Perihepatitis.
As a result of inflammation of contiguous serous membranes, such as pleuritis or peritonitis, or perhaps as the result of cirrhosis, a chronic form of inflammation may develop in the capsule of the liver, and thence be conveyed to the underlying tissues or structures of the organ. This is a true perihepatitis, sometimes designated as capsular-cirrhosis. It may be either acute or chronic.
The acute form may also result from an injury, or from a penetrating wound, or it may be the direct result of a cold, but extension of an acute inflammation from contiguous organs as above specified, or extension directly from the parenchyma of the liver, is the most common cause. In a large number of cases it has resulted from perforation by ulceration, either of the stomach, duodenum or colon, or from carcinoma. It tends rapidly to suppuration and results in subphrenic or other abscess.
Symptomatology:—There is acute pain, which may be at times almost agonizing, and when involving the diaphragm, it is greatly increased on each inspiration. In other cases the pain is less sharp and cutting but more constant. It may be distinctly circumscribed in location, and will be accompanied by extreme tenderness on pressure and by faintness, nausea, often vomiting, prostration and heart weakness, with rapid and feeble pulse. If the condition is protracted, there is irregular chilliness or rigors, and erratic temperature, with profuse sweating.
Diagnosis:—The disease is difficult of recognition. If associated with diaphragmatic pleurisy, it may be so diagnosed, or it may be confounded with empyema. The cough which is often induced, and the pleuritic pain are especially misleading, but the local circumscribed pain ought to assist in an exact diagnosis. There is bulging in the right hypochondrium, and dulness extending upward to the fifth or even the fourth rib, which may change if the patient changes position. Aspiration will disclose the character of the fluid.
Prognosis:—Prognosis depends upon the cause and upon an early recognition of the conditions, and also upon an early ability to freely evacuate the pus. It should be good in cases not too seriously complicated. Cases have subsided and reasonably good health followed where the pus was walled off or reabsorbed.
Treatment:—The symptoms are so similar to suppurative pleuritis, or to peritonitis of a local character, that the disease should be so treated. A hot mustard poultice is applied over the entire organ for a few minutes, over the reddened surface vaseline or sweet oil is rubbed freely, and hot applications are then applied. An exploratory needle should be early introduced. Thorough evacuation is highly essential. Tincture of aconite and specific bryonia, the latter persisted in, will be of pronounced efficiency. Fifteen drops of each should be added to four ounces of water, and a teaspoonful should be given every hour for several days, unless the temperature remains normal, when aconite should be discontinued. If opium be given, it should be in doses of from two to five drops only, of the aqueous tincture, every two hours, until the pain is in a large part relieved. Subsequently echinacea is indicated to inhibit pus formation, and tonics should be given freely as needed during convalescence.
Chronic Perihepatitis.
This disease may develop insidiously. It has been observed in a number of cases where tight corsets have been worn, or from other persistent local pressure; also from the slow development of the causes above mentioned, or from syphilis. There is persistent pain and tenderness in the region of the liver, with but few other diagnostic evidences. It may not be distinguished during life. The treatment is symptomatic and supportive. If syphilis or Other blood disorder is present, these should be persistently treated. No specific rules can be laid down.
