General discussion about tumors in the liver and adjacent areas

Tumors arising in the liver area are formed either in the liver itself, or in the muscles lying on it, or in the mesentery; tumors that arise in the liver itself are formed either in its upper parts and closer to the convex side, or in the lower parts, closer to the concave side, or they form in its membranes, membranes and vessels - this is the least common, and sometimes the tumor spreads to several different parts of the liver. Further, the tumor itself cannot but be either phlegmon, in the form of an abscess or not in the form of an abscess, or yellow-billed, or mucous, or hard, in the form of cancer or not in the form of cancer, or windy, in the form of swelling. The cause of all this is a hot nature, with or without debilitating fevers, or a cold nature, which prevents digestion and expulsion of excess, or weakness in the stomach, or a blockage that collects the juices and then sends them to different parts of the liver in an unnatural direction. The cause of blockages can also be the small size of the liver and similar circumstances that cause blockage. When such obstruction a occurs in the region of the gallbladder,  it causes the blood to boil and be absorbed into the liver particles in an unnatural manner due to the abundance of bile; In general, an abundance of bile is one of the causes of hot tumors in the liver. Sometimes a tumor forms as a result of damage and complicity of the stomach and spoils digestion. Heating and rough foods and foods that are poorly digested contribute to the formation of tumors in the liver. If the liver strongly attracts nutrients and draws them in more than it should, so that they are followed by a fair amount of excess that should be rushed out, this also prepares the tumor. It sometimes happens as a result of a blow or bruise.

Any tumor in the liver is resolved by crisis. If it is formed on the convex side, then the crisis is expressed in perspiration, increased urination or nosebleeds, and if it is on the concave side, then perspiration or vomiting or diarrhea are a sign of the crisis; a tumor in the convex part is more malignant than a tumor near the depression. Any tumor that arises in the liver, hot or cold, produces a blockage, allowing only watery blood into the liver. In this case, the liver turns out to be too weak to separate aqueous humor, and as a result, a lot of aqueous humor is retained in the mesentery; This is the cause of “meat dropsy” and “skin dropsy”. If a hot tumor passes from the liver to the spleen, then it is harmless, but if it passes from the spleen to the liver, then it is malignant.

General signs of liver tumor due to complicity. As for the general symptoms, they are as follows: the patient feels a constant heaviness under the false ribs and feels severe pain in this place from time to time, but not as much as with blockages, because blockages are devoid of severe pain. With tumors, the appearance changes, and the situation is not the same as with swelling, when the appearance does not change, and there is also a feeling of pulling the collarbones downwards, which is felt often, but not constantly; such stretching occurs only due to the tension of the vena cava and suspensory ligaments. With liver tumors, hot and other, there is no beating, because the arteries branch finely in its membrane, and the heaviness occurs only to an imperceptible degree.

The posterior ribs are sometimes involved in pain in the liver and its tumors, high and rising, although they are not always involved. Those suffering from tumors in the liver, especially hot and large ones, cannot sleep on the right side; It is also difficult for them to sleep on their left side, since the swelling pulls downward, and they are most likely to sleep lying on their back. If the tumor is on the convex side, then heaviness is felt in this place; Tension is also felt near the hypochondrium and suspensory ligaments, and when palpated, the tumor is detected more often and more clearly, especially in a thin patient. There is also a dry cough and shortness of breath, especially if the patient inhales forcefully, because the abdominal obstruction and lungs participate with the liver in suffering. Urine becomes scarce, and sometimes it is completely retained if the tumor is large, since the tumor causes an obstruction on the convex side of the liver and a weakening of the expelling force. The severity of such a tumor is greater than that of a tumor that forms near the cavity, because the concave side rests on the stomach and the severity is then less. The pulling of the collarbone downwards on the right side is less, especially in people whose liver, due to its structure, is not very tightly adjacent and in contact with the ribs; As for the pulling of the collarbone downwards and the participation of the collarbone in liver pain in people whose liver is tightly adjacent to the ribs, it is stronger and more obvious. Hiccups are insignificant with a tumor in the convex part and significant with a tumor in the hollow, because the convex part of the liver is further from the mouth of the stomach.

If the tumor is located on the concave part and on the lower side, then the severity is less, since this side rests on the stomach. In this case, there is no cough or shortness of breath, which should be taken into account, and when palpated, the tumor is not discernible any clearly. The pain, however, is stronger due to tightness in this place, especially if the tumor pulls on the abdominal walls. When the tumors in the liver are large, then nature is more drawn to lying supine than on the side; if they become excessive, then lying on your back also becomes difficult. Tumors on the concave side often accompany tumors in the mesenteric vessels. In general, if the tumor is on the concave side of the liver, then the stomach is more involved in the disease and hiccups, nausea and thirst appear when the tumor is hot. One of the doctors claims that the complicity between them is due to a thin nerve that connects the liver with the mouth of the stomach, and because of this hiccups arise, while another says that hiccups occur only when there is a large tumor that presses on the mouth of the stomach; According to Galen, the cause of hiccups is the outpouring of acute juice from the tumor into the stomach through the mouth. Generally speaking, hiccups, according to some doctors, appear only with a large tumor, because the distance between the liver and the mouth of the stomach is remote, and if there is a nerve common to both of them and connecting them, then it is very thin. In general, when there is no large tumor, in most cases there is no complicity between the liver and stomach. Liver tumors that form near membranes and blood vessels hurt more and give a milder fever if it is hot.

If the tumor is present on both sides at the same time, then the signs inherent in the tumor appear on both sides at the same time. Sometimes one side participates in the disease of the other to an insignificant extent; Often tumors in the liver, both hot and cold, lead to dropsy. Know that if diarrhea is combined with a tumor in the liver, it is destructive.