Jaundice: Its occurrence and significance

Abstract

Thus the subject of jaundice has been briefly reviewed by outlining the pathogenesis, the various classifications and by enumerating the most important liver function tests. In obscure cases of jaundice a definite diagnosis cannot be made on the basis of one test alone. The method of study of my patients includes a careful history, a diligent physical examination and an examination of blood, urine and feces: blood, complete blood count and hemoglobin, icterus index, van den Bergh (qualitative and quantitative), total proteins, albumin-globulin ratio, prothrombin time, cholesterol and cholesterol esters, cephalin flocculation and thymol turbidity tests; urine, for urobilinogen and bile; feces, for urobilinogen and bile. Recent studies by electrophoretic methods have demonstrated an increase in the gamma globulin of the serum in patients with hepatic disease. Electrophoretic methods surpass all others in sensitivity and accuracy but this test required too much time and the cost of the apparatus makes it so that its use is restricted to medical centers and research institutes. Briefly, the surgical indications are: (1) obstruction either due to a stone or to some extrahepatic mechanical interference to the natural flow of bile, (2) complete acholia, (3) development of jaundice after cholecystectomy and (4) biliary fistula.