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ABC of Liver, Pancreas and Gall Bladder
  1. P Hungin

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The ABC Series are well established as handy reference guides but they sometimes struggle from not being clear about their target readership. Midway between a textbook and an update, this publication follows the usual format. The topic is covered from investigations used in liver and biliary disease to the clinical conditions themselves, ranging from gall stones to liver and pancreatic transplantation. Because of the nature of the clinical area, the book will probably appeal more to the hospital clinician than the general practitioner although the latter will gain much in having a source of reference for unusual and awkward clinical situations.

Although the list of topics is complete, there are still problems in interpreting some of the information for use in the pragmatic clinical setting. The section on gall stones, for example, while full with detail of aetiology and presentation does not make it any easier for the clinician trying to decide whether to refer the patient with stones or when cholecystectomy is indicated. It may well be that in some areas, such as gall stone management, clinical judgement still outdistances evidence but it would have been useful to have had available evidence about different management approaches.

The book also has a feel of having been constructed from an upstream viewpoint. Apart from a hepatologist, the other five contributors are all surgeons—it might have been useful to have had the perspectives of a general physician and a general practitioner, even if only to raise the pragmatic queries that arise at the earlier stage of management of hepatobiliary problems. An example is the potential prophylactic management of patients with varices. As it stands, variceal management in this publication commences essentially after the bleed with only a few lines on prophylactic management, and even those largely dismissive of possible measures apart from the global use of beta blockers. So what should a primary care practitioner dealing with a patient who might have varices actually do, and at what stage of abnormal liver tests or clinical findings is referral likely to be rewarding?

Increasingly, on a worldwide basis, a primary care clinician or a general practitioner with generic interests provides initial healthcare. Many of them will rely on such publications as a ready source of information. Ease of access to the information is important—this is assisted in this ABC by the use of summary points and clear illustrations. The aim of the publication is given as the desire to provide an overview and to enable the clinician to keep abreast of advances in the common and the rarer conditions. It succeeds in this.