Pediatrics : the hygienic and medical treatment of children . ntion. Examination in this stage may show slightenlargement of the liver. With the advance of the disease process, the most characteristicsymptom is ascites, which is usually moderate in amount at thisstage. The liver may be enlarged, or may be of normal size. Thesurface may seem somewhat irregular to palpation. Next to ascites. 164 Diseases of Liver, Pancreas and Peritoneum the most characteristic symptom of this stage is dilatation of thesuperficial veins of the abdominal wall. The spleen is usually en-larged. There may be hemorrh
Pediatrics : the hygienic and medical treatment of children . ntion. Examination in this stage may show slightenlargement of the liver. With the advance of the disease process, the most characteristicsymptom is ascites, which is usually moderate in amount at thisstage. The liver may be enlarged, or may be of normal size. Thesurface may seem somewhat irregular to palpation. Next to ascites. 164 Diseases of Liver, Pancreas and Peritoneum the most characteristic symptom of this stage is dilatation of thesuperficial veins of the abdominal wall. The spleen is usually en-larged. There may be hemorrhages from the nose, stomach orintestines. Icterus may be present, but is usually slight. In the late stage of the disease ascites is very marked, and occa-sionally there is general dropsy. The liver is smaller than normaland is usually not palpable. Diarrhea is often present. Cachexiabecomes very marked, the course of the disease is more rapid thanin adults, and death occurs either from exhaustion, or from a terminalgeneral streptococcus infection. Fig. 237. Hypertrophic cirrhois. Female, 18 months old DIAGNOSIS.—In early infancy a marked enlargement of theliver usually means S3^hilitic cirrhosis. In late infancy and child-hood, if enlargement of the liver is unaccompanied by ascites, cir-rhosis should be considered as no more than a very remote possi-bihty. All the other causes of enlargement of the liver, namely,passive congestion, abscess, sarcoma, fatty infiltration and leukem^ia,are more common than cirrhosis as a cause of hepatic when all these conditions can be excluded, should cirrhosisbe suspected. A more difficult problem in diagnosis is presented when ascites Cirrhosis of the Liver 165 is the principal clinical manifestation. The other conditions causingascites in children are cardiac disease, nephritis and tuberculousperitonitis. It must be remembered that all these are much morecommon than cirrhosis of the liver. The differential diagnosis ofthe
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectpediatr, bookyear1917
