Ptosis or dropping of the liver sometimes occurs and is due to the stretching of the ligaments. Rupture is common, generally as the result of a fall from a height, on account of its size and friability. The liver is also subject to many diseases. Cirrhosis occurs in people who drink a good deal and in its later stages is accompanied by ascites, an accumulation of fluid in the abdominal cavity. When there is a general accumulation of fluid throughout the body it is known as anasarca. Syphilis causes enlargement of the liver. Abscesses occur, perhaps oftener in the tropics than farther north, and may break into the lungs, stomach, or intestine.
The Gall-bladder.—The [gall-bladder], which is simply a reservoir for the bile, is a pear-shaped organ three inches long and one inch broad. It lies in a fossa on the [under side of the liver], with the large end or fundus touching the abdominal wall just below the ninth costal cartilage. Here it can be felt as a small mass in empyema of the gall-bladder. Normally it holds a little over one ounce, but with occlusion it may become stretched. Its duct is the cystic duct, which joins the hepatic duct in the common bile duct, but bile only passes up into the gall-bladder when the opening into the duodenum is closed, that is, between meals.
If one of the bile ducts is stopped up by a stone or cancer or for any other cause, the bile backs up in the liver, the pigments are absorbed into the circulation, and jaundice results. In this condition operation is dangerous, as the time of coagulation of the blood, normally five minutes or less, is much delayed. Gall stones, formed largely of bile pigments and cholesterin, sometimes collect in the gall-bladder, where they cause irritation and may give rise to empyema of the gall-bladder. The stones vary in size from a pea to a hen’s egg and when small may be very numerous.
Fig. 57.—The pancreas, spleen, gall-bladder, etc., showing their relations.
(After Sobotta.)
The Pancreas.—Another accessory organ of digestion is [the pancreas], the abdominal salivary gland, as it is sometimes called on account of its close resemblance to the parotid gland. This is a grayish-white racemose gland, six and a half inches long by one and a half inches wide and one inch thick, lying behind the stomach on a level with the first and second lumbar vertebræ and shaped like a pistol with its handle toward the right. In an emaciated person it can be felt. The pancreatic duct runs the whole length of the gland from left to right and conveys the pancreatic juice from various little glands in the substance of the organ to the duodenum, into which it empties along with the common bile duct by a common orifice. The arteries are from the celiac axis and superior mesenteric, the veins belong to the portal system, and the nerves come from the solar plexus.
Surgically the pancreas is of no special importance, though acute pancreatitis does occasionally occur and is a very serious condition and one hard to diagnose.
The Spleen.—The largest and most important of the ductless glands is [the spleen], an oblong, flattened organ lying deep in the left [hypochondriac region] between the stomach and diaphragm above the [descending colon], and corresponding to the ninth, tenth, and eleventh ribs. It is soft, brittle, and very vascular. Its artery is a branch of the celiac axis and the vein belongs to the portal system. Its nerves are the pneumogastric and branches from the solar plexus. The function is not well understood but probably it is connected with or related to the vascular system in some way. Perhaps it manufactures blood corpuscles.
The spleen varies more in size than any other organ. Normally it cannot be felt, but in typhoid it usually can. It is generally atrophied in old age and hypertrophied in almost all acute infectious diseases, especially in typhoid fever and malaria. In leukemia it is often greatly enlarged. Sometimes in violent falls it is ruptured and there is considerable hemorrhage.
The Suprarenal Capsules.—The other ductless glands, the suprarenal capsules, yellowish triangular bodies, are situated just above and in front of the kidneys. Their function is important but not well understood. Death, accompanied by great muscular weakness, follows the removal of both, and when they are diseased, similar weakness is observed and the skin becomes bronzed. Injection of the extract of the suprarenals stimulates the muscular system. So probably they secrete into the blood minute quantities of a substance or substances beneficial to the body, especially to the muscular system.