Perihepatitis

PERIHEPATITIS (from Greek peri- around and hepatitis- inflammation of the liver), inflammation of the capsule of the liver. The term P. primarily refers to true inflammatory changes in the capsule of the liver, but in addition it is traditionally applied to many processes of connective tissue growth in or around the capsule of the liver that do not essentially have an inflammatory character. This includes in particular so-called "chronic P." - purulent pathological conditions in the form of adhesions, synechiae between the liver and surrounding parts, focal or diffuse thickening of the capsule of the liver of various origins, "glazed" liver (perihepatitis hyperplastica, s. cartilaginea) (see Glazed organs) and others. P. can be acute and chronic. In acute P., a serous, fibrinous, or purulent exudate is observed, but most often P. takes the form of fibrinopurulent inflammation of the peritoneum covering the liver in general peritonitis; sometimes, conversely, acute purulent P. is the result of purulent processes of various origins in the liver itself with spread to the rest of the peritoneum. As an outcome of acute purulent P., the exudate may become encapsulated between the diaphragm and the surface of the liver, i.e., a subphrenic abscess develops (see). Chronic perihepatitis, characterized by the formation of new connective tissue, occurs either as an outcome of acute exudative inflammation with organization of the exudate or (less often) the process from the very beginning proceeds as chronic productive inflammation (for example in liver cirrhosis). The outcome in organization of acute P. results in the formation of adhesions; sclerosing P. without the formation of peritoneal adhesions but with persistent changes and hyalinization of the connective tissue of the capsule is encountered much less frequently, which relates to so-called glazed liver. In addition to P. resulting from the spread of inflammation to the capsule from the liver itself or as a partial manifestation of general peritonitis, the inflammatory process can spread to the liver capsule from nearby organs, e.g., from the gallbladder in pericholecystitis, from the serous membrane of the stomach, and even from distant areas, e.g., from the pleura. In the latter case, the spread of the process occurs exclusively through lymphatic pathways connecting the liver capsule with the diaphragm, pleura, and mediastinum. In turn, from the liver capsule the process can spread to adjacent parts, e.g., to the porta hepatis. In this case, with purulent inflammation, thrombosis of the portal vein may occur, and with chronic inflammation accompanied by shrinkage of connective tissue, compression of blood vessels and bile ducts, stagnation of blood in the portal vein, or obstructive jaundice. Finally, from the liver capsule the inflammatory process can spread more or less deeply to the liver itself - "subcapsular (marginal) cirrhosis" of the liver (see also Hepatitis). All these complex relationships in the spread of the process indicate the possibility of P. of combined origin, which is actually observed. Special description is deserved by those cases of chronic P. when it occurs in connection with changes in the liver itself. An essential condition for the development of chronic P. in these cases is disturbance of blood circulation in the liver. With prolonged stagnation of blood in the liver, serous P. is often observed (Rossle), the outcome of which is clouding and thickening of the liver capsule, either uniform and diffuse, or in the form of separate spots. Mild thickening of the liver capsule (chronic P.) is a fairly common phenomenon in liver cirrhosis (see). In specific diseases of the liver, e.g., in its syphilis, the liver capsule is particularly prone to chronic inflammatory changes and is usually markedly thickened. Finally, the persistent changes obtained in some cases of isolated glazed liver also belong here. But for the origin of this special type of chronic P., in addition to stagnation of blood in the liver, the participation of a second factor is necessary, namely - intoxication causing changes in the endothelium of the capillaries of the liver capsule and in the endothelial covering of the peritoneum itself (chronic plastic P.). In addition to the usual chronic perihepatitis of the glazed liver and Pick's pericarditic pseudocirrhosis of the liver, nodular P. is also distinguished: the formation of the smallest fibrous nodules on the surface of the liver, for example in chronic endocarditis. Their rheumatic nature, however, has not been proven.-- Being a fairly frequent pathological-anatomical finding, perihepatitis nevertheless does not give typical clinical symptoms. The only form of perihepatitis that has been well studied clinically is perhaps the glazed liver observed in Pick's pseudocirrhosis. Lit.-see lit. to art. Liver.