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The Liver and Systemic Disease

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The Liver and Systemic Disease. Gitlin N. (Pp 300; illustrated; £95.00.) Edinburgh: Churchill Livingstone, 1997. ISBN 0-443-05546-7.

All hepatologists and right-thinking physicians are well aware that the liver is not only the largest internal organ but also the most important. In systemic diseases, the liver is often affected and liver function disturbed; conversely, primary liver disease can affect every other organ system. While most of the major medical and hepatological textbooks have sections on the liver in systemic disease, this inevitably tends to be rather a rag-bag of topics. The laudable purpose of this book is “to provide a review of the hepatic manifestations occurring or resulting from diseases of other organs”. To this end, Professor Gitlin has brought together a galaxy of eminent hepatologists from North America with a few non-hepatologists to produce a well presented and extensively illustrated book, and has largely succeeded in his aim.

There are 14 chapters which encompass the major body systems. Although this volume will be used as a reference source, there are several chapters which make compelling reading: those on the liver in diabetes and hyperlipidaemia, nutritional and haematological disorders, and sarcoidosis (which is rather a review of hepatic granulomas) were especially enjoyable to read. There are a few puzzling omissions: for example, I could find no mention in the index or within the appropriate chapters any discussion of the liver involvement in coeliac disease; iron overload is discussed briefly in the context of thalassaemia but no mention is made of haemochromatosis. There is only fleeting reference to the liver disorders associated with ulcerative colitis and Crohn’s disease. With respect to the effect of liver disease on other organ systems, some areas, such as the hepatopulmonary syndrome, are fully covered, whereas there is no discussion on hepatorenal syndrome or hepatic osteopenia. There is scant discussion of the haemodynamic disturbances in either acute or chronic liver disease. Mechanisms of liver diseases are patchily covered: there is a full and clear description of the fatty liver yet the mechanism of sepsis related jaundice is only briefly discussed. Finally, it would have been helpful to have a review of postoperative and ITU jaundice.

This volume is a pleasure to look at and read; whether clinicians will wish to invest £95.00 for a book which provides little more information than may be found in major textbooks is less certain.