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CHAPTER Ⅰ THE TYPES OF LIVER INJURY AND THEIR STRUCTURAL CONSEQUENCES 1

INTRODUCTORY 1

NECROSIS OF THE LIVER 3

REGENERATION FOLLOWING INJURY 8

FIBROSIS AFTER INJURY 9

SPLENOMEGALY AS A CONSEQUENCE OF LIVER INJURY 14

INJURIES CONSEQUENT UPON DEGENERATION 15

INJURIES CONSEQUENT UPON INFLAMMATION 16

FACTORS PRODUCING LIVER DAMAGE 17

CHAPTER Ⅱ THE VASCULAR FACTOR IN LIVER INJURY 19

THE VASCULAR ANATOMY OF THE LIVER 19

OBSTRUCTION OF THE HEPATIC VESSELS 20

Portal vein 20

Hepatic artery 23

Hepatic veins 24

LOCAL VARIATIONS IN THE INTRAHEPATIC CIRCULATION 26

Stream-line effects in the portal vein 26

CHANGES IN THE INTERNAL ENVIRONMENT OF THE PARENCHYMA DUE TO CIRCULATORY OBSTRUCTION 29

Anoxia 29

Deprivation of components of the portal blood 30

Severe and mild deprivations 31

DERANGEMENTS OF THE CIRCULATION IN THE DISEASED LIVER AND THEIR CONSEQUENCES 31

Centrilobular and periportal zonal necrosis 32

Focal and midzonal necrosis 36

Massive hepatic necrosis 37

Infiltrations of the liver 40

Fibrosis 43

RELATIVE IMPORTANCE OF CIRCULATORY FACTORS IN THE PATHOGENESIS OF HEPATIC LESIONS 44

CHAPTER Ⅲ NUTRITIONAL FACTORS IN LIVER INJURY：EXPERIMENTAL 48

TYPES OF DIETETIC INJURY 48

CLINICAL FEATURES OF THE TWO TYPES OF DIETETIC INJURY 49

Massive hepatic necrosis and its sequelae 49

Diffuse hepatic fibrosis 50

PATHOLOGICAL FEATURES OF DIETETIC LIVER INJURY 51

Massive hepatic necrosis and its sequelae 51

Diffuse hepatic fibrosis 54

CHEMICAL PATHOLOGY OF DIETETIC INJURY 56

Massive hepatic necrosis 56

Diffuse hepatic fibrosis 58

PATHOGENESIS OF DIETETIC MASSIVE HEPATIC NECROSIS 59

Dietary factors responsible 59

Production of dietetic massive necrosis 63

Sulphur metabolism and hepatic necrosis 65

PATHOGENESIS OF DIFFUSE HEPATIC FIBROSIS 66

Dietary factors responsible 66

Production of diffuse hepatic fibrosis 68

MIXED LESIONS 69

PARTIAL LESIONS 70

＇SUBACUTE＇(RECURRENT LIMITED) MASSIVE NECROSIS 71

EFFECT OF GROWTH IN PRECIPITATING NUTRITIONAL INJURY 73

POSSIBLE RELATION BETWEEN MASSIVE NECROSIS AND DIFFUSE HEPATIC FIBROSIS PRODUCED BY DIET 74

CHAPTER Ⅳ NUTRITIONAL FACTORS IN LIVER INJURY：HUMAN 78

PATHOLOGICAL CONDITIONS IN MAN RESEMBLING THE LESIONS OF EXPERIMENTAL DIETETIC INJURY 78

Massive hepatic necrosis 78

Post-necrotic scarring of the liver 78

Diffuse hepatic fibrosis 82

Hepatic fibroses in general 84

DIETETIC FACTORS AS POSSIBLE CAUSATIVE AGENTS IN HUMAN DISEASES OF THE LIVER 87

Massive hepatic necrosis，post-necrotic scarring，and primary cancer of the liver in the tropics 87

Diffuse hepatic fibrosis in the tropics 89

＇Alcoholic cirrhosis of the liver＇ 94

SECONDARY NUTRITIONAL DEFICIENCY AS A CAUSE OF LIVER DISEASE 97

Pregnancy 97

Thyrotoxicosis 98

Amino-aciduria 98

METABOLIC DISORDERS PRODUCING DIFFUSE HEPATIC FIBROSIS 101

CHAPTER Ⅴ NOXIOUS FACTORS CAUSING LIVER INJURY 105

EXPERIMENTAL HEPATIC NECROSES ASSOCIATED WITH POISONING 105

Immediate necrosis 106

Comparison of immediate necrosis due to poisoning with dietetic necrosis 106

Delayed necrosis 108

FACTORS MODIFYING EXPERIMENTAL IMMEDIATE HEPATIC NECROSIS DUE TO POISONING 110

Dosage 110

Nutrient factors 110

PATHOGENESIS AND CLASSIFICATION OF HEPATIC NECROSES IN GENERAL 113

HEPATIC LESIONS IN MAN ASSOCIATED WITH NOXIOUS AGENTS 115

Toxipathic hepatitis 115

Delayed massive hepatic necrosis after exposure to poisons 118

Trophopathic hepatitis as a complication of toxipathic hepatitis 118

CHAPTER Ⅵ THE SYNDROMES OF HEPATIC FAILURE 126

EXCRETORY FAILURE 126

PORTAL OBSTRUCTION 130

Ascites and oedema 131

ENLARGEMENT OF THE LIVER 137

HEPATIC PAIN 138

PARENCHYMAL FAILURE 140

Acute 141

Chronic 141

Extreme 143

LIVER FUNCTION TESTS 146

PUNCTURE BIOPSY OF THE LIVER 147

CHAPTER Ⅶ THE CLINICAL CLASSIFICATION OF LIVER DISEASE 150

GENERAL 150

CHAPTER Ⅷ INFILTRATIONS OF THE LIVER AND POST-INFILTRATIVE FIBROSIS 152

CLASSIFICATION AND GENERAL FEATURES 152

INTRINSIC INFILTRATIONS 153

Fatty 153

Glycogen 155

EXTRINSIC INFILTRATIONS 155

Lipoidoses 155

Reticuloses 157

Amyloid 157

POST-INFILTRATIVE FIBROSIS 158

CHAPTER Ⅸ PARENCHYMATOUS HEPATITIS 160

ACUTE PARENCHYMATOUS HEPATITIS 160

Zonal 162

Massive 167

SUBACUTE MASSIVE HEPATITIS 169

CHRONIC HEPATITIS 173

Post-necrotic scarring(Chronic massive hepatitis) 174

Diffuse hepatic fibrosis 176

HEPATIC FIBROSIS OF DOUBTFUL AETIOLOGY 177

CLINICAL SEQUENCES IN PARENCHYMATOUS HEPATITIS 179

DIETETIC TREATMENT OF HEPATITIS 180

CHAPTER Ⅹ CHOLANGIO-HEPATITIS，OBSTRUCTION TO THE BILE DUCTS，AND BILIARY DIFFUSE HEPATIC FIBROSIS 185

INTRODUCTORY 185

PATHOLOGY OF CHOLANGIO-HEPATITIS 186

AETIOLOGY OF CHOLANGIO-HEPATITIS 189

CLINICAL TYPES OF CHOLANGIO-HEPATITIS 189

Subacute 190

Acute suppurative 193

Intermittent acute 194

Mild 196

Chronic(Diffuse biliary hepatic fibrosis) 198

HANOT＇S ＇HYPERTROPHIC BILIARY CIRRHOSIS＇ 199

＇CHOLANGITIS LENTA＇ 201

GENERAL CONSIDERATIONS 202

CHAPTER Ⅺ CIRCULATORY DISORDERS；FOCAL LESIONS；AND CANCER OF THE LIVER 204

CIRCULATORY DISORDERS 204

VASCULAR OCCLUSION 204

Thrombosis of the portal vein 204

Occlusion of the hepatic artery 205

Occlusion of the hepatic veins 205

CARDIAC FAILURE AND LIVER DISEASE 206

THYROTOXICOSIS 207

FOCAL LESIONS 208

Suppurative pyelophlebitis 209

CANCER OF THE LIVER 209

Primary carcinoma 209

Secondary cancer 210

CHAPTER Ⅻ 214

CONCLUSIONS 214

INDEX 216