Diseases of the liver and biliary system / Sheila Sherlock, James Dooley.

Format:

Book

Author/Creator:

Sherlock, Sheila, Dame

Contributor:

Dooley, James (James S.)

Language:

English

Subjects (All):

Liver--Diseases.

Liver.

Biliary tract--Diseases.

Biliary tract.

Liver Diseases.

Biliary Tract Diseases.

Medical Subjects:

Liver Diseases.

Biliary Tract Diseases.

Physical Description:

xvi, 706 pages : illustrations (some color) ; 29 cm

Edition:

Eleventh edition.

Place of Publication:

Oxford ; Malden, MA : Blackwell Science, [2002]

Contents:

1 Anatomy and Function 1

Functional anatomy: sectors and segments 2

Anatomy of the biliary tract 3

Development of the liver and bile ducts 4

Anatomical abnormalities of the liver 4

Surface marking 5

Methods of examination 5

Hepatic morphology 6

Electron microscopy and hepato-cellular function 9

Sinusoidal cells 11

Hepatocyte death and regeneration 13

Extra-cellular matrix 14

Altered hepatic microcirculation and disease 14

Adhesion molecules 14

Functional heterogeneity 14

Sinusoidal membrane traffic 16

Bile duct epithelial cells 16

2 Assessment of Liver Function 19

Selection of biochemical tests 19

Bile pigments 20

Bilirubin 20

Urobilinogen 20

Bromsulphalein 21

Serum enzyme tests 21

Alkaline phosphatase 21

Gamma glutamyl transpeptidase 22

Aminotransferases 22

Other serum enzyme 23

Quantitative assessment of hepatic function 23

Galactose elimination capacity 23

Breath tests 23

Salivary caffeine clearance 24

Lignocaine metabolite formation 25

Arterial blood ketone body ratio 25

Antipyrine 25

Indocyanine green 25

Asialoglycoprotein receptor 25

Excretory capacity (BSP) 25

Lipid and lipoprotein metabolism 26

Lipids 26

Lipoproteins 26

Changes in liver disease 27

Bile acids 28

Changes in disease 29

Serum bile acids 30

Amino acid metabolism 31

Clinical significance 31

Plasma proteins 32

Electrophoretic pattern of serum proteins 33

Carbohydrate metabolism 34

Effects of ageing on the liver 34

3 Biopsy of the Liver 37

Selection and preparation of the patient 37

Techniques 37

Difficulties 40

Liver biopsy in paediatrics 40

Risks and complications 40

Pleurisy and peri-hepatitis 40

Haemorrhage 40

Intra-hepatic haematomas 41

Haemobilia 41

Arteriovenous fistula 42

Biliary peritonitis 42

Puncture of other organs 43

Infection 43

Carcinoid crisis 43

Sampling variability 43

Naked eye appearances 43

Preparation of the specimen 43

Interpretation 43

Indications 44

Special methods 44

4 The Haematology of Liver Disease 47

The liver and blood coagulation 49

Haemolytic jaundice 53

The liver in haemolytic anaemias 54

Hereditary spherocytosis 54

Thalassaemia 55

Paroxysmal nocturnal haemoglobinuria 56

Acquired haemolytic anaemia 56

Haemolytic disease of the newborn 56

Incompatible blood transfusion 56

The liver in myelo- and lymphoproliferative disease 56

Leukaemia 57

Myeloid 57

Lymphoid 57

Hairy cell leukaemia 57

Bone marrow transplantation 57

Lymphoma 58

Jaundice in lymphoma 59

Primary hepatic lymphoma 60

Lymphosarcoma 60

Multiple myeloma 61

Angio-immunoblastic lymphadenopathy 61

Extra-medullary haemopoiesis 61

Systemic mastocytosis 61

Langerhans' cell histiocytosis (histiocytosis X) 61

Lipid storage diseases 62

Primary and secondary xanthomatosis 62

Cholesteryl ester storage disease 62

Gaucher's disease 62

Niemann-Pick disease 63

