This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
The issue raised by Dr Assatourians is what is the most informative and safest procedure in a patient who has total bilirubin levels of 32 mg/100 ml; alkaline phosphatase, 215 IU/100 ml; and SGOT, 260 IU/100 ml. This combination of laboratory abnormalities might well be seen in drug jaundice but is certainly compatible with extrahepatic obstruction. Even if there were only a 25% chance that this patient had a dilated biliary tree, I would prefer not to risk bile peritonitis with a liver biopsy. The risks of liver biopsy in patients with obstructive jaundice have been reviewed by Harold Conn, MD, in an editorial (Gastroenterology 68:817, 1975) and are not negligible. In addition, a liver biopsy cannot always differentiate between extrahepatic and intrahepatic cholectasis.
Endoscopic retrograde cholangiopancreatography is a rapid and safe method of visualizing the biliary tract. Our selection of it as our initial diagnostic approach seems
Schneider R. Dantrolene Hepatitis-Reply. JAMA. 1976;236(12):1351. doi:10.1001/jama.1976.03270130015006
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: