THE CARE of a patient with obstructive jaundice still remains a challenge to the surgeon's judgment and skill. With our increasing knowledge of the effect of operation on the metabolic response of the patient we now have a much better understanding of the significance of the term "surgical risk" than ever before. The manner in which the patient with obstructive jaundice is prepared for surgery, however, still demands improvement. Some of these patients continue to die of liver failure in the immediate postoperative period, owing either to inadequate preparation or to the limitations of our knowledge at present.
The following study was carried out to determine the nature of liver failure in the presence of complete biliary obstruction. Emphasis has been placed upon serial tests of several liver functions rather than upon pathological examination of the tissue.
Effort has been made to correlate the times of appearance of impairment of