Acute Yellow Atrophy of the Liver.
Synonyms:—Malignant jaundice; icterus gravis.
Definition:—A serious acute disorder characterized by degeneration of the parenchyma of the liver, marked jaundice and violent headache, and occasionally, by delirium, and other cerebral manifestations, and perhaps hemorrhage.
Etiology:—This disorder is not common in our own country. It occurs more frequently in females than in males, and depends upon causes which are not as yet positively determined. There are good reasons for believing that it depends upon pronounced general infection from some virulent toxin. It may be due to impressions upon the central nervous system, and occurs occasionally during pregnancy. The condition may occur primarily, or it may be secondary to other predisposing causes. It is more common in early adult life.
Symptomatology:—It develops in much the same manner as that of an ordinary case of catarrhal jaundice. There is usually weight and heaviness in the region of the liver, with perhaps tenderness and some pain. Nausea and vomiting are early symptoms, and with these severe headaches appear. From the first there is rapid increase in the discoloration of the skin, until it quickly assumes a very deep yellow color; the vomiting increases and is difficult of control; hematemesis is common. As the headache increases, the patient becames at first mildly delirious, and appears to be threatened with convulsions. Occasionally muscular tremors and convulsions appear; the patient becomes drowsy and stupid; the secretions are suppressed; the mouth is dry, the mucous membranes are dark colored; the tongue is coated with a dry brown coat and sordes appear. Usually there is some fever, although in many cases there is no change in the temperature. The pulse is slow, round and full at first, later it becomes small and rapid. The urine is scanty and has a high specific gravity, is highly colored from the presence of bile, and albumin, leucin and tirosin are frequently found present.
From absence of bile, the feces are pasty and of a grayish or slate color, will float on water and are scanty in quantity.
Diagnosis:—The rapid development of jaundice, with pronounced constitutional impressions, should be regarded with suspicion. If cerebral symptoms follow quickly, and upon examination it is determined that the size of the liver is very perceptibly reduced, a diagnosis of this disease is assured.
Prognosis:—But few cases of yellow atrophy recover.
Treatment:—The use of external heat, and the faradic current over the liver should not be omitted at the onset of the treatment. The use of active intestinal antiseptics with echinacea in half dram doses every two hours, to antagonize the toxins in the blood, and fifteen minims of chionanthus every two hours, to facilitate the normal action of the liver, should be tried. But few of us have experience in the treatment of this disorder and are able to suggest measures from personal observation.