In this form the liver is larger than normal, 2000 to 4000 grams, and the main lesion is an inflammation of the minute bile capillaries between the columns of liver-cells. Is probably of an infectious origin.

Its surface is smooth or finely granular, dense and firm, and cuts with difficulty, but not with so much as in the atrophic form. The cut surface shows usually a decidedly mottled appearance, areas of yellow, gray, and green being intermingled. The connective tissue is not seen in bands surrounding islands of liver-cells, but occurs in a diffuse arrangement. It does not tend to contract and interference with the portal circulation is unusual.

Microscopically the new-formed connective tissue is seen to extend into the lobules between the columns of cells as well as in the interlobular areas. Proliferation and desquamation of the epithelium of the small biliary ducts occur and lead to obstruction with subsequent dilatation. There is also a multiplication of the pre-existing ducts, with the formation of new ones through a reversion of the liver epithelium. Surrounding them is an increase of connective tissue, a periangiocholitis. The number of bile-ducts may be so great as to give rise to a condition resembling an adenoma or even a carcinoma.

On account of the obstruction to the ducts jaundice is present and the liver may be dark green in color.

Portal Cirrhosis.

(Laennec's)

Biliary Cirrhosis.

(Hanot's)

Acute, 3 years or less. Small. Surface uneven, pale.

Chronic, 5 to 10 years. Large. Surface smooth, mottled green.

Connective tissue surrounding acini.

Connective tissue generally diffused and extending into acini.

Ascites appears early and often severe.

Appears late if at all.

Jaundice rarely present.

Jaundice comes on early and is very marked.

Hemorrhoids common.

Unusual.

Hemorrhage early, often profuse hematemesis.

Hemorrhage occurs late and is slight.

Obstructive biliary cirrhosis is a condition in which there has been an overgrowth of connective tissue as a result of obstruction of the large bile-ducts. The congestion of the bile in itself acts as an irritant, but there is usually an infection by micro-organisms from the intestine. The liver becomes swollen, and inflammatory reactions appear. The surface is smooth and the tissue is deeply stained by the bile. The peripheral zones of the acini show small areas of necrosis which may become transformed into minute abscesses if bacteria are present. Instead of suppurating, the necrotic areas may be replaced by connective tissue and give rise to wide-spread induration that closely resembles hypertrophic cirrhosis.

(Hypertrophic) Diffuse Cirrhosis of the Liver. X 160 (Dürck).

Fig. 159.-(Hypertrophic) Diffuse Cirrhosis of the Liver. X 160 (Dürck).

Lobular marking lost, the liver tissue separated into narrow strands by proliferating young connective tissue with short fibers, in which are wide capillaries with distinct endothelium.

The bile-ducts may increase in number, and evidences of regeneration of the hepatic cells are shown by the presence of mitotic figures.

This form generally follows obstruction of one of the larger hepatic ducts or of the common duct. If the obstruction has been complete, rapid fatty degeneration and acute atrophy may occur.

Perihepatitis or inflammation of the capsule of the liver may be present in cirrhosis and as a result of chronic peritonitis. The capsule may become greatly thickened and by contraction bring about atrophy of the hepatic tissue immediately underlying.

Rupture of the liver usually results from direct injury. Is more commonly seen in the newly born when there has been instrumental interference.