Factors influencing bromsulphalein retention and its evaluation in bilharzial hepatic fibrosis

Abstract

EDITORIAL SYNOPSIS Thirty-six patients with bilharzial hepatic fibrosis were investigated, and five other patients were studied before and after portacaval shunt operation. The liver parenchyma is well preserved in bilharzial hepatic fibrosis and this is reflected in the almost normal results of liver function tests. In 40% of the patients bromsulphalein was retained to an abnormal degree and retention was increased post-operatively in the patients studied before and after portacaval shunt operations. The increased retention of bromsulphalein was found to be the result of prehepatic factors, namely, diminished hepatic blood flow and increased systemic portal collateral circulation either singly or in combination.In schistosomal hepatic fibrosis the various liver function tests give normal or only slightly abnormal results, particularly in tests depending on alterations in the serum proteins; these are not specific for liver diseases. Most other liver function tests yield normal results except the bromsulphalein retention test. This fact stimulated us to search for factors other than liver cell dysfunction which might modify the results. PROCEDUREThirty-six patients with confirmed bilharzial hepatic fibrosis were studied. In addition to routine investigations, the icterus index, thymol turbidity, plasma proteins, and prothrombin activity were estimated.Bromsulphalein was injected intravenously in a dose of 2 mg./kg. body weight (Kolmer, Spaulding, and Robinson, 1952), and a sample of blood from the opposite arm was collected half an hour after the injection. Blood was then left to coagulate and serum was separated by centrifuging and 2 drops of a 10% solution of sodium hydroxide were added to the serum to bring out the colour. The amount of the dye retained in the serum was estimated by direct comparison with prepared standards. Retention of more than 10% of the dye was considered abnormal.The portal pressure was measured by the intrasplenic technique in all the patients, the hepatic vein was catheterized in 26, the pressures were recorded in all, and the hepatic blood flow was estimated in 15 of them by the bromsulphalein clearance technique.Liver biopsy specimens were obtained and examined in 28 patients.Various tests were carried out to prove and assess the degree of systemic portal collateral circulation. These included radiological examination of the oesophagus for oesophageal varices. Portal collateral veins on the anterior abdominal wall were sought and demonstrated in some patients by infra-red photography. Splenoportography was carried out in 34 patients to study the intra-abdominal portal collateral veins, and haemorrhoids were detected by proctoscopy.We also studied the results of bromsulphalein retention and other liver function tests in five patients with bilharzial hepatic fibrosis before and after portacaval shunt operations. RESULTSResults of bromsulphalein retention tests ranged from 2 to 36% of the injected dye. Normal values (up to 10%) were observed in 21 patients, while abnormal results rangi...