Jaundice in Chronic Hepatitis (Cirrhosis of the Liver)

Summary In order to determine the meaning and pathogenesis of jaundice in portal cirrhosis, 28 consecutive cases with marked jaundice were studied by simultaneous clinical and histological observation and by conventional biochemical determinations. A previous history of alcoholism was found in 23 of the 28, and an insidious onset of jaundice in 21 of 28. The presence of one or several of the following findings was of considerable importance in establishing the diagnosis of chronic hepatitis: collateral circulation of the abdomen, spider nevi, telangiectasis, hard or nodular liver, and varicose veins of the esophagus. Punch liver biopsy was the most important single diagnostic procedure used, since it served to demonstrate not only liver fibrosis but also changes of the liver parenchyma. Jaundice in patients with cirrhosis represents active parenchymatous liver disease and as such cannot be regarded as a manifestation of "compensated cirrhosis." Pathologically there were active changes of the liver parenchyma; which varied considerably in type and severity. There was no relation between jaundice and the degree or type of fibrosis. Jaundice appeared as a slight, transitory, almost unnoticed episode in the course of chronic hepatitis, or most commonly it was accompanied by other symptoms and findings of liver failure such as edema, ascites, and encephalopathy. Jaundice is considered a very serious sign; its presence contraindicates abdominal surgery. The importance of adequate medical management of portal cirrhosis with jaundice is emphasized, since even patients with severe liver failure can recover clinically. Recovery is accompanied by disappearance of degenerative features, regeneration of the liver parenchyma, and marked improvement of parenchymal function.