Book Review

Liver and Biliary Diseases

N Engl J Med 1993; 328:1856-1857June 24, 1993

Article

Liver and Biliary Diseases
Edited by Neil Kaplowitz. 732 pp., illustrated. Baltimore, Williams and Wilkins, 1992. $105. ISBN: 0-683-04528-8

This book neatly fills a niche among liver textbooks. It is designed to reach a wide audience of physicians in training, internists, and gastroenterologists. It is not meant to compete with weighty, multiauthored reference works, of which several excellent ones can be recommended. It does not offer the consistent style and approach of a single-authored textbook, such as Sherlock's classic Diseases of the Liver and Biliary System (9th ed. Boston: Blackwell Scientific, 1993), with its very personal approach to liver diseases. It combines the strengths of chapters written by authorities with a conscious effort to avoid being encyclopedic. This approach makes it eminently suitable for its targeted audience.

The design and organization of the book allow it to be used on several levels and for different purposes. The first quarter is devoted to the cell biology of the liver and the pathophysiology of liver disease. Chapters on diagnostic studies for liver and biliary disease follow: “Liver Chemistry Tests,” “Serologic Tests for Viral Hepatitis,” “Imaging of the Liver and Biliary Tract,” and “Liver Biopsy Interpretation.” The remainder of the book is organized according to disease entity, with the exception of two chapters entitled “Liver Transplantation” and “An Integrated Approach to the Diagnosis of Jaundice.”

The separation of an authoritative but concise treatment of pathophysiology from the discussion of particular diseases allows the latter to be pointed and pragmatic. For example, the book could be used as a reference work by a clinician considering the treatment options for a patient with chronic hepatitis B, since the chapter on chronic hepatitis is straightforward and practical without being dogmatic. For those who might want to delve further into the mechanisms of disease and other manifestations of hepatitis B infection, there are several chapters of interest: two pathophysiologic chapters (“Immunologic Mechanisms of Hepatobiliary Injury” and “Molecular Biology of Viral Hepatitis and Liver Cancer”), the chapter on serology in the diagnostic-studies section, and four chapters on specific diseases (“Acute Viral Hepatitis,” “Fulminant Hepatitis,” “Chronic Hepatitis,” and “Neoplasia of the Liver”).

Although inveterate “lumpers” might object to this organizational strategy, I found it one of the strengths of the book. Each chapter could stand alone but was integrated with the others. That this was accomplished without recognizable repetition speaks well of the editor's skill and diplomacy. Having one authority write about pathophysiology and another write about the disease state risks the possibility of differences of opinion and even conflicting recommendations in the same book. I searched actively, however, and was amazed to come up with only one, easily understood disagreement.

The organization of each chapter recapitulates the multilayered focus of the entire book. Each chapter begins with an overview and ends with a summary of like size. Important points are highlighted in bold type. Liberal use is made of schematic diagrams, graphs, tables, and photographs, which are simple, clear, and well reproduced. It is possible to get a quick idea of a chapter by reading the overview and summary and scanning the bold print and illustrative material. The bibliographies are well annotated and short, with no attempt to be complete. They point the way for those who want more depth than is provided in the chapter itself or elsewhere in the book. In general, the chapters are lean and mean; they synthesize concepts and summarize areas of controversy fairly.

Although there is generally excellent coordination among chapters covering interrelated topics, as in the discussions of viral hepatitis in several chapters, there were occasional examples of what seemed like needless repetition. Thus, although “An Integrated Approach to the Diagnosis of Jaundice” lived up to its title, there seemed to be little integration of this chapter with that on “Bilirubin Metabolism and Its Disorders.” This may be more an unwanted consequence of the otherwise successful “stand-alone” concept than an editorial problem.

Liver and Biliary Diseases is authoritative, well written, and up to date. It provides sufficient clinical depth and breadth for all but those specializing in diseases of the liver. Its editorial structure makes it an excellent reference work on pathophysiology for the interested reader, from the preclinical medical student to the practicing gastroenterologist. Its combination of strength in both clinical and scientific domains with a manageable size makes it an ideal book for internists and gastroenterologists, as well as for gastroenterology fellows in training.

Peter F. Ells, M.D.
State University of New York Health Science Center, Stony Brook, NY 11794