This section is from the book "A Manual Of Pathology", by Guthrie McConnell. Also available from Amazon: A Manual Of Pathology.
Edema Of The Liver occurs in the course of long-continued circulatory disturbances and in severe infections. The tissue is swollen and many of the cells may contain vacuoles.
Atrophy as a primary condition depending upon local anemia is rare. Is quite common as a secondary lesion, depending upon pressure, such as tight lacing, or that resulting from the contraction of cicatricial bands. The organ becomes irregularly atrophic, the cells in the involved areas are distorted, irregular, granular, and pigmented. The nuclei generally break down.
In leukemia there are collections of lymphocytes in the connective tissue between the lobules.
Acute interstitial inflammation of the liver usually follows upon acute infectious conditions elsewhere, particularly in the intestines, but may be due to trauma. Is always suppurative in character and may appear as a single large abscess or as numerous small ones. The exciting microorganism may gain a foothold in the liver by means of (I) the portal vein, (2) the hepatic artery, (3) the hepatic veins, (4) the umbilical vein in the newborn, (5) the bile-ducts.
The organisms lodging as emboli within the capillaries set up a focus of suppuration.
Infection from amebic dysentery generally gives rise to a single large abscess in the right lobe. The pus contained within such differs from that ordinarily found in that it is grayish or pinkish in color, and mucilaginous in consistency. The exciting organism may be present.
In bacillary dysentery numerous miliary suppurative foci are found.
In suppurative thrombophlebitis (pylephlebitis) the purulent process follows along the course of the infected vessels, where it can be seen in the form of soft, white lines of suppuration with inflammatory reaction in the adjoining tissue.
The liver-cells degenerate, lose their nuclei, and become necrotic. At the same time there is extensive round-cell infiltration within as well as around the lobules. Pus cells soon appear and a small focus of suppuration is formed. This process may continue until a large abscess results.
If the abscesses are small the organ may regain an approximately normal condition through absorption of the pus with cicatrization. Large abscesses may very slowly become absorbed and their walls much thickened; lime salts may be deposited.
Fig. 157. - Atrophic Cirrhosis of the Liver. X 40 (Durck).
Well-marked bands of connective-tissue (2) divide the parenchyma of the liver into irregular islands of varying size; even in the larger of these there is no division into lobules (1). Vena centralis absent in some places; in others, excentric (upper right corner). 3. Smaller islands of liver cells. Scattered heaps of round cells in the connective tissue and toward the left a few epithelial canals with darkly colored nuclei (newly formed bile-ducts).
Instead of a favorable termination the abscess may rupture into the abdomen, into the thorax, or if adhesions have formed through the abdominal wall.
Chronic interstitial hepatitis is characterized by an overgrowth of fibrous connective tissue supposed to be due to the long-continued action of some mild irritant. Alcohol is thought to be the commonest cause.
The more usual form is that resulting from the irritating substance being conveyed in the blood, hematogenous; a second and rare form is the hepatogenous, one in which the changes follow upon an obstruction to the bile-vessels.