Pathological Physiology

The liver is the great storehouse of latent energy in the body, which is accumulated in glycogen and fat. A certain proportion of fat is to-be regarded as a normal constituent of the parenchyma of the liver. This varies considerably within normal limits, depending upon the character of the food ingested and the degree of its oxidation in the liver and other tissues. After a diet consisting largely of fats and oils or of carbohydrates the accumulation of fat in the liver is considerable. Lack of exercise and unfavourable hygienic conditions, by retarding oxidation processes, also promote its accumulation. Persons addicted to constant overeating of carbohydrates are therefore liable to this affection. They become stout, take less and less exercise, and the second condition favouring fatty infiltration of the liver - namely, lack of oxidation - is added. Fatty liver is also caused by various diseases in which the composition of the blood is altered and the metabolism of oxidation is interfered with. Such are advanced anaemia, chronic alcoholism, and tuberculosis.

It is suggested by Fitz that the fatty diet often recommended for the latter disease - consisting of cod-liver oil, rich milk, butter, cream, etc. - is productive of fatty disease of the liver.

Dietetic Treatment

The dietetic treatment is indicated by the previous considerations, but since the local condition is commonly merely an accompaniment of more serious general disease, it may be unwise to advise too sudden or extreme alterations in the accustomed diet of the patient. In general, all forms of sugar, starch, and fat should be reduced gradually to a minimum, and, if possible, finally omitted entirely, excepting in tuberculous patients whose general bodily nutrition is of more importance than the danger of local fatty infiltration. In these cases the object desired is better promoted by increasing oxidation processes by climatic and hygienic treatment rather than by withholding the carbohydrates. Malt liquors and alcoholic drinks in general must be forbidden. In other cases, especially in the alcoholic form, the diet should consist of nitrogenous food, fresh green vegetables, and fresh succulent fruits. The following articles may be taken: Lean meat, boiled or broiled fresh fish, lettuce, spinach, celery, tomatoes, gluten bread, and toast.

Amyloid Liver

The condition of amyloid liver after it has become sufficiently pronounced for diagnosis is usually fatal within a short period, and consequently but little aid can be derived from dietetic treatment. The diet should be so regulated as to burden the digestive organs as little as possible, and in advanced cases such predigested foods as peptonised meat or milk ought to be given. If the stomach digestion is fairly active, nitrogenous food will agree better than the carbohydrates.

Syphilis Of The Liver

In advanced syphilitic hepatic disease non-stimulating food only is permissible, such, for example, as milk and eggs, chicken, beef or mutton broths, fresh fish, oatmeal, boiled rice, semolina, reva-lenta, bread, and light farinaceous puddings - such as tapioca, sago, blancmange, and custards. Alcohol in all forms is prohibited.

Abscess Of The Liver

In hepatic abscess the same general dietetic treatment is to be followed as that indicated for syphilitic disease of the liver. The aim should be to carefully avoid overloading the digestive organs at any time, and to give assimilable and predigested food in small quantities at frequent intervals, at least once in three hours. Animal broths and light vegetable purees, with various combinations of milk and eggs, should form the staple articles. No solid foods should be given, excepting such as a little fish, such as sole or haddock, a few oysters, sweetbread, and milk toast.

Fats in all forms are forbidden. Malt liquors, port, sherry, and all forms of strong alcohol must be prohibited. If any stimulant is required, a little hock, Moselle, or champagne may be taken, or very weak brandy, diluted with Apollinaris or Vichy.