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Read e-book online Liver Disease PDF

By A. Paton (Auth.)

ISBN-10: 0433247207

ISBN-13: 9780433247203

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No patient with uncomplicated obstructive jaundice should be operated on for at least two weeks after the onset. On the other hand, it is seldom necessary to wait longer than six weeks if there has been no improvement provided the patient has been properly investigated. Where gallstones are thought to be present some surgeons prefer to wait for the jaundice to subside though the wisdom of this may be questioned. There is one exception to these general rules and that is cholangitis which, in the absence of stricture, should be regarded as a surgical emergency.

Intrahepatic Cholestasis Intrahepatic cholestasis is characterised by insidious jaundice and severe pruritus. The reason for itching is not known with certainty but is believed to be due to retention of bile salts in the blood. There is, however, a poor correlation between blood levels and itching though pruritus can sometimes be provoked by administration of bile salts and can be relieved by cholestyramine, which forms a non-absorbable complex with bile acids in the intestine. There is seldom any prodromal illness though transient abdominal * Formerly called cholangiolitic hepatitis.

This difference is partly due to the fact that older people are affected by the latter and may already be suffering from other diseases. The use of drugs may also enhance the severity of the attack. Pathology (Fig. 16) Varying degrees of liver cell damage are seen so that the lobules lose their uniformity. Features include swelling of liver cells, granularity and condensation into small, deeply staining, acidophil bodies. Necrosis tends to be patchy and prominent near the central veins where groups of enlarged Kiipffer cells may be present.

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Liver Disease by A. Paton (Auth.)


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