Sea-blue histiocyte syndrome 64

5 Ultrasound, Computed Tomography and Magnetic Resonance Imaging 67

Radio-isotope scanning 67

Positron emission tomography (PET) 67

Ultrasound 67

Doppler ultrasound 69

Endoscopic ultrasound 70

Computed tomography 70

Magnetic resonance imaging 74

MR spectroscopy 76

Conclusions and choice 77

6 Hepato-cellular Failure 81

General failure of health 81

Jaundice 81

Vasodilatation and hyperdynamic circulation 81

Hepato-pulmonary syndrome 82

Pulmonary hypertension 84

Fever and septicaemia 86

Fetor hepaticus 87

Changes in nitrogen metabolism 87

Skin changes 87

Vascular spiders 87

Palmar erythema (liver palms) 88

White nails 89

Mechanism of skin changes 89

Endocrine changes 89

Hypogonadism 90

Hypothalamic-pituitary function 91

Metabolism of hormones 91

General treatment 92

Precipitating factors 92

General measures 92

7 Hepatic Encephalopathy 93

Clinical features 93

Investigations 95

Neuropathological changes 96

Clinical variants in cirrhotics 97

Differential diagnosis 98

Prognosis 99

Pathogenetic mechanisms 99

Portal-systemic encephalopathy 99

Intestinal bacteria 100

Neurotransmission 100

Treatment of hepatic encephalopathy 104

Diet 104

Antibiotics 105

Lactulose and lactilol 105

Sodium benzoate and L-ornithine-L-aspartate 106

Levodopa and bromocriptine 106

Flumazenil 106

Branched-chain amino acids 106

Other precipitating factors 106

Shunt occlusion 106

Temporary hepatic support 107

Hepatic transplantation 107

8 Acute Liver Failure 111

Causes 111

Clinical features 113

Investigations 113

Prognosis 118

Treatment 119

9 Ascites 127

Mechanism of ascites formation 127

Underfill and peripheral vasodilation hypotheses 127

Overfill hypothesis 129

Other renal factors 129

Circulation of ascites 130

Clinical features 130

Spontaneous bacterial peritonitis 132

Treatment of cirrhotic ascites 134

Refractory ascites 138

Prognosis 139

Hepato-renal syndrome 140

Hyponatraemia 143

10 The Portal Venous System and Portal Hypertension 147

Collateral circulation 147

Intra-hepatic obstruction (cirrhosis) 147

Extra-hepatic obstruction 148

Effects 148

Pathology of portal hypertension 148

Varices 149

Portal hypertensive intestinal vasculopathy 151

Haemodynamics of portal hypertension 151

Clinical features of portal hypertension 152

History and general examination 152

Abdominal wall veins 153

Spleen 154

Liver 154

Ascites 154

Rectum 154

X-ray of the abdomen and chest 154

Barium studies 155

Endoscopy 155

Imaging the portal venous system 157

Ultrasound 157

Doppler ultrasound 157

CT scan 158

Magnetic resonance angiography 158

Venography 158

Venographic appearances 158

Visceral angiography 159

Digital subtraction angiography 159

Splenic venography 159

Carbon dioxide wedged venography 160

Portal pressure measurement 160

Variceal pressure 160

Estimation of hepatic blood flow 161

Azygous blood flow 162

Experimental portal venous occlusion and hypertension 163

Classification of portal hypertension 163

Extra-hepatic portal venous obstruction 163

Aetiology 163

Clinical features 165

Prognosis 166

Treatment 167

Splenic vein obstruction 167

Hepatic arterio-portal venous fistulae 167

Porto-hepatic venous shunts 168

Intra-hepatic pre-sinusoidal and sinusoidal portal hypertension 168

Portal tract lesions 168

Toxic causes 168

Hepato-portal sclerosis 168

