The biliary excretion of bromsulfalein as a test of liver function in a group of patients following hepatitis or serum jaundice.

Prolonged or permanent impairment of liver function is now known to occur in a variable proportion of patients following an attack of infectious hepatitis or serum jaundice (1-11). However, the incidence of this chronic hepatic disease is not well established because of the difficulty in correlating symptomatology with the available liver function tests or with liver biopsy (12-15). Of the means available for the study of the posthepatitis patient liver biopsy has gained favor because the positive findings have a concreteness lacking in the chemical liver function studies. However, it is not without risk to the patient and conceivably early alterations in physiology could precede structural hepatic change by many months (16-20). The bromsulfalein, cephalin flocculation, thymol turbidity and Van den Bergh are the tests generally employed but frequently the abnormality shown is slight, and is not uniformly present when they are run simultaneously. The blood clearance of bromsulfalein is generally considered a highly useful chemical test when liver impairment is minimal (21). However, we have experimental evidence tn dogs which suggests that the clearance of bromsulfalein from the blood is probably dependent upon a dual mechanism; first, removal from the blood by the reticulo-endothelial system (Kupfer cells) and second, excretion by the hepatic polygonal cells into the bile and that early hepatic damage can cause severe impairment of the excretion of bromsulfalein in the bile without interfering with its removal from the blood (2224). The cephalin flocculation and thymol turbidity tests are not specific tests of liver function because they have been shown to yield positive results in other diseases. Consequently it has been difficult at times to determine the significance of minimal abnormality when it occurs in only one of these tests (25, 26). An elevated serum bilirubin in a post-hepatitis patient is probably a reliable index of altered liver function but it is not often the case that hyperbilirubinemia exists when the other three tests are normal. Because of these discrepancies it was felt that it would be of interest to test the excretion of bromsulfalein in the bile in a selected group of patients in whom impaired liver function was suspected but difficult to prove.