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  1. PATRICIA MCCLEAN, Consultant Paediatrician

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    Diseases of the liver and biliary system in children. Edited by Kelly DA. (Pp 375, hardback; £99.50.) Oxford: Blackwell Science Ltd, 1999. ISBN 0 632 04802 6

    Complete textbooks about liver disease in children are few compared to the literature available to our colleagues on adult liver disease. Yet because of the broad spectrum of illnesses associated with liver dysfunction in children, and the rapid developments in the speciality over the last 20 years, all paediatricians need a basic knowledge of this area. This book covers the wide spectrum of liver disease in children in a practical, clinical format. It dispenses with indepth descriptions of the pathophysiology of liver disease and concentrates on providing up to date clinical information. There are numerous tables, bullet lists, and flow charts, which give a very didactic but accessible style.

    Perhaps the most important chapter in a book about paediatric hepatology is that describing the jaundiced newborn infant, a clinical scenario encountered regularly by neonatologists and general paediatricians as well as those interested in liver disease. Appropriate investigation of jaundice or abnormal liver function tests in neonates may be the only route to early diagnosis and treatment of conditions as diverse as hypopituitarism and biliary atresia. Eva Roberts' chapter “The jaundiced baby” is a thorough exposition of the diagnostic approach to this topic. There is enough detail about each condition to show why it should be considered in the differential diagnosis of prolonged neonatal jaundice, but the clinical message is not swamped by speculations on aetiology. It is complimented by the following chapter about the acutely ill baby presenting as true or apparent liver failure. Here there is an emphasis on metabolic diseases, and a clear alogorithm for initial investigation of these babies.

    Unusual chapters include those on “Skin disorders in liver disease” and “Dental care of children with liver disease”. They mainly describe problems in the post-transplant, immunosuppressed child, again both reflecting the very practical approach of the book. The atlas section at the back provides 75 plates with excellent clinical photographs, but some of the radiological investigations and histology pictures are poorly demonstrated. Common to all multiauthored books, there is some overlap between the chapters, which is not always clearly cross referenced in the text. This can be frustrating when the reader is trying to quickly check the facts on a specific condition.

    In summary, this book provides a good overview of paediatric hepatology for the non-specialist. The style reflects the broad clinical experience of the authors. The information is presented in a clear, uncluttered fashion, but with adequate references at the end of each chapter for those who wish to explore a topic in greater depth.

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