Clinical lectures on diseases of the liver, jaundice and abdominal dropsy : including the Croonian lectures on functional derangements of the liver delivered at the Royal College of Physicians in 1874 / by Charles Murchison.

  • Murchison, Charles, 1830-1879.
Date:
1877
Catalogue details

Licence: Public Domain Mark

Credit: Clinical lectures on diseases of the liver, jaundice and abdominal dropsy : including the Croonian lectures on functional derangements of the liver delivered at the Royal College of Physicians in 1874 / by Charles Murchison. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    percussion, and also, if diseased, by means of palpation. When healthy, the lower margin of the liver cannot be distinctly felt, except in the epigastrium. Even when the organ is diseased, it is, as a rule, less easily defined than the upper margin, being often obscured by a distended condition of the stomach or intes- tines, or by fluid in the peritoneum. Hence it is always most satisfactorily examined when the stomach is empty, and after the bowels have been freely moved. The liver may then be dis- tinguished from the intestines by the greater resistance it offers to pressure by the hand. In the right mammary line, the lower margin, in health, usually corresponds with the margin of the costal arch, or is half an inch above or below this; in the right axillary line, it corresponds to the tenth intercostal space; and in the right dorsal line, to the twelfth rib, although here it is usually difficult to define it from the dulness of the kidney. In the epigastrium, the lower margin of the right and left lobes usually descends to nearly half-way between the ensiform cartilage and the umbilicus. The ordinary extent of hepatic dulness, in an adult of average size, is 4 inches in the right mammary line, 4h or 5 inches in the right axillary line, 4 inches in the right dorsal line, and 3 or 4 inches in the median line anteriorly. But it must not be forgotten that, even in the same indi- vidual, the liver is constantly liable to slight alterations in its position consistently with health. During the act of inspira- tion the whole organ is slightly lowered—about half an inch— and its upper surface is somewhat flattened, whereas during expiration the organ ascends. Again, in the erect position, the lower margin will extend somewhat lower than when the patient is recumbent. If in the mammary line it correspond to the lower margin of the costal arch in the latter position, it may be a half or a quarter of an inch lower in the former. These variations however are slight, and are not likely to em- barrass the diagnosis. But difficulties in diagnosis may sometimes arise from the boundaries of the liver, as above defined, being greatly ex- ceeded without any real enlargement of the organ. After death it is often found that a liver which during life had been thought to be greatly enlarged is even smaller than it ought to be. Hence, in all cases of suspected enlargement of the liver it is important to keep in view the possibility of its being of a spurious character.