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Associate Professor, School of Pharmacy, University of Washington, Seattle, WA
Published Online, March 28, 2006. www.theannals.com, DOI 10.1345/aph.1G340
Format: This text is divided into 6 parts encompassing 29 chapters written primarily by gastroenterologists/hepatologists. Other contributors include surgeons, pulmonologists, and intervention radiologists who write on topics such as shunt placement, liver transplant, and pulmonary complications. Most of the authors are researchers and clinicians from all over the world and have extensive publications in their respective areas.
Audience: Clinical specialists and researchers who deal with endstage liver disease are primarily the intended audience for this book. Pharmacists managing patients with end-stage liver disease will find the balanced coverage of pathophysiology, molecular biology, diagnosis, and therapy to be very helpful.
Purpose: The editors state that they hope their book will provide useful information for individuals actively engaged in the investigative aspect of portal hypertension, as well as for clinicians who care for patients with portal hypertension. True to their goal, the book provides scientific updates on key topics related to the clinical and basic investigation, evaluation, and management of portal hypertension and related clinical circumstances.
Content: The 6 dedicated parts of the book include: (1) a historical perspective of portal hypertension, (2) pathobiology and experimental progress in portal hypertension, (3) methodology to assess portal hypertension, (4) natural history and treatment of esophageal varices, (5) natural history and treatment of ascites and hepatorenal syndrome, and (6) evaluation and treatment in special circumstances of portal hypertension. There are also 4 full pages of color illustrations. The first 2 parts of the book provide an exceptionally detailed and up-to-date discussion regarding the molecular biology, physiology, hemodynamics, vascular changes, and interaction with the cardiopulmonary system associated with portal hypertension. Readers will undoubtedly find these sections invaluable in enhancing their understanding of the disease state and the rationale for various therapeutic approaches.
The third part of the book provides a comprehensive review of the techniques used in assessing portal hypertension in humans. The clinical definition of portal hypertension is presented and the quantitative techniques for establishing the diagnosis are clearly explained. The next 2 parts are most useful for clinicians, as these 11 chapters are dedicated to the treatment of clinical conditions associated with portal hypertension. In-depth coverage of such topics as esophageal varices, ascites, peritonitis, and hepatorenal syndrome are provided. The last part of the book completes the discussion by addressing special topics such as management of portal hypertension in children and pregnant women, Budd-Chiari Syndrome, venoocclusive disease, and portal vein thrombosis, and providing an overview of future treatments. The book is organized logically and provides a balanced discussion regarding the science, pathogenesis, and clinical assessment of portal hypertension as well as a management approach to the disease and its associated complications.
Usability: Considering the breadth and depth of the contents, this book is reasonably priced. Although it may not be the best textbook for a doctoral-level student to learn about basic pathophysiology of liver diseases, it is a very helpful reference for researchers and practitioners who see patients with end-stage liver disease on a periodic basis. It also serves as an excellent reading assignment for research fellows or specialty practice residents who hope to advance their knowledge in this area.
Highlights: Those who are unfamiliar with the anatomy, physiology, and basic cytology of the normal liver are encouraged to review such information before reading Part 2 of the book. Most clinicians, especially clinical pharmacists, will find Parts 4 and 5 to be most helpful and relevant, because the focus of these 200 pages is on clinical management. These sections adequately address the management of complications that can result from portal hypertension. Topics such as management strategies for the prophylaxis and treatment of esophageal variceal rupture, pharmacologic therapy for esophageal varices, management of ascites, and spontaneous bacterial peritonitis and other infections in cirrhosis are well discussed, with updated information. Clinical pharmacists and general internists will find the chapters on surgical therapies, transjugular intrahepatic portosystemic stent-shunt, endoscopic treatment of bleeding esophageal varices, and diagnosis and management of hepatorenal syndrome extremely helpful, as these topics are inadequately addressed in most textbooks and review articles.
Limitations: This book would have been more complete if additional color photographs had been included. The addition of photographs illustrating the histologic changes of the liver in portal hypertension, esophageal varices before and after various endoscopic interventions, and the sizes and shapes of different stents and shunts would be helpful for most readers. Also, some of the electron microscopy pictures published in black and white are difficult to read.
Comparison with Other Related Books or Products: Compared with existing textbooks and references on gastroenterology and hepatology, this book provides the most up-to-date and focused discussion on portal hypertension and its associated complications. However, readers should keep in mind that this book is not a replacement for a general reference book in hepatology/liver diseases.
Reviewer's Summary: This text is highly recommended as a personal reference for clinicians and researchers who have frequent contacts with patients with end-stage liver disease or portal hypertension. It is also a valuable shelf reference in nursing units, research units, and drug information centers where patients with portal hypertension are seen on a regular basis.
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