Regurgitation Jaundice Clinical Differentiation of the Common Forms, With Particular Reference to the Degree of Biliary Obstruction

The recognition of two main varieties of jaundice, namely retention and regurgitation jaundice according to Rich's classification, 1 is of fundamental value. The presence of bilirubin in the urine, likewise the finding of a prompt van den Bergh reaction, at once identifies regurgitation jaundice and separates it from retention jaundice, in which there is simply a hepatocellular inability to dispose of bilirubin provided from the circulating blood. In retention jaundice hepatocellular function may be regarded as sluggish as far as bilirubin excretion is concerned. 2 This sluggishness is more or less relative in hemolytic icterus (one of the principal representatives of the retention type) but must be considered absolute in the rare condition best known as constitutional hepatic dysfunction. 3 In retention jaundice bilirubin alone is held back and accumulated, while in regurgitation jaundice there is the fundamental difference that whole bile returns to the blood. There is much reason