This is commonly termed a =floating liver=. There is prolapse of the
organ as well as its being abnormally movable. It is not of frequent
occurrence; women suffer from it much oftener than men.
Normally, the liver is partially held in place, in the concavity of the
diaphragm, by a number of peritoneal folds. The attachment of these
ligaments is to the spine and the diaphragm; their principal function
is to prevent extended lateral movements. Of greater importance in
supporting the liver in a normal position is the integrity of the
abdominal walls, and the position of the stomach and intestines. If
the abdominal walls are of normal tone the liver is very apt to be in
correct position. And the rest of the abdominal organs, especially
intestines and stomach, act as a cushion support. Often when the liver
is displaced the remaining abdominal organs are, also, out of normal
position and relation to each other; in fact, general prolapse of the
abdominal viscera is a frequent cause of liver prolapse. An additional
support of the liver is a certain cohesion of the liver and diaphragm,
and the elastic traction of the lungs.
Foremost among the =causes= that predispose to inelastic and atonied
abdominal walls are spinal irregularities, deviations, and curvatures,
which impinge nerve force and obstruct blood supply. These same lesions
weaken ligamentous supports of the liver and lessen tonicity of the
other abdominal organs, so that local or general displacements are
readily forthcoming. Strains, injuries, frequent pregnancies, etc.,
also act as causes that weaken the supports of abdominal tissues and
organs. In a word it is very often the pendulous abdomen that is the
immediate cause of a floating liver.
It is very rare to find the liver displaced to the lower region of the
abdomen. The ptosis is usually somewhat slight. The organ generally
rotates on descent, the right lobe being the lowest portion, owing to
the attachment of a ligament, the ligamentum teres, to the umbilicus.
Probably in some cases there is a congenital tendency to relaxation
of the ligaments, and, thus violent exertions and atonic and flabby
abdominal walls and diaphragm are secondary but important factors.
The principal =symptom= of a floating liver is a tumor in the right
side, which may be low down. Palpation will usually determine this.
Then the abdominal walls are flabby. Pain and bearing down of the right
side are common. There is apt to be considerable indigestion. Various
reflex symptoms are often present. The floating liver will seem larger
than normal, as the liver is below the costal arch and much of it can
be felt. Percussion will be of value in determining the extent of the
disorder.
Much can be accomplished by =treatment=, especially where the
displacement is of a lesser degree. Correcting the spinal lesions,
toning up the abdominal walls and diaphragm, and replacing the
displaced organs will be extremely effectual. The abdominal bandage may
be of service. Certainly abdominal exercises will be beneficial.
A point to remember is, stimulation over the abdomen beneath the right
costal arch will cause the liver to contract and retract. This is of
considerable osteopathic note. The liver will often recede at least a
half an inch. This is a liver reflex (Abrams).