the interlobular veins appear as bluish-red stripes; hæmorrhages appear as red points in the glomeruli and convoluted tubules, as red stripes in the collecting tubules. The blood-content is increased in chronic passive congestion and chronic alcoholism. On the cut-surface anæmic infarcts are usually wedge-shaped, with the base toward the cortical surface. The color of the kidney-parenchyma is usually gray; in fatty degeneration and cloudy swelling it becomes yellow or grayish-yellow. The areas of greatest degeneration appear as cloudy, opaque, yellowish points and stripes. Slight degenerations are shown by slight cloudiness of the cortex. The contrast between the grayish-white cortex and the dark-red medulla is often very striking in severe parenchymatous nephritis. In uric-acid infarction of the new-born ochre-yellow or vermilion-red stripes or lines are seen in the medullary pyramids; white lines indicate chalk-infarction; golden-yellow lines a bilirubin infarction. In gout whitish deposits of urates occur in the kidney; they are usually surrounded by scar-tissue. In purulent pyelonephritis yellow stripes of pus surrounded by hæmorrhage occur in the pyramids. Tuberculosis begins usually in the papillæ, destroying the pyramids first and then the cortex, forming a multilocular sac lined with caseating tissue. In hydronephrosis due to obstruction of the ureter the kidney becomes converted into a multilocular sac without ulceration or caseation of its papillæ. Note size of pelvis and calices, contents, character of mucosa, concretions, etc. The normal mucosa is grayish-red and delicate; it is rose-red in inflammation and often shows petechiæ. In severe inflammations grayish-white sloughs encrusted with urates are often found. Concretions of urates, phosphates or oxalates may be present, often associated with decubital ulcers of the mucosa. Tuberculous ulcers of the pelvic mucosa are common. The ureters are straight and about 4 mm. thick. Note size, contents, thickness of wall, changes in the mucosa, obstruction, dilatation, concretions, etc.
The most important pathologic conditions of the kidneys are anomalies (horse-shoe kidney, dystopia, double ureters, congenital lobulation), floating kidney, congestion, anæmia, infarction, thrombosis and embolism of renal vessels, atrophy (simple, arteriosclerotic), hydronephrosis, nephrolithiasis, nephritis (parenchymatous, hæmorrhagic, secondary contracted, primary contracted), rupture, amyloid degeneration, abscess, pyelonephritis, tuberculosis, syphilis, actinomycosis, uric-acid infarct, hæmatoidin- and hæmosiderin-infarct, bilirubin-infarct, chalk-infarct, argyrosis, retention- and degeneration-cysts, congenital cystic kidney, neoplasms (hypernephroma and adenoma the most common; carcinoma infrequent, sarcoma more common, particularly the congenital adenosarcoma or rhabdomyosarcoma; fibroma, leiomyoma, lipoma and angioma are relatively rare. Secondary carcinoma and sarcoma are common), pyelitis, ureteritis (cystica, polyposa, diphtheritica, purulenta), pyonephrosis, parasites (distomum hæmotobium, echinococcus, filaria, cysticercus, pentastomum and dioctophyme renale).
14. Abdominal Aorta, Iliacs and Vena Cava. Note size of lumen, thickness of wall, character of endothelium and contents. Sclerosis, fatty degeneration of intima, atheroma, calcification, aneurism, inflammation, thrombosis, stenosis, dilatation, compression, and infiltrations with pus or neoplasm are the most important conditions.