THE CHEMISTRY OF THE LIVER 



651 



The blood lipase is increased in certain cases of liver disease. 



In the absence of pernicious anemia or hemolytic jaundice, the pres- 

 ence of increased amounts of urobilin and urobilinogen in the urine is 

 said to be a delicate index of disturbed liver function. The chemistry 

 and clinical significance of these substances have been discussed in a 

 previous chapter. 



During latter years, Rowntree and collaborators have studied the rate 

 of excretion of tetrachlorphthalein in liver disease. This dye is normally 

 excreted in the bile. About 0.4 gram are administered intravenously and 

 the amount contained in the 48-hour quantity of stool is determined. A 

 normal person eliminates about 30 to 52 per cent of the dye within this 

 time. A diminished excretion of the dye or its appearance in the urine 

 is said to be indicative of liver disease. 



Owing to the unsatisfactory state of our knowledge it is safe to say 

 that considerable work remains to be done before the value of the various 

 functional tests will be definitely established. 



Pathochemistry of the Liver 



The Liver Functional Tests in Disease. The opinions of observers 

 regarding the value of any one functional test vary considerably and arc 

 often contradictory. 



Jacobson has recently shown that in Eck fistula dogs the tolerance for 

 levulose is diminished while that for glucose is normal. The following 

 table gives the results of the levulose test in various hepatic disorders 

 (Strauss(/)): 



A positive result was obtained in 15 per cent of patients not suffering 

 from apparent disease of the liver. Churchman likewise obtained positive 

 results in 23 per cent of 38 cases not suffering from liver disease. Rown- 

 tree, Hurwitz and Bloomfield found that of 534 levulose tests collected 

 from the literature, 70 per cent of the patients with liver disease gave 

 positive results, while 15 per cent of the patients not suffering from liver 

 disease also gave positive results. Falk and Saxl(a) obtained positive 

 levulose tests in 90 per cent of the patients afflicted with one of the follow- 



