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The Influence of Stress upon Liver Function in Obstructive Jaundice

The Influence of Stress upon Liver Function in Obstructive Jaundice Abstract Liver failure and death following surgery on patients with obstructive jaundice are not uncommon. Such a postoperative course is usually manifested in part by a febrile coma, a rising level of serum bilirubin, and a falling level of cholesterol esters and albumin. There can be little doubt that the operation in some way has directly influenced the course of the patient. The specific etiological details, however, are rather obscure. The relative importance of such details is difficult to assess from clinical cases. Some of these factors are the impaired liver function existing preoperatively, the anesthesia, the nonspecific stress of the operation and coincident hypoxia or sepsis. In an effort to clarify the problem by experimental observations the authors have undertaken a series of studies to evaluate the relative importance of each factor. A detailed and thorough analysis of the course of liver function in dogs with simple uncomplicated obstructive jaundice References 1. References 30, 31, 32, and 33. 2. Acthar-gel, supplied by Armour Laboratories, Chicago. 3. References 7 and 8. 4. References 34, 35, and 36. 5. References 7 and 8. 6. Macgregor, C. A.: Nature of Liver Failure Due to Complete Biliary Obstruction , A. M. A. Arch. Surg. 67:878 ( (Dec.) ) 1953.Crossref 7. Fine, J.; Seligman, A. M., and Frank, H. A.: Specific Role of the Liver in Hemorrhagic Shock: Report of Progress to Date , Ann. Surg. 126:1002 ( (Dec.) ) 1947.Crossref 8. Moon, V. H.: The Pathology of Secondary Shock , Am. J. Path. 24:235 ( (March) ) 1948. 9. Levin, L.: Physical Stress and Liver Fat Content of the Fasted Mouse , Federation Proc. 8:218 ( (March) ) 1949. 10. Gillman, J., and Gillman, T.: Anoxia and the Liver with Special Reference to Shock and Chronic Malnutrition , Am. J. Digest. Dis. 16:348 ( (Oct.) ) 1949.Crossref 11. Frank, H. A.: Present Day Concepts of Shock , New England J. Med. 249:445 ( (Sept. 10) ) 1953.Crossref 12. Fairlie, C. W.; Barss, T. P.; French, A. B.; Jones, C. M., and Beecher, H. K.: Metabolic Effects of Anesthesia in Man: IV. A Comparison of the Effects of Certain Anesthetic Agents on the Normal Liver , New England J. Med. 244:615 ( (April 26) ) 1951.Crossref 13. French, A. B.; Barss, T. P.; Fairlie, C. B.; Bengle, A. L., Jr.; Jones, C. M.; Linton, R. R., and Beecher, H. K.: Metabolic Effects of Anesthesia in Man: V. A Comparison of the Effects of Ether and Cyclopropane Anesthesia on the Abnormal Liver , Ann. Surg. 135:145 ( (Feb.) ) 1952.Crossref 14. Forsham, P. H.; Thorn, G. W.; Prunty, F. T. G., and Hills, A. G.: Clinical Studies with Pituitary Adrenocorticotropin , J. Clin. Endocrinol. 8:15 ( (Jan.) ) 1948.Crossref 15. Sayers, G.; Burns, T. W.; Tyler, F. H.; Jager, B. V.; Schwartz, T. B.; Smith, E. L.; Samuels, L. T., and Davenport, H. W.: Metabolic Actions and Fate of Intravenously Administered Adrenocorticotropic Hormone in Man , J. Clin. Endocrinol. 1:593 ( (July) ) 1949.Crossref 16. Thorn, G. W., and Forsham, P. H.: Metabolic Changes in Man Following Adrenal and Pituitary Hormone Administration in Pincus, G., Editor: Recent Progress in Hormone Research: Proceedings of the Laurentian Hormone Conference , New York, Academic Press, Inc., 1949, Vol. 4, Pt. 2, pp. 229. 