INTRAHEPATIC OBSTRUCTIVE JAUNDICE (PRIMARY CHOLESTASIS), A CLINICOPATHOLOGIC SYNDROME OF VARIED ETIOLOGY: A REVIEW WITH OBSERVATIONS OF THE USE OF CORTICOTROPIN AS A DIAGNOSTIC TOOL
Authors: H C JOHNSON, J P DOENGES
Journal: Annals of Internal Medicine (1956)

Article1 April 1956INTRAHEPATIC OBSTRUCTIVE JAUNDICE (PRIMARY CHOLESTASIS), A CLINICOPATHOLOGIC SYNDROME OF VARIED ETIOLOGY: A REVIEW WITH OBSERVATIONS OF THE USE OF CORTICOTROPIN AS A DIAGNOSTIC TOOLHENRY C. JOHNSON JR., M.D., JOHN P. DOENGES, M.D.HENRY C. JOHNSON JR., M.D.Search for more papers by this author, JOHN P. DOENGES, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-44-4-589 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe clinical task of differentiating intrahepatic from extrahepatic jaundice is a problem frequently encountered by both physicians and surgeons. The divergent therapeutic implications in the management of these two forms of jaundice make their differentiation imperative. Careful attention to the clinical history and physical findings, utilization of the growing number of available chemical tests of liver cell function1-4and selective use of needle biopsy of the liver5-7have made it possible to arrive at the correct diagnosis in a high percentage of such cases. Of particular interest, however, and offering unusual diagnostic difficulty, are certain instances of acute or subacute...Bibliography1. Watson CJ: Regurgitation jaundice; clinical differentiation of the common forms with particular reference to the degree of biliary obstruction, J. A. M. A. 114: 2427, 1940. Google Scholar2. Klatskin G: Some observations on liver function tests, Yale J. Biol. and Med. 21: 127, 1948. MedlineGoogle Scholar3. BrugerOppenheimer ME: The present status of liver function tests, including observations on the newer flocculation procedures, Bull. New York Acad. Med. 25: 16, 1949. MedlineGoogle Scholar4. Althausen TL: Liver function tests in the differential diagnosis of jaundice, Am. J. Med. 4: 208, 1948. CrossrefMedlineGoogle Scholar5. KumpeGallShiffMolleSafdiSteinberg CWEALWESAHH: Needle biopsy of the liver. I. General considerations, Gastroenterology 9: 672, 1947. MedlineGoogle Scholar6. VolwilerJones WCM: The diagnostic and therapeutic value of liver biopsies, New England J. Med. 237: 651, 1947. CrossrefMedlineGoogle Scholar7. PopperSchaffner HF: Laboratory diagnosis of liver disease, coordinated use of histological and biochemical observations, J. A. M. A. 150: 1367, 1952. CrossrefMedlineGoogle Scholar8. WatsonHoffbauer CJFW: The problem of prolonged hepatitis with particular reference to the cholangiolitic type and to the development of cholangiolitic cirrhosis of the liver, Ann. Int. Med. 25: 195, 1946. LinkGoogle Scholar9. HangerGutman FMAB: Postarsphenamine jaundice, J. A. M. A. 115: 263, 1940. CrossrefGoogle Scholar10. WernerHangerKritzler SCFMRA: Jaundice during methyl testosterone therapy, Am. J. Med. 8: 325, 1950. CrossrefMedlineGoogle Scholar11. Wood JC: Jaundice due to methyl-testosterone therapy, J. A. M. A. 150: 1484, 1952. CrossrefMedlineGoogle Scholar12. BrickKyle IBLH: Jaundice of hepatic origin during the course of methyltestosterone therapy, New England J. Med. 264: 176, 1952. CrossrefGoogle Scholar13. Kinsell LW: Factors affecting protein balance in presence of chronic viral liver damage, Gastroenterology 11: 672, 1948. MedlineGoogle Scholar14. ZatuchniMiller JG: Jaundice during chlorpromazine therapy, New England J. Med. 251: 1003, 1954. CrossrefMedlineGoogle Scholar15. LehmanHanrahan HEGE: Chlorpromazine, new inhibiting agent for psychomotor excitement and manic states, Arch. Neurol. and Psychiat. 