Tropical splenomegaly syndrome 169

Intra-hepatic portal hypertension 169

Cirrhosis 169

Non-cirrhotic nodules 170

Bleeding oesophageal varices 170

Predicting rupture 170

Prevention of bleeding 171

Diagnosis of bleeding 172

Prognosis 172

Management of acute variceal bleeding 173

Vaso-active drugs 174

Sengstaken-Blakemore tube 174

Endoscopic sclerotherapy and banding 175

Emergency surgery 176

Prevention of re-bleeding 176

Portal-systemic shunt procedures 177

Porta-caval 177

Meso-caval 178

Selective 'distal' spleno-renal 178

General results of portal-systemic shunts 178

TIPS (transjugular intrahepatic portosystemic shunt) 178

Shunt stenosis and occlusion 179

Control of bleeding 180

TIPS encephalopathy 180

Circulatory changes 180

Other indications 180

Hepatic transplantation 180

Pharmacological control of the portal circulation 180

11 The Hepatic Artery and Hepatic Veins: the Liver in Circulatory Failure 187

The hepatic artery 187

Hepatic artery occlusion 188

Hepatic arterial lesions following liver transplantation 189

Aneurysms of the hepatic artery 189

Hepatic arteriovenous shunts 190

The hepatic veins 190

Experimental hepatic

venous obstruction 191

Budd-Chiari (hepatic venous obstruction) syndrome 192

Pathological changes 193

Clinical features 193

Diagnosis 195

Prognosis 196

Treatment 197

Veno-occlusive disease 198

Spread of disease by the hepatic veins 198

Circulatory failure 199

Hepatic changes in acute heart failure and shock 199

Ischaemic hepatitis 200

Post-operative jaundice 200

Jaundice after cardiac surgery 201

The liver in congestive heart failure 201

The liver in constrictive pericarditis 203

12 Jaundice 205

Bilirubin metabolism 205

Hepatic transport and conjugation of bilirubin 205

Distribution of jaundice in the tissues 207

Factors determining the depth of jaundice 207

Classification of jaundice 208

Diagnosis of jaundice 209

Clinical history 209

Examination 211

Diagnostic routine 212

Familial non-haemolytic hyperbilirubinaemias 213

Primary hyperbilirubinaemia 213

Gilbert's syndrome 213

Crigler-Najjar syndrome 215

Dubin-Johnson syndrome 216

Rotor type 217

The group of familial non-haemolytic hyperbilirubinaemias 217

13 Cholestasis 219

Anatomy of the biliary system 219

Secretion of bile 220

Cellular mechanisms 221

Syndrome of cholestasis 223

Classification 223

Pathogenesis 224

Pathology 224

Clinical features 226

Diagnostic approach 231

Diagnostic possibilities 232

14 Primary Biliary Cirrhosis 241

Aetiology 241

Epidemiology and genetics 243

Clinical features 24

Diagnosis 246

Prognosis 247

Treatment 248

Immune cholangiopathy 250

Autoimmune cholangitis 253

15 Sclerosing Cholangitis 255

Primary sclerosing cholangitis (PSC) 255

Infective sclerosing cholangitis 261

Bacterial cholangitis 261

Immunodeficiency-related opportunistic cholangitis 261

Graft-versus-host disease 263

Vascular cholangitis 263

Drug-related cholangitis 263

Histiocytosis X 263

16 Viral Hepatitis: General Features, Hepatitis A, Hepatitis E and Other Viruses 267

Pathology 267

Clinical types 268

Investigations 271

Differential diagnosis 271

Prognosis 272

Treatment 272

Follow-up 272

Hepatitis A virus 273

Epidemiology 274

Clinical course 275

Prognosis 275

Prevention 275

Hepatitis E virus 276

Clinical features 277

Diagnostic tests 277

Liver biopsy 277

Prevention 277

Hepatitis G virus 278

