Study of Liver Disorder in Ulcerative Colitis

THOMAS (i874) and Lister ( I899) first demonstrated histological abnormalities in the liver of patients with ulcerative colitis, and there has been a series of further reports (Elsom and Ferguson, 194I; Kimmelstiel, Large and Verner, 1952; Kleckner, Stauffer, Bargen and Dockerty, 1952; Boden, Rankin, Goulston and Morrow, I959) describing a varying pattern of damage. In a series of 245 cases of ulcerative colitis coming to operation at this hospital, jaundice was a marked feature in I9, in two occurring before operation (both of whom died) and in the rest immediately after operation with the exception of three who developed the complication at a late stage and also suffered from cirrhosis. The Coomb's test was negative when performed and thus hkmolysis was an unlikely cause for the rise in serum bilirubin; it seems more likely that the hyperbilirubinaemia was the result of a deterioration in liver function. That a considerable degree of histological abnormality can occur in the liver before jaundice becomes manifest may be seen from Fig. i, a liver biopsy taken from a woman at a time when she was not jaundiced and whose serum bilirubin level was then only i.8 mg./ioo ml.; clinical jaundice developed before she died io days after operation. In its clinical manifestations ulcerative colitis presents itself in two distinct forms: either as a chronic or recurrent diarrhcea in an individual who otherwise shows no marked general disorder save wasting, or as a severely toxic general disorder in addition. The deaths occurring in our series of operation cases are shown in Table i, together with the incidence of jaundice in the fatal cases. Of the non-jaundiced patients, causes of death included infection (7), intestinal obstruction (2), myocardial infarction (i), pulmonary embolus (i), .. i.