Definition:—This condition may exhibit itself in either one of two distinct pathological forms, as in fatty heart. There may be a simple infiltration of fat cells into the tissues of the liver, or there may be actual degeneration of the liver cells by the conversion of their protoplasm, or their albuminates, into fat.
In infiltration the liver becomes enlarged, sometimes greatly so, weighing thirteen to fourteen pounds. It is of a grayish yellow color and portions of it will float, as fat will, upon water. In fatty degeneration there is an atrophy of the organ. It is smooth, soft, friable, and of a grayish yellow color with spots or areas throughout its substance which are distinctly pigmented.
Etiology:—There may be a fat liver which is not pathological, with a free deposit of fat, which is uniform throughout other portions of the body, and which increases or decreases somewhat with the ingestion of fatty foods and does not interfere with the function of the organ. This occurs in fatty persons in the enjoyment of good health. Actual degeneration is found in those who are excessive beer or wine drinkers, or who have other intemperate habits of eating and drinking—who are high livers—and yet who take but little, if any, physical exercise. It may follow the acute infectious diseases, pyemia or septicemia—any purulent inflammation—or waxy degeneration; or chlorosis or pernicious anemia, and cachexias, or any disorder in which there is a diminution of the oxygen supply to the tissues or in which there is a destruction of the red corpuscles, thereby diminishing the oxygen carrying power of the blood.
This condition follows the toxic action of several mineral substances which may be taken as poisons, or administered for a long time as medicines. These are arsenic, antimony and mercury, which were entirely excluded as medicines by the old school of eclectics, and copper, albumin, phosphorus, the mineral acids, carbolic acid and iodoform. It is also caused by autotoxemia, and by certain toxins ingested with decomposing food, as ptomaine poisoning.
Symptomatology:—Except in extreme cases the function of the liver is not greatly disturbed and no jaundice appears, and there is seldom pain or dropsy. In protracted cases there are quite serious digestive disturbances, eructations of gas, nausea, constipation with clay colored stools, or occasional diarrhea. There are frequent headaches and vertigo. There are no evidences from percussion or palpitation in the severe cases, as there is a reduction of the size of the liver, and but little soreness or pain.
Diagnosis:—In fatty degeneration, the condition is marked by a progressive reduction in the size of the organ, and there are the other results of alcoholic excesses, or poisoning. There may be present other serious disorder, or heart disease, which may act as the cause.
The diagnosis of fatty infiltration is much more simple than that of degeneration. The organ is increased in size, and there is an increase also in the size of the spleen, and usually there is general adiposity.
Prognosis:—The course of the disease is protracted and the prognosis of degeneration is serious.
Treatment:—These patients should be deprived of all alcoholics, and of tea and coffee. They should engage little by little, as they become able, in more active physical exercise in the open air, overcoming their previous habits of physical inaction. They should eat but little of fats, starches, or sugar, but should subsist on stale bread, and dry lean meats and should limit the quantity of fluids drunk at meals.
An increase of oxygen in the system is important. I believe the inhalation of oxygen, or the taking of oxygen carrying remedies, as the oxids and manganates or permanganates should be efficacious. The ferric chlorid or oxid will restore the oxygen carrying power of the blood and this restoration is important. The entire course advised for the anemias may be selected from. There should be a positive avoidance of all those mineral agents which could induce the disorder, and all conditions which act as inducing causes must be corrected.