71: 227, 1954. CrossrefGoogle Scholar16. Winkleman NW: Chlorpromazine in treatment of neuropsychiatric disorders, J. A. M. A. 155: 18, 1954. CrossrefMedlineGoogle Scholar17. AzimaOgle HW: Effects of largactil in mental syndromes, Canad. M. A. J. 71: 116, 1954. MedlineGoogle Scholar18. MoyerKentKnightMorrisDizonRogersSpurr JHBRWGMSC: Clinical studies of an anti-emetic agent, chlorpromazine, Am. J. M. Sc. 228: 174, 1954. CrossrefMedlineGoogle Scholar19. Van OmmenBrown RACH: Obstructive type jaundice due to chlorpromazine (Thorazine), J. A. M. A. 157: 321, 1955. CrossrefMedlineGoogle Scholar20. HodgesLaZerte HHGD: Jaundice and agranulocytosis with fatality following chlorpromazine therapy, J. A. M. A. 158: 114, 1955. MedlineGoogle Scholar21. HuberWiley TEAT: Cortisone in the treatment of infectious hepatitis, Ann. Int. Med. 42: 1011-1025 (May) 1955. LinkGoogle Scholar22. LemireMitchell RERA: Regurgitation type of jaundice during prolonged therapy with chlorpromazine, Arch. Int. Med. 95: 840, 1955. CrossrefGoogle Scholar23. SteigmannPopper FH: Intrahepatic obstructive jaundice, Gastroenterology 1: 645, 1943. Google Scholar24. Naunyn B: Ueber Ikterus and seine Beziehungen zu den Cholangien, Mitt. a. d. Grenzgeb. d. Med. u. Chir. 31: 537, 1919. Google Scholar25. Siegmund H: Selbstandige intrahepatische Cholangitis, Beitr. z. path. Anat. u. z. allg. Path. 87: 425, 1931. Google Scholar26. Eppinger H: Allgemeine und spezielle Pathologie des Ikterus, in Spezielle Pathologie und Therapie, by Kraus, F., and Brugsch, T., Bd. V1, Tiel 3, 1923, Urban und Schwarzenburg, Berlin. Google Scholar27. Eppinger H: Die Leberkrankheiten, allgemeine und spezielle Pathologie und Therapie der Leber, 1937, Julius Springer, Vienna. Google Scholar28. TurnerSnavelyGrossmanBuchananFoster RHJREBRNSO: Some clinical studies of acute hepatitis occurring in soldiers after inoculation with yellow fever vaccine; with especial consideration of severe attacks, Ann. Int. Med. 20: 193-218 (Feb.) 1944. LinkGoogle Scholar29. FoxMansoPennaPará JPCHAM: Observations on the occurrence of icterus in Brazil following vaccination against yellow fever, Am. J. Hyg. 36: 68, 1942. Google Scholar30. EvansSprinzNelson ASHRS: Adrenal hormone therapy in viral hepatitis, Parts I, II and III, Ann. Int. Med. 38: 1115-1159 (June) 1953. LinkGoogle Scholar31. FernandoThanabalasunderam PBRS (Ceylon, Colombo): Infective hepatitis and cirrhosis of the liver, Quart. J. Med. 20: 403, 1951. MedlineGoogle Scholar32. Popperde la HuergaSteigmannSlodki HJFM: Turbidimetric gamma globulin determinations in hepatobiliary diseases, J. Lab. and Clin. Med. 35: 391, 1950. Google Scholar33. Broadman RH: Fatal case of toxic hepatitis implicating chlorpromazine (medical memoranda), Brit. M. J. 2: 579, 1954. CrossrefGoogle Scholar34. Chesney WM: Chlorpromazine and jaundice (correspondence), Brit. M. J. 2: 591, 1954. CrossrefGoogle Scholar35. Klemperer P: Chronic intrahepatic obliterating cholangitis, J. Mount Sinai Hosp. 4: 279, 1937. Google Scholar36. GargillLesses SLMF: Toxic reactions to thiouracil: report of cases with one fatality, J. A. M. A. 127: 890, 1945. CrossrefGoogle Scholar37. Bockus HL: Acute and chronic cholangitis, in Gastroenterology, 1946, W. B. Saunders Co., Philadelphia, p. 671. Google Scholar38. KlempererKillianHeyd PJACG: The pathology of "icterus catarrhalis, " Arch. Path. 2: 631, 1926. Google Scholar39. RoholmIverson KP: Changes in the liver in acute epidemic hepatitis (catarrhal jaundice) based on 38 aspiration biopsies, Acta path. et microbiol. Scandinav. 16: 427, 1939. CrossrefGoogle Scholar40. AhrensHarrisMcMahon EHRCHE: Atresia of intrahepatic bile ducts, Pediatrics 8: 628, 1951. MedlineGoogle Scholar41. Moschcowitz E: Morphology and pathogenesis of biliary cirrhosis, Arch. Path. 54: 259, 1952. MedlineGoogle Scholar42. JonesMinot CMGR: Infectious (catarrhal) jaundice. An attempt to establish a clinical entity (case reports No. 24 and No. 25), Boston M. and S. J. 189: 531, 1923. CrossrefGoogle Scholar43. Medical brochure supplied with Thorazine by Smith, Kline, and French Co. Google Scholar44. Cholangiolitic biliary cirrhosis (Editorial), J. A. M. A. 150: 1313, 1952. CrossrefMedlineGoogle Scholar45. AhrensPayneKunkelEisenmengerBlondheim EHMAHGWJSH: Primary biliary cirrhosis, Medicine 29: 299, 1952. CrossrefGoogle Scholar46. Chabrol E: Les cirrhoses biliaires xanthomateuses ont-elles des liens avec les hepatities a virus? Rev. prat. Paris 4: 12, 1954. Google Scholar47. RickettsWissler WERW: Cholangiolitic biliary cirrhosis (primary biliary cirrhosis), Ann. Int. Med. 36: 1241-1277 (May) 1952. LinkGoogle Scholar48. ForshamRenoldFrawley PHAETF: Nature of ACTH resistance, J. Clin. Endocrinol. 11: 757, 1951. Google Scholar49. ThornForshamFrawleyHillRocheStaehelinWilson GWPHTFSRMDDL: Clinical usefulness of ACTH and cortisone, New England J. Med. 242: 865, 1950. CrossrefMedlineGoogle Scholar50. ThornJenkinsLaidlawGoetzDinghamAronsStreetenMcCracken GWDJCFCJFWLDHBH: Pharmacologic aspects of adrenocortical steroids and ACTH in man, New England J. Med. 248: 332, 1953. CrossrefGoogle Scholar51. PattersonDingmanShawachmanThorn PRJFHGW: Choleretic action of cortisone, New England J. Med. 251: 502, 1954. CrossrefMedlineGoogle Scholar52. AlmadenRoss PJSW: Jaundice due to methyl-testosterone therapy, Ann. Int. Med. 40: 146, 1954. LinkGoogle Scholar53. Kleckner MS: Needle biopsy of the liver; an appraisal of its diagnostic indications and limitations, Ann. Int. Med. 40: 1177, 1954. LinkGoogle Scholar54. Movitt ER: Differential diagnosis of "regurgitation" jaundice; the role of needle liver biopsy, Ann. Int. Med. 40: 932, 1954. LinkGoogle Scholar55. Sborov VM: ACTH therapy in acute viral hepatitis, J. Lab. and Clin. Med. 43: 48, 1954. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Fort Jackson, South Carolina*Received for publication September 21, 1955.From the U. S. Army Hospital, Fort Jackson, South Carolina.†Senior Assistant Resident, Medicine, Duke University Hospital, Durham, North Carolina; formerly Chief of Gastroenterology Service, U. S. Army Hospital, Fort Jackson, South Carolina.‡Internist, Olney Sanitarium Clinic, Olney, Illinois; formerly Assistant Chief of Medical Service, U. S. Army Hospital, Fort Jackson, South Carolina. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe General Appearance (Habitus)The-Effect of Cortisone on Cholangitis Induced by α-Naphthyl-Isothiocyanate in RatsThe Place of Steroid Therapy in the Treatment of Liver DiseaseCorticotropin and Corticosteroids in Human Viral InfectionsTHE ACUTE CHOLESTATIC SYNDROMEThe cholestatic form of viral hepatitisAcute Intrahepatic CholestasisIntrahepatic cholestasis following administration of chlorpropamideIntrahepatic Obstructive JaundiceSerum alkaline phosphatase activity in diseases of the skeletal and hepatobiliary systemsHeatstroke and jaundicePharmakologische Wirkungen bei psychischen ErkrankungenIntrahepatic cholestasisGelbsucht mit Verschlusssyndrom aus nichtmechanischer UrsacheDrug reactions characterized by cholestasis associated with intrahepatic biliary tract obstructionCHLORPROMAZINE HEPATITIS TREATED WITH CORTISONE*MORGAN CUTTS, M.D., F.A.C.P.Chlorpromazine jaundiceBILIARY SURGERY IN CHLORPROMAZINE JAUNDICEZur Therapie diffuser hepatocellulärer Erkrankungen (Hepatitis, Cirrhose usw.)DIAGNOSIS AND TREATMENT OF PRIMARY INTRAHEPATIC CHOLESTASIS 1 April 1956Volume 44, Issue 4Page: 589-616KeywordsAdrenocorticotropic hormoneHepatitisHepatitis AHepatitis E virusHospital medicineLiver function testsMedical servicesPathogensSurgeonsToxic agents ePublished: 1 December 2008 Issue Published: 1 April 1956 Copyright & PermissionsCopyright ©, 1956, by The American College of PhysiciansPDF downloadLoading ...