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JAMA. 1927;89(24):2018-2021. doi:10.1001/jama.1927.02690240010004.
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When a patient with jaundice presents himself, the clinician is confronted with the necessity of speedy diagnosis, and he will remember that operation on jaundiced patients carries the extra hazard of increased liability to hemorrhage. The need for prompt relief of obstruction in the extrabiliary passages has been illustrated by the work of Counseller and Mclndoe, who have shown in necropsy specimens the enormous dilatation of the intrahepatic biliary vessels which occurs in obstructive jaundice. When obstruction occurs rapidly, as in pancreatic carcinoma, this dilatation may quickly induce pressure atrophy of the parenchymal and vascular tissues of the liver. When obstruction occurs more slowly, dilatation of the bile passages is in part opposed by concomitant thickening of the walls of the ducts and proliferation of the interstitial or supporting tissue of the liver, a compensatory mechanism which may express itself later as biliary cirrhosis. But while surgical intervention should be


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