Obstructive Biliary Cirrhosis With Ascites

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BILIARY cirrhosis has long been of interest in clinical and experimental medicine. Karsner1 has classified biliary cirrhosis into two main categories, the first resulting from extrahepatic obstruction of the large bile ducts and the second caused by intrahepatic obstruction of the finer bile channels. The important feature in Karsner’s classification is that the changes in the liver parenchyma are brought about by obstruction of the bile flow, whether the obstruction lies outside the liver in the large bile ducts or within the liver in finer biliary channels. Both give signs of obstructive jaundice when examined by liver function tests and bile circulation studies. This is in contradistinction to Laennec’s cirrhosis or hepatitis, diseases primarily effecting the parenchymal cell of the liver. In the present discussion, we are concerned only with the liver changes caused by obstruction in the large extrahepatic bile ducts.

Experimentally, changes typical of biliary cirrhosis have been produced in animals. Rous and Larimore2 reported that ligation of the common duct in rabbits resulted in cirrhosis of an interlobular type with many new bile ducts, simple atrophy of the parenchyma of the liver, and a dwindling in the size of the lobule. By ligation of smaller ducts they were able to produce a pure mono-lobular cirrhosis. They reported similar changes in the dog. Cameron and Oakley3 found that occlusion of the common bile duct in rats, guinea pigs, and rabbits resulted in comparable findings with bile duct hyperplasia, dilatation of the bile passages, the growth of new bile. . .



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