17. Adlersberg, D.; Schaefer, L. E., and Drachman, S. R.: Development of Hypercholesteremia During Cortisone and ACTH Therapy , J. A. M. A. 144:909 ( (Nov. 11) ) 1950.Crossref 18. Sprague, R. G.; Power, M. H., and Mason, H. L.: Physiological Effects of Cortisone and Pituitary Adrenocorticotropic Hormone (ACTH) in Man , J. A. M. A. 144:1341 ( (Dec. 16) ) 1950.Crossref 19. Sprague, R. G.; Power, M. H.; Mason, H. L.; Albert, A.; Mathieson, D. R.; Hench, P. S.; Kendall, E. C.; Slocumb, C. H., and Polley, H. F.: Physiologic Effects of Cortisone and ACTH in Man , Arch. Int. Med. 85:199 ( (Feb.) ) 1950.Crossref 20. Conn, J. W.; Vogel, W. C.; Louis, L. H., and Fajans, S. S.: Serum Cholesterol: A Probable Precursor of Adrenal Cortical Hormone , J. Lab. & Clin. Med. 35:504 ( (April) ) 1950. 21. Thorn, G. W., and others: Medical Progress: Clinical Usefulness of ACTH and Cortisone , New England J. Med. 242:824 ( (May 25) ) 1950. 22. Havens, W. P., Jr.; Myerson, R. M., and Carroll, I. N.: Effect of ACTH, Cortisone and Progesterone on Patients with Chronic Hepatic Disease , Metabolism 1:172 ( (March) ) 1952. 23. Bernfeld, P.; Bonner, C. D., and Homburger, F.: ACTH and Plasma Proteins , in Mote, J. R., Editor: Proceedings of Second Clinical ACTH Conference , New York, The Blakiston Company, 1951, Vol. 1, p. 282. 24. Flink, E. B., and Williams, C. F.: The Treatment of Chronic Liver Disease with Pituitary Adrenocorticotropic Hormone (ACTH) , J. Lab. & Clin. Med. 36:822 ( (Nov.) ) 1950. 25. Colbert, J. W., Jr.; Holland, J. P.; Heissler, I., and Knowlton, M.: The Use of ACTH in Acute Viral Hepatitis , in Mote, J. R., Editor: Proceedings of Second Clinical ACTH Conference , New York, The Blakiston Company, 1951, Vol. 1, p. 371. 26. Bongiovanni, A. M., and Eisenmenger, W. J.: Observations During the Administration of ACTH to Patients with Chronic Liver Disease , in Mote, J. R., Editor: Proceedings of Second Clinical ACTH Conference , New York, The Blakiston Company, 1951, Vol. 1, p. 390. 27. Gyorgy, P., and Bluemle, I. W., Jr.: The Treatment of Chronic Inflammatory Liver Disease with ACTH and Cortisone , in Mote, J. R., Editor: Proceedings of Second Clinical ACTH Conference , New York, The Blakiston Company, 1951, Vol. 1, p. 386. 28. Thorn, G. W.; Jenkins, D.; Laidlaw, J. C.; Gortz, F. C.; Dingiman, J. F.; Arons, W. L.; Streeten, D. H. P., and McCracken, B. H.: Pharmacologic Aspects of Adrenocortical Steroids in Man , New England J. Med. 248:369 ( (April 2) ) 1954. 29. Peters, J. P., and Van Slyke, D. D.: Determinations of Plasma Nitrogen , in Quantitative Clinical Chemistry , Vol. II, Methods, Baltimore, Williams & Wilkins, Company, 1932, pp. 291-393. 30. Sperry, W. M., and Webb, M. A.: A Revision of the Schoenheimer-Sperry Method for Cholesterol Determination , J. Biol. Chem. 187:97 ( (Nov.) ) 1950. 31. Bodansky, A.: Notes on Determination of Serum Inorganic Phosphate and Serum Phosphatase Activity , Am. J. Clin. Path. (Tech. Supp.) 7:51 ( (Sept.) ) 1937. 32. Malloy, H. T., and Evelyn, K. A.: Determination of Bilirubin with the Photoelectric Colorimeter , J. Biol. Chem. 119:481 ( (July) ) 1937. 33. Ducci, H.: Thymol Test of Maclagen: Standardization and Adaptation to Evelyn Photoelectric Colorimeter , J. Lab. & Clin. Med. 32:1266 ( (Oct.) ) 1947. 34. Aggeler, P. M.; Howard, J.; Lucia, S. P.; Clark, W., and Astoff, A.: Standardization of the Quick Prothrombin Test , Blood , 1:220 ( (May) ) 1946. 35. King, E. J., and Aiken, R. S.: An Intravenous Galactose-Tolerance Test , Lancet 2:543 ( (Nov. 2) ) 1940. 36. Colcher, H.; Patek, A. J., Jr., and Kendall, F. E.: Galactose Disappearance from the Blood Stream: Calculation of Galactose Removal Constant and Its Application as a Test for Liver Function , J. Clin. Invest. 25:768 ( (Sept.) ) 1946. 37. Raymond, A. L., and Blanco, J. G.: Blood Sugar Determination and Separation of Sugars with Live Yeast , J. Biol. Chem. 79:649 ( (Oct.) ) 1928. 38. Benedict, S. R.: The Determination of Blood Sugar II , J. Biol. Chem. 76:457 ( (Feb.) ) 1928. 39. Snell, A. M.; Greene, C. H., and Rowntree, L. G.: Diseases of the Liver: Further Studies in Experimental Obstructive Jaundice , Arch. Int. Med. 40:471 ( (Oct.) ) 1927. 40. Carr, J. L., and Foote, F. S.: Progressive Obstructive Jaundice: Changes in Certain Elements of Blood and Their Relation to Coagulation , Arch. Surg. 29:277 ( (Aug.) ) 1934. 41. Tanturi, C. A.; Canepa, J. F.; Bay, R., and Banfe, R. F.: Experimental Study on Liver Function Tests , Surg., Gynec. & Obst. 83:171 ( (Aug.) ) 1946. 42. Robscheit-Robbins, F. S., and Whipple, C. H.: Hemoglobin Production Factors in the Human Liver: II. Liver Degeneration, Cancer, Cirrhosis and Hepatic Insufficiency , J. Exper. Med. 57:653 ( (April) ) 1933. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives Surgery American Medical Association

The Influence of Stress upon Liver Function in Obstructive Jaundice

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American Medical Association
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Copyright © 1955 American Medical Association. All Rights Reserved.
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0096-6908
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10.1001/archsurg.1955.01270150089010
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Abstract

Abstract Liver failure and death following surgery on patients with obstructive jaundice are not uncommon. Such a postoperative course is usually manifested in part by a febrile coma, a rising level of serum bilirubin, and a falling level of cholesterol esters and albumin. There can be little doubt that the operation in some way has directly influenced the course of the patient. The specific etiological details, however, are rather obscure. The relative importance of such details is difficult to assess from clinical cases. Some of these factors are the impaired liver function existing preoperatively, the anesthesia, the nonspecific stress of the operation and coincident hypoxia or sepsis. In an effort to clarify the problem by experimental observations the authors have undertaken a series of studies to evaluate the relative importance of each factor. A detailed and thorough analysis of the course of liver function in dogs with simple uncomplicated obstructive jaundice References 1. References 30, 31, 32, and 33. 2. Acthar-gel, supplied by Armour Laboratories, Chicago. 3. References 7 and 8. 4. References 34, 35, and 36. 5. References 7 and 8. 6. Macgregor, C. A.: Nature of Liver Failure Due to Complete Biliary Obstruction , A. M. A. Arch. Surg. 67:878 ( (Dec.) ) 1953.Crossref 7. Fine, J.; Seligman, A. M., and Frank, H. A.: Specific Role of the Liver in Hemorrhagic Shock: Report of Progress to Date , Ann. Surg. 126:1002 ( (Dec.) ) 1947.Crossref 8. Moon, V. H.: The Pathology of Secondary Shock , Am. J. Path. 24:235 ( (March) ) 1948. 9. Levin, L.: Physical Stress and Liver Fat Content of the Fasted Mouse , Federation Proc. 8:218 ( (March) ) 1949. 10. Gillman, J., and Gillman, T.: Anoxia and the Liver with Special Reference to Shock and Chronic Malnutrition , Am. J. Digest. Dis. 16:348 ( (Oