Illingworth, Charles Frederick William

2019-02-15T14:30:37Z

2019-02-15T14:30:37Z

1939

It is established that in toxiinfective and obstructive forms of jaundice there commonly develops a state characterised by an undue liability to haemorrhage.

The bleeding may occur from a mucous or serous surface or into the skin. It commonly gives rise to epistaxis, haematemesis, melaena, purpura. The danger of haemorrhage is greatest in the period immediately after operation, and herein lies its special importance from the surgical standpoint. The usual experience is that no excessive bleeding is noticed during the operation, and haemostasis is generally secured without difficulty; the bleeding takes place a few days later, and the period of greatest danger lies between the third and the sixth day. Such post- operative bleeding may occur at the sites already mentioned, but more commonly it takes place from the raw surfaces in the operative field. It is very apt to take the form of a slow ooze into the depths of the wound, forming a haematoma there or perhaps leaking to the surface at the incision.

Haemorrhage in jaundice is thus a condition of no little surgical importance. In the investigation reported here I have aimed at the solution of three problems related to the subject, the cause of the bleeding tendency, its recognition and its prevention or treatment.

The work is based upon a study of 50 cases of jaundice under treatment in the Edinburgh Western Hospital and the Edinburgh Royal Infirmary, including 12 cases in which spontaneous or postoperative haemorrhages developed. It comprises clinical and laboratory investigations, with special reference to the coagulability of the blood and other factors concerned in the arrest of haemorrhage Special attention has been directed to the prothrombin content of the blood, and evidence is presented in support of the view that a prothrombin deficiency is an important factor predisposing to haemorrhage in jaundice. The results of prothrombin estimations on 34 jaundiced cases are given,' and the value of this test as a method of gauging the risk of haemorrhage is discussed. The cause of the prothrombin deficiency is considered, and the evidence attributing it to faulty absorption or faulty utilisation of a vitamin is studied. Finally observations are recorded on the effect of administering preparations containing the vitamin to jaundiced patients.

http://hdl.handle.net/1842/34731

The University of Edinburgh

Annexe Thesis Digitisation Project 2019 Block 22

Haemorrhage in jaundice

Thesis or Dissertation

Doctoral

ChM Master of Surgery