It is now a well established fact that patients with biliary fistulas or with chronic biliary tract obstruction do not absorb adequate amounts of vitamin K from the ordinary diet. Without absorption of this vitamin, prothrombin cannot be produced in the body and a marked tendency to bleed develops.
In many of these cases in which there are depleted reserves the prothrombin level is only slightly reduced prior to operation, but commonly it falls markedly after operation. This dangerous postoperative fall may be due to either of two factors: (1) excessive loss of prothrombin through hemorrhage at operation and through the postoperative formation of fibrin exudate in the margins of the wound and (2) interference with the manufacture of prothrombin by the liver. Such interference might result from decreased consumption of food or from injury to the liver. Such injury might be brought about by mechanical trauma at the time
CULLEN SC, ZIFFREN SE, GIBSON RB, SMITH HP. ANESTHESIA AND LIVER INJURYWITH SPECIAL REFERENCE TO PLASMA PROTHROMBIN LEVELS. JAMA. 1940;115(12):991–994. doi:10.1001/jama.1940.02810380021004
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