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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.
List of contents
Coagulation factor synthesis by the liver, with special reference to factor VIII and factor V.- Oral anticoagulants: unexpected side-effects or new fields of application?.- Protein C, an inhibitor of blood coagulation, in liver disease and other clinical conditions.- Intravascular coagulation in liver disease.- Abnormalities of fibrin formation in severe hepatic diseases.- Platelet involvement in the haemostatic failure of liver disease.- The significance of several coagulation tests in the evaluation of the risk of bleeding.- Clinical manifestations of the haemostatic failure in acute and chronic liver disease.- Coagulation defects following peritoneovenous shunts.- Bleeding during orthotopic liver transplantation in man.- Main problems in the treatment of bleeding in cirrhosis patients.- Treatment of bleeding by methods not directly related to haemostasis.- Strategies for rational haemotherapy.- AT-III concentrate treatment: current experience.
