J. DE GROOTE One of the most ominous and troublesome complications
of the liver disease is the appearance of hemorrhagic phenomena.
Many careful clini- cal observations about the relationship of
liver function and of bilia- ry tree pathology have been published.
A vast amount of research work has been devoted to the subject. The
severity of the hemorrhagic disor- der is usually in relation to
the liver disease. In mild chronic hepa- titis or short lasting
obstruction slight subcutaneous or mucosal blee- ding may (lraw the
attention of the patient and the doctor, but they are as such far
from dangerous. However in acute hepatic insufficiency, in biliary
cirrhosis the bleeding tendency is to be considered as a life
threatening complication in about half of the cases. Moreover
coagulation disturbances aggravate bleeding not only from ruptured
oesophageal or gastric varices but also from gastritis or peptic
ulcer. 11enometrorrhagia, epistaxis and gingival bleeding may be
very trouble- some in these conditions. The use of diagnostic
procedures sucl. as liver puncture biopsy and peritoneoscopy are
often impossible when platelets and prothrombine time are too low.
In order to overcome this difficul- ty a procedure has been worked
out taking a biopsy through a trans- jugular catheter placed in the
hepatic vein. If a bleeding from the liver occurs it will be in the
circulatory system and not cause any trouble.
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