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Hepatology: a Textbook of Liver Disease, 4th edition
  1. D H Adams

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The fourth edition of Zakim and Boyer’s Hepatology: a Textbook of Liver Disease is published this year and significantly updates the previous edition published in 1996. The work once again comes in two volumes with exactly 100 contributing authors, the majority of whom are from the USA. The book is arranged into four sections. Sections 1–3 are in volume 1 and cover cell biology, biochemistry, and physiology (section 1); the systemic effects of liver disease (section 2); and laboratory methods for evaluating liver disease (section 3). The whole of volume 2 is taken up by section IV covering aetiology, clinical features, diagnosis, and treatment of specific liver diseases subdivided into toxic injury, infection, chronic liver disease, tumours, childhood liver disease, diseases of the biliary tree, and special topics.

The approach works well and all the relevant areas are comprehensively covered. There is inevitably some duplication between sections but this is kept to a minimum. Placing most of the basic science in the first volume allows readers who want to concentrate on specific diseases to do so easily and then to refer to the first volume if they need further background. There are some inconsistencies in this approach, for instance immunology is included under section IV “Diagnosis and management of chronic forms of liver disease”. Given the major physiological role of the liver as an immune organ and the fact that many acute liver diseases have an immunological basis, it might have been appropriate to highlight immunology in volume 1 where it would fit very well with the excellent chapters on hepatic regeneration and fibrosis. Section 3 contains an informative chapter on laparoscopy but only a four page section on hepatic imaging. Imaging is subsequently covered in the individual chapters in section IV but given the major advances in interventional radiology and imaging it would have been appropriate to give this subject a chapter of its own. For example, there are only two brief references to positive emission tomography in the whole book.

Individual chapters are extremely well referenced although it might help to highlight the most significant references or those that provide an in depth review. One minor criticism is the quality of some of the figures. The chapters are richly illustrated but there is an irritating variation in the quality and style of the line drawings. It would have improved the overall appearance of the book if figures had been redrawn in a uniform style, and for some of the figures this would also have improved their clarity. The reluctance to use colour is presumably based on cost considerations. However, the recently published Comprehensive Clinical Hepatology edited by O’Grady, Lake, and Howdell (Mosby), provides an example of how the use of modern technology can provide outstanding illustrations that enhance the readability of the book.

How does Zakim and Boyer compare with other similar volumes? The two main rivals are the Oxford Textbook of Clinical Hepatology and Schiff’s Diseases of the Liver, both of which were last updated in 1999. All three works are excellent. There are some differences in emphasis and presentation between them but all three are highly readable and cover the field comprehensively. I have greatly enjoyed having access to Zakim and Boyer over the last few weeks and would recommend the fourth edition unreservedly to anyone with an interest in liver disease, whether research scientists, specialist hepatologists, or gastroenterologists. The editors are to be congratulated for managing to improve an already outstanding reference work.

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