Hepatitis TT virus 278

Yellow fever 279

Pathology 279

Clinical features 279

Treatment 279

Infectious mononucleosis (Epstein-Barr virus) 279

Hepatic histology 279

Clinical features 280

Diagnosis 280

Distinction from viral hepatitis 280

Other viruses 281

Cytomegalovirus 281

Herpes simplex 281

Hepatitis due to exotic viruses 282

Treatment 283

17 Hepatitis B Virus and Hepatitis Delta Virus 285

Hepatitis B virus (HBV) 285

Acute hepatitis B 287

Epidemiology 290

Clinical course 290

Prevention 292

Chronic hepatitis B 294

Clinical relapse and reactivation 294

Laboratory tests 295

Needle liver biopsy 295

Course and prognosis 295

Treatment 296

Outstanding problems 298

Screening for hepato-cellular carcinoma 298

Hepatitis delta virus (HDV) 300

Epidemiology 300

Diagnosis 301

Clinical features 301

Hepatic histology 302

Prevention 302

Treatment 302

18 Hepatitis C Virus 305

Molecular virology 305

Serological tests 306

Immune response 307

Epidemiology 307

Natural history 308

Clinical course 308

Hepatic histology 309

Hepatitis C and serum autoantibodies 310

Associated diseases 310

Diagnosis 311

Prognosis 311

Prevention: vaccines 312

Treatment 312

Hepatic transplantation 316

19 Chronic Hepatitis: General Features, and Autoimmune Chronic Disease 321

Clinical presentation 321

Hepatic histology 322

The role of liver biopsy 322

Classification 324

Autoimmune chronic hepatitis 325

Type 1 (formerly called lupoid) 326

Type 2 326

Primary biliary cirrhosis and immune cholangitis 326

Chronic autoimmune hepatitis (type 1) 326

Aetiology 326

Hepatic pathology 328

Clinical features 328

Differential diagnosis 330

Treatment 331

Course and prognosis 332

Syncytial giant-cell hepatitis 332

20 Drugs and the Liver 335

Hepato-cellular zone 3 necrosis 340

Carbon tetrachloride 342

Amanita mushrooms 343

Paracetamol (acetaminophen) 343

Salicylates 344

Hyperthermia 344

Hypothermia 344

Burns 344

Hepato-cellular zone 1 necrosis 344

Ferrous sulphate 345

Phosphorus 345

Mitochondrial cytopathies 345

Sodium valproate 345

Tetracyclines 345

Tacrine 345

Antiviral nucleoside analogues 345

Bacillus cereus 346

Steato-hepatitis 346

Perhexiline maleate 346

Amiodarone 346

Synthetic oestrogens 346

Calcium channel blockers 347

Fibrosis 347

Methotrexate 347

Other cytotoxic drugs 347

Arsenic 348

Vinyl chloride 348

Vitamin A 348

Retinoids 348

Vascular changes 348

Sinusoidal dilatation 348

Peliosis hepatis 349

Veno-occlusive disease (VOD) 349

Acute hepatitis 349

Isoniazid 350

Methyl dopa 351

Halothane 351

Hydrofluorocarbons 352

Systemic antifungals 352

Oncology drugs 352

Nervous system modifiers 353

Sustained-release nicotinic acid (niacin) 353

Sulphonamides and derivatives 353

Non-steroidal anti-inflammatory drugs 353

Anti-thyroid drugs 353

Quinidine and quinine 353

Troglitazone 354

Anti-convulsants 354

Chronic hepatitis 354

Herbal remedies 354

Recreational drugs 355

Canalicular cholestasis 355

Cyclosporin A 355

Ciprofloxacin 355

Hepato-canalicular cholestasis 355

Chlorpromazine 356

Penicillins 357

Sulphonomides 357

Erythromycin 357

Haloperidol 357

Cimetidine and ranitidine 357

Oral hypoglycaemics 357

Tamoxifen 357

Other causes 357

Dextropropoxyphene 357

Ductular cholestasis 357

Biliary sludge 357

Sclerosing cholangitis 357

Hepatic nodules and tumours 358

Hepato-cellular carcinoma 358

