There is infiltration into the tissues of the liver, of the so-called
amyloid substance. The infiltration begins in the blood-vessels, the
hepatic artery first, then the central zone or periphery, and finally
all structures of the liver. This disorder should be viewed as a
disturbance of metabolism.
=Etiology= and =Pathology=.—This condition is usually found in cases of
prolonged suppuration, especially associated with tubercular disease
of the bones as in hip-disease, syphilis, rickets, malaria, cancer
and leukemia. It is believed by some to be the result of microbic
invasion, especially the tubercle bacillus and staphylococcus. Lesions
are frequently found from the fifth to the tenth dorsal vertebræ, which
probably act as predisposing factors.
The liver is considerably enlarged and rounded. It is pale or waxy in
appearance and is doughy in consistency. On section it is anemic and
whitish, partly due to infiltration into the walls of the blood-vessels
narrowing the lumen. The amyloid changes may be circumscribed and in
some cases fatty infiltration is present.
=Symptoms.=—There are no characteristic symptoms except the enlargement
of the liver, although the complexion may be waxy and there may be some
gastro-intestinal disturbances. Pain is absent, although occasionally
there is a dragging sensation, due to the weight of the organ. Jaundice
is not present, but the stools may become light colored, owing to a
diminished secretion of bile. The urine may be increased in amount and
contain some albumin if amyloid occur in the kidneys. Emaciation and
anemia are present and ascites seldom occurs. Amyloid changes involve
the spleen, kidneys, intestines and other organs.
=Diagnosis.=—The organ being large, hard and smooth, with absence of
jaundice and ascites, the presence of albuminuria and an enlarged
spleen and with the history of the case, mistakes are not likely to be
made.
=Prognosis.=—Depends upon the cause. The progress may be rapid or slow.
=Treatment.=—Careful attention to the primary disturbing factor and
direct treatment to the liver will, in some instances, reduce the
size of the organ. Nitrogenous food and hygienic measures should be
instituted. The vasomotor nerves of the portal system (fifth to last
dorsal) should be treated thoroughly.