Careful preparation of the patient who is a poor surgical risk has greatly reduced the morbidity and mortality following surgical operations. In no field of surgery has this been more definitely proved than in the treatment of obstruction of the common bile duct and of serious hepatic injury. The histologic picture of the liver in these conditions often is one of extensive hepatitis, fibrous tissue replacement, parenchymal degeneration and fatty infiltration. Prior to operation, tests of hepatic function may give little or no indication of the degree of injury to the liver parenchyma. However, subsequent to the trauma of operation and anesthesia, hepatic insufficiency of such degree as to jeopardize the life of the patient may become evident. Extensive damage to the liver may be present before it is detectable by the tests now available. For this reason it is safe to assume that damage to the liver is present
JOHNSON J, RAVDIN IS, VARS HM, ZINTEL HA. EFFECT OF DIET ON COMPOSITION OF THE LIVER IN THE PRESENCE OF OBSTRUCTION OF THE COMMON BILE DUCT. Arch Surg. 1940;40(6):1104–1115. doi:10.1001/archsurg.1940.04080050067006
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