21 Hepatic Cirrhosis 365

Classification of cirrhosis 368

Clinical cirrhosis 371

Compensated cirrhosis 374

Decompenstated cirrhosis 375

Prognosis 376

Treatment 377

22 Alcohol and the Liver 381

Risk factors for alcoholic liver diseases 381

Metabolism of alcohol 382

Mechanisms of liver injury 384

Morphological changes 386

Fatty liver (steatosis) 386

Alcoholic hepatitis 387

Cirrhosis 387

Early recognition 389

Investigation 389

Clinical syndromes 390

Fatty liver 390

Acute alcoholic hepatitis 390

Hepatic cirrhosis 391

Cholestatic syndromes 391

Relationship to hepatitis B and C 391

Hepato-cellular cancer 393

Associated features 393

Prognosis 393

Treatment 394

Acute alcoholic hepatitis 394

Cirrhosis 395

Hepatic transplantation 395

23 Iron Overload States 399

Normal iron metabolism 399

Iron overload and liver damage 401

Genetic haemochromatosis 401

Other iron storage diseases 407

Non-HFE-related inherited iron overload 407

Dysmetabolic syndrome 408

Erythropoietic siderosis 408

Late stage cirrhosis 408

Chronic viral hepatitis 408

Non-alcoholic fatty liver disease 408

Neonatal haemochromatosis 409

African iron overload (Bantu siderosis) 409

Porphyria cutanea tarda 409

Haemodialysis 409

Acaeruloplasminaemia 409

Transferrin deficiency 409

24 Wilson's Disease 413

Molecular genetics: pathogenesis 413

Pathology 414

Clinical picture 415

Hepatic forms 416

Neuropsychiatric forms 417

Renal changes 417

Other changes 417

Laboratory tests 417

Liver biopsy 418

Scanning 418

Diagnostic difficulties 418

Treatment 419

Prognosis 420

Indian childhood cirrhosis 421

Hereditary acaeruloplasminaemia 421

25 Nutritional and Metabolic Liver Diseases 423

Malnutrition 423

Fatty liver 423

Diagnosis 424

Classification 424

Non-alcoholic fatty liver disease 427

Non-alcoholic hepatic steatosis 428

Non-alcoholic steatonecrosis 428

Effects of jejuno-ileal bypass 429

Parenteral nutrition 429

Vitamins 429

Carbohydrate metabolism in liver disease 431

Hypoglycaemia 431

Hyperglycaemia 431

The liver in diabetes mellitus 431

Insulin and the liver 431

Hepatic histology 431

Clinical features 432

Liver function tests 432

Hepato-biliary disease and diabetes 432

Glucose intolerance of cirrhosis 432

Treatment of diabetes in cirrhotic patients 433

Glycogen storage diseases 434

Type I (von Gierke's disease) 435

Type II (Pompe's disease) 436

Type III (Cori's disease) 436

Type IV (Andersen's disease) 437

Type VI (Hers' disease) 437

Hepatic glycogen synthetase deficiency (type 0) 437

Hereditary fructose intolerance 438

Glutaric aciduria type II 438

Galactosaemia 438

Mucopolysaccharidoses 439

Familial hypercholesterolaemia 439

Amyloidosis 440

[alpha subscript 1]-Antitrypsin deficiency 443

Hereditary tyrosinaemia 445

Cystic fibrosis 446

Liver and thyroid 447

Thyrotoxicosis 447

Myxoedema 447

Changes with hepato-cellular disease 447

Liver and adrenal 448

Liver and growth homone 448

Hepatic porphyrias 448

Acute intermittent porphyria 449

Hereditary coproporphyria 450

Variegate porphyria 450

Porphyria cutanea tarda 450

Erythropoietic protoporphyria 450

Congenital erythropoietic porphyria 451

Hepato-erythropoietic porphyria 451

Secondary coproporphyrias 451

Hereditary haemorrhagic telangiectasia 452

Dystrophia myotonica 452

26 The Liver in Infancy and Childhood 453

Neonatal hyperbilirubinaemia 453

Unconjugated hyperbilirubinaemia 453

Haemolytic disease of the newborn 454

Hepatitis and cholestatic syndromes (conjugated hyperbilirubinaemia) 455

Viral hepatitis 457

Non-viral causes of hepatitis 459

Urinary tract infections 459

Neonatal hepatitis syndrome 459

Infantile cholangiopathies 460

Biliary atresia 460

Extra-hepatic biliary atresia 460

Alagille's syndrome (arterio-hepatic dysplasia) 462

Prolonged parenteral nutrition 462

Abnormal bile acid synthesis 463

Genetic cholestatic syndromes 463

Symptomatic treatment of cholestatic syndromes 464

Other causes of cholestatic jaundice 464

Reye's syndrome 465

Reye-like syndromes 465

Cirrhosis in infancy and childhood 465

Indian childhood cirrhosis 466

Non-Indian childhood cirrhosis (copper-associated liver disease) 466

Hepatic steatosis 467

Fetal alcohol syndrome 467

Idiopathic steato-hepatitis 467

Tumour of the liver 467

Hamartomas 467

Mesenchymal hamartoma 467

Malignant mesenchymoma (undifferentiated sarcoma) 467

Adenomas 467

Hepato-cellular carcinoma 467

Hepatoblastoma 467

Infantile haemangio-endothelioma 467

Nodular regenerative hyperplasia 468

Hepatic transplantation 468

27 The Liver in Pregnancy 471

Normal pregnancy 471

Liver disease in pregnancy 471

Hyperemesis gravidarum 471

Liver diseases of late pregnancy 471

Acute fatty liver of pregnancy 471

Pregnancy toxaemias 474

The HELLP syndrome 474

Toxaemia and the HELLP syndrome 475

Hepatic haemorrhage 475

Cholestasis of pregnancy 475

Budd-Chiari syndrome 476

Intercurrent jaundice 476

Viral hepatitis 476

Biliary tract disease 477

Hepato-toxic drugs and the pregnant woman 478

Effect of pregnancy on pre-existing chronic liver disease 478

Pregnancy in liver transplant recipients 478

28 The Liver in Systemic Disease, Granulomas and Hepatic Trauma 481

The liver in collagen diseases 481

Arthropathy associated with liver disease 481

Genetic haemochromatosis 481

Hepatitis B virus (HBV) associations 481

Hepatitis C virus (HCV) associations 482

Hepatic granulomas 482

Clinical syndrome of hepatic granulomas 483

'Granulomatous hepatitis' 484

Sarcoidosis 484

Granulomatous drug reactions 486

Granulomas associated with infections 487

Hepatic granulomas in the patient with AIDS 488

Industrial causes 489

Other conditions with hepatic granulomas 489

Hepato-biliary associations of inflammatory bowel disease 490

Hepatic trauma 490

Rupture of the gallbladder 492

29 The Liver in Infections 495

Pyogenic liver abscess 495

Other infections 498

Hepatic amoebiasis 498

Tuberculosis of the liver 501

Hepatic actinomycosis 502

Other fungal infections 502

Syphilis of the liver 503

Congenital 503

Secondary 503

Tertiary 503

Jaundice complicating penicillin treatment 504

Leptospirosis 504

Weil's disease 504

Other types of leptospirosis 506

Relapsing fever 507

Lyme disease 507

Q fever 507

Rocky mountain spotted fever 508

Schistosomiasis (bilharziasis) 508

Malaria 510

Kala-azar (leishmaniasis) 511

Hydatid disease 511

Echinococcus multilocularis (alveolar echinococcosis) 516

Ascariasis 517

Strongyloides stercoralis 518

Trichiniasis 518

Toxocara canis (visceral larva migrans) 518

Liver flukes 518

Clonorchis sinensis 518

Fasciola hepatica 519

Recurrent pyogenic cholangitis 519

Peri-hepatitis 520

Hepato-biliary disease in HIV infection 520

Infections 521

Hepatitis B, C and D co-infection 522

Neoplasms 522

Hepato-biliary disease 523

Acaculous cholecystitis 524

Jaundice of infections 525

Bacterial pneumonia 525

Septicaemia and septic shock 525

30 Nodules and Benign Liver Lesions 527

Small hepato-cellular cancer 527

Nodules in the absence of underlying liver disease 528

Simple cysts 528

Haemangioma 528

Focal nodular hyperplasia 530

Hepatic adenoma 531

Focal nodular hyperplasia and adenoma contrasted 532

Liver metastases 532

Other benign tumours 534

Cholangioma (bile duct adenoma) 534

Biliary cystadenoma 534

Nodular regenerative hyperplasia 534

Partial nodular transformation 535

31 Malignant Liver Tumours 537

Hepato-cellular cancer 537

Aetiological factors 537

Pathology 540

Clinical features 541

Tumour localization 543

Needle liver biopsy 546

Screening 546

Prognosis and risk factors 547

Surgical treatment 547

Non-surgical treatment 548

Fibro-lamellar carcinoma of the liver 551

Hepatoblastoma 551

Intra-hepatic cholangiocarcinoma 552

Combined hepato-cellular-cholangiocarcinoma 553

Other primary liver tumours 553

Cystadenocarcinoma 553

Angiosarcoma (haemangio-endothelioma) 553

Epitheloid haemangio-endothelioma 554

Undifferentiated sarcoma of the liver 554

Benign tumours of the liver 554

Mesenchymal hamartoma 554

Paraneoplastic hepatopathy 554

Hepatic metastases 554

32 Imaging of the Biliary Tract: Interventional Radiology and Endoscopy 563

Plain film of the abdomen 563

Ultrasound (US) 563

Bile ducts 563

Gallbladder 563

Computed tomography (CT) 564

Magnetic resonance cholangiopancreatography (MRCP) 565

Endoscopic ultrasound (EUS) 566

Biliary scintigraphy 567

Oral cholecystography 567

Intravenous cholangiography 568

Endoscopic retrograde cholangiopancreatography 568

Endoscopic sphincterotomy 570

Endoscopic biliary endoprostheses 573

Percutaneous trans-hepatic cholangiography 576

Percutaneous bile drainage 576

Percutaneous biliary endoprosthesis 577

Resectability of tumours 578

Choice between surgical and non-surgical palliation of malignant obstruction 578

Choice between endoscopic and percutaneous approach 578

Percutaneous cholecystostomy 578

Operative and post-operative cholangiography 579

33 Cysts and Congenital Biliary Abnormalities 583

Fibropolycystic disease 583

Childhood fibropolycystic diseases 584

Adult polycystic disease 584

Congenital hepatic fibrosis 586

Congenital intra-hepatic biliary dilatation (Caroli's disease) 588

Congenital hepatic fibrosis and Caroli's disease 589

Choledochal cyst 589

Microhamartoma (von Meyenberg complexes) 591

Carcinoma secondary to fibropolycystic disease 591

Solitary non-parasitic liver cyst 591

Other cysts 591

Congenital anomalies of the biliary tract 592

Absence of the gallbladder 592

Double gallbladder 592

Accessory bile ducts 593

Left-sided gallbladder 594

Rokitansky-Aschoff sinuses 594

Folded gallbladder 594

Diverticula of the gallbladder and ducts 594

Intra-hepatic gallbladder 594

Congenital adhesions to the gallbladder 594

Floating gallbladder and torsion of the gallbladder 594

Anomalies of the cystic duct and cystic artery 595

34 Gallstones and Inflammatory Gallbladder Diseases 597

Composition of gallstones 597

Composition of bile 597

Factors in

cholesterol gallstone formation 598

Pigment gallstones 603

Radiology of gallstones 603

Natural history of gallstones 604

Silent gallstones 605

