Passive Hyperemia.

Synonyms.—Passive Congestion of the Liver; Nutmeg Liver; Cyanotic Liver.

Definition.—Enlargement of the liver due to an increase of venous blood.

Etiology.—Increased pressure in the sublobular branches of the hepatic veins causes an engorgement of venous blood, and is most frequently due to chronic cardiac lesions, especially those affecting the right heart, the blood being dammed back in the inferior vena cava and hepatic veins. This retardation of the blood also occurs in pulmonary lesions, such as chronic interstitial pneumonia, pleural effusions, and intrathoracic tumors.

Pathology.—The liver is enlarged, smooth, and of a dark-red color. A section reveals an engorgement of the hepatic vessels; these, compressing the hepatic cells, produce atrophy of many of them, while brown pigment is deposited in the lobules; this gives the liver a mottled appearance, which has given to this disease the title nutmeg liver. The sluggish circulation favors fatty infiltration. When of long standing, connective tissue formation occurs about the intralobular veins.

Symptoms.—These depend largely upon the primary lesions giving rise to it. In addition to the cardiac or pulmonary symptoms, there will be a sense of fullness and tenderness in the right hypochondriac region. Gastro-intestinal catarrh is usually present, and hematemesis may occur. There is usually more or less jaundice. Owing to portal obstruction, ascites occurs, followed later by general dropsy. The stools are light or clay colored, and the urine is colored by bile. On palpation, the liver is found enlarged and tender, sometimes extending several inches below the costal margin.

Treatment.—This is directed largely to removing the cause, or, where tliat is impossible, to modifying its effects. Thus hygienic and dietary measures must be carried out, even although it. is due to valvular lesions; but we will also use digitalis, cactus, convallaria, and other cardiac remedies. The bowels should be kept open, which is better accomplished with the salines and vegetable cathartics. Podophyllin, polymnia, chionanthus, and like remedies, influence the liver favorably, and will be used. Where there is respiratory trouble, lobelia, bryonia, and asclepias are to be given.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.