Studies on Pathophysiology of Viral Hepatitis and Cirrhosis by Means of Peritoneoscopy 2. Observations on Changes of the Surface of the Liver in Hepatitis

Alterations of the surface of the liver, in relation to histological findings, period of the course of hepatitis, splenomegaly, intraspleuic pressure and hepatic hemodynamics, were studied on 273 cases of viral hepatitis, which corresponded to "grosse rote Leber" and "grosses weisse Leber" introduced by Kalk. 1. Redness of the surface and enlargement of the liver were most frequently observed in the earliest stages of the disease and exhibited a relationship to the active histological changes of viral hepatitis. 2. Increased number and dilatation of small blood vessels as well as formation of small scars on the surface of the liver were observed in many cases showing a protracted course and were related to irreversible histological alterations. Abnormal hepatic blood flow was often demonstrated in these cases. 3. Splenomegaly was more frequently detectable in cases. with a longer period of the disease course. In relation to changes of the surface of the liver, increased, dilated small vessels on the surface were positively correlated with splenomegaly, whereas formation of small scars was negatively correlated. 4. There were some cases showing high intrasplenic pressure without an elevation of wedged hepatic venous pressure. These cases often. corresponded to those of chronic hepatitis type Ⅲ in peritoneoscopic classification (atype characterized by dilatation of small vessels on the liver surface) and type ⅡB in histological classification (a type characterized by scars in the Glisson's capsules). 5. Two sorts of small vessels were peritoneoscopically discernible on the surface of the liver: one was dendriform and the other retiform. Using intravascular injection of guttapercha, it was demonstrated that the majority of the former were originated from portal vein and the remainder from hepatic veins. On the other hand, the latter were branches of hepatic artery.