Treatment of gallstones in the gallbladder 605

Cholecystectomy 605

Laparoscopic cholecystectomy 605

Non-surgical treatment of gallstones in the gallbladder 607

Dissolution therapy 607

Direct solvent dissolution 608

Shock-wave therapy 608

Percutaneous cholecystolithotomy 609

Acute cholecystitis 610

Empyema of the gallbladder 612

Perforation of the gallbladder 612

Emphysematous cholecystitis 612

Chronic calculous cholecystitis 613

Acalculous cholecystitis 614

Acute 614

Chronic 614

Typhoid cholecystitis 614

Acute cholecystitis in AIDS 614

Other associations 615

Other gallbladder pathology 615

Cholesterolosis of the gallbladder 615

Xanthogranulomatous cholecystitis 615

Adenomyomatosis 615

Porcelain gallbladder 615

Post-cholecystectomy problems 615

Sphincter of Oddi dysfunction 616

Gallstones in the common bile duct (choledocholithiasis) 616

Managment of common duct stones 618

Acute obstructive suppurative cholangitis 618

Acute cholangitis 618

Common duct stones without cholangitis 619

Patients with gallbladder in situ 619

Acute gallstone pancreatitis 619

Large common duct stones 619

Trans T-tube tract removal of stones 620

Intra-hepatic gallstones 620

Mirizzi's syndrome 620

Biliary fistulae 621

External 621

Internal 621

Gallstone ileus 621

Haemobilia 622

Bile peritonitis 622

Association of gallstones with other diseases 623

Colorectal and other cancers 623

Diabetes mellitus 623

35 Benign Stricture of the Bile Ducts 629

Post-cholecystectomy 629

Bile duct/bowel anastomotic stricture 634

Post liver transplantation 635

Primary sclerosing cholangitis 636

Other causes 636

36 Diseases of the Ampulla of Vater and Pancreas 639

Peri-ampullary carcinoma 639

Benign villous adenoma of the ampulla of Vater 644

Cystic tumours of the pancreas 644

Endocrine tumours of the pancreas 644

Chronic pancreatitis 644

Obstruction of the common bile duct by enlarged lymph glands 645

Other causes of extrinsic pressure on the common bile duct 645

37 Tumours of the Gallbladder and Bile Ducts 647

Benign lesions of the gallbladder 647

Carcinoma of the gallbladder 647

Other tumours 648

Benign tumours of the extra-hepatic bile duct 648

Carcinoma of the bile duct (cholangiocarcinoma) 648

Cholangiocellular carcinoma 654

Metastases at the hilum 655

38 Hepatic Transplantation 657

Selection of patients 657

Candidates: outcome 657

Cirrhosis 659

Autoimmune chronic hepatitis 659

Chronic viral hepatitis 659

Neonatal hepatitis 660

Alcoholic liver disease 660

Cholestatic liver disease 660

Primary metabolic disease 661

Acute liver failure 662

Malignant disease 662

Absolute and relative contraindications 663

Absolute 663

Relative (higher risk) 664

General preparation of the patient 664

Donor selection and operation 664

The recipient operation 665

Segmental (split liver) transplantation 665

Auxiliary liver transplantation 666

Xeno-transplantation 666

Domino liver transplantation 666

Hepatocyte transplantation 667

Liver transplantation in paediatrics 667

Immunosuppression 667

Tolerance 668

Post-operative course 668

Post-transplantation complications 668

Rejection 671

Infections 673

Malignancies 675

Drug-related toxicity 675

Disease recurrence 675

Central nervous system toxicity 675

Bone disease 675

Ectopic soft-tissue calcification 675.

Notes:

Includes bibliographical references and index.

ISBN:

0632055820

OCLC:

48256954