Schiff’s Diseases of the Liver, 10th ed. Eugene R. Schiff, Michael F. Sorrell, and Willis C. Maddrey. 1856 pp. $299.00. Philadelphia, Pennsylvania, Lippincott Williams and Wilkins. ISBN 0-7817-6040-2. Web site for ordering: www.lww.com.

Reviewing the 10th edition of this classic textbook is a most difficult task for me. What do you say about the bible of clinical hepatology, first published in 1956 when most of us in the practice of gastroenterology and hepatology were either children or not even born yet? What about the three editors—Gene Schiff, Willis Maddrey, and Mike Sorrell—the grand masters of hepatology? Note that I did not say grand old men of Hepatology because, if you know these three, you know that each is as vibrant and active today as any young hepatologist out there and their contribution with this 10th edition is the proof of their continued mastery of the subject and their relevance in the modern age of hepatology. The 10th edition is dedicated to Telfer Reynolds, another grand master of hepatology. Pete Reynolds, as he was known to his friends, died several years ago, after a long and distinguished career in hepatology. He was responsible for the training of hundreds of hepatologists in the United States and in many foreign countries, many of whom are now the senior generation. Pete Reynolds was one of the founding fathers of hepatology in the United States and as the consummate clinician and, in keeping with his character, would be quietly thrilled that this edition was dedicated to him. Like a good bowl of New Orleans gumbo, the 10th edition of this textbook has a little something in it for everybody with 60 chapters divided into 12 sections. It begins with an overview on the fundamentals of clinical hepatology and ends with a brand new section on the elements of liver transplantation. There are 115 contributors from North America, Europe, Australia, and Asia, making this a truly international effort and reflecting the tremendous impact that scientists and investigators from around the world have had on the expansion of knowledge in hepatology. The authors’ commitment to international contributors dates to the early days of this book and is to be commended. The groundwork of clinical hepatology is laid out in the first section—“Overview: Clinical Fundamentals of Hepatology”—where in 6 chapters we learn the basics of the evaluation of liver patients. I found the chapters on interventional radiology and endoscopic retrograde cholangiopancreatography particularly informative and up to date, a difficult task in two areas that are rapidly evolving and where new techniques can come and go more quickly than you can say TIPS. Both of these chapters are replete with radiographs and endoscopic pictures, which add immeasurably to the text. Of particular note are the sections on hepatobiliary surgery and its complications and on malignant biliary obstruction, which I found to be particularly practical and helpful for all, even those who do not routinely perform these procedures. The section entitled “General Considerations” has an excellent chapter on hepatic histopathology by Zachary Goodman and Hala Maklouf. This chapter is 66 pages long, full of histologic pictures, and is as good as any that I have ever read and can probably stand alone as its own textbook! This chapter alone is worth the price of the entire book. The section that focuses on consequences of liver disease begins with the basics on hepatic fibrosis by Scott Friedman and has chapters on portal hypertension management, ascites, renal complications, hepatic encephalopathy, and fulminant hepatic failure. In this section, I found the chapter on portal hypertension and nonsurgical management by Bosch, D’Amico, and Garcia-Pagan particularly useful, with very practical but thorough explanations of the different types of portal hypertension and their causes. There are also great sections that focus on the pathophysiology of variceal hemorrhage and on assessment of portal hemodynamics in patients with cirrhosis. As with many of the chapters in this book, I found these to be thorough and with an appropriate balance of anatomy, physiology, and clinical application. The sections dealing with specific liver disorders are separated into cholestatic liver disorders, viral hepatitis, alcohol- and drug-induced liver disease, genetics and metabolism, vascular, benign and malignant tumors, and infections. All are up to date and well written, again, with the clinician in mind and with a good balance of basic knowledge and clinical application. I particularly enjoyed the chapter on liver disease in infancy and childhood by Maureen Jonas and Antonio Perez–Atayde. This chapter is a great introduction to the pediatric world of hepatology for those of us who focus on the adult patient. The chapter on hepatobiliary manifestations of human immunodeficiency virus was very helpful, covering not only the standard chronic viral disease such as hepatitis B and C, but the now less commonly seen mycobacterial and fungal infections. Finally, the pièce de résistance of this 10th edition, the section on liver transplantation. Edited by Mike Sorrell, this section has chapters on selection and timing of transplantation, immunosuppression, long-term care of the transplant patient, surgical options for liver transplantation, recurrent disease after transplantation, and hepatobiliary complications of bone marrow transplantation. All are well thought out and written in a concise and clear manner that provides the clinician with an excellent base of information on these very important topics. Everyone in the practice of gastroenterology today has exposure to transplant patients and may be called upon to participate in their care. Therefore, it is imperative that this information be made part of all standard textbooks as has been done here. As with other sections, the liver transplant section by itself, comprising more than 100 pages, could be a standalone textbook. Bottom Line: Despite the long history of this book, its ubiquitous presence in our lives through training and then in real life in the practice of gastroenterology and hepatology, I can say that this latest edition of Schiff’s Diseases of the Liver is by far the most thorough, complete, and practical and is a must for all of those who practice gastroenterology and hepatology.