Abnormities of position are either congenital or acquired. To the former belong the abnormal position of the liver, external and internal to the abdominal cavity; as in cases of fissure of the abdominal parietes and eventration, of deficient diaphragm, of congenital umbilical hernia, of lateral transposition of the viscera. In the latter case, the entire relations of the organs have undergone a corresponding change, the large right lobe now being on the left side, and vice versa, and the vesical fossa to the left of the umbilical fissure.

Some of the acquired malpositions of the liver resemble the former, as in the case of extensive wounds of the abdominal parietes, and of the diaphragm, and of certain rare anomalies, resulting from acquired umbilical hernia. A more common occurrence is the abnormal position of the liver within the abdominal cavity, in consequence either of pressure exerted by other viscera, or of a change in the size and weight of the organ. We find the liver and the neighboring organs pushed out of their proper place by distortions of the spine; by hypertrophied neighboring viscera, e. g., the right kidney, by expansions of adjoining cavities, as of the pericardium, but more especially of the right pleura. In the latter case it is forced down into the mesogastric region by the diaphragm which is depressed by the accumulation of gases or fluids in the pleura; and as the pressure especially affects the right lobe, this portion occupies the lowest position, and comes to be placed under the left lobe.

The liver may be pushed upwards into the concavity of the diaphragm and into the thorax, by gaseous accumulations in the abdominal cavity, by ascites, by peritoneal effusion, and by tympanitic distension of the intestines. It is as variously affected by partial exudations and by morbid growths, and the change of position corresponds to their seat and magnitude.

The spontaneous change of position which the liver undergoes in consequence of increase in size and weight, is invariably a descent to a lower region of the abdomen, and it follows from the anatomical relations of the parts that it must be the right lobe which is peculiarly involved.

5. Changes Of Consistency

As these changes are always allied to other anomalies of more importance, and have therefore been already alluded to, or will be subsequently considered, we here only advert to the diminution in the consistency of the organ which takes place without any change in the hepatic tissue, in all dyscrasic processes accompanied by decomposition or subsequent to excessive elimination of the fibrine of the blood, as occurring in typhus and typhoid states, in purulent infection of the blood, and acute tuberculoses, or subsequent to extensive exudation on serous membranes, and especially in puerperal fever. The liver appears flabby, collapsed, and pultaceous; its parenchyma is softened and infiltrated with serum, generally very pale and exsanguine, or containing only pale, thin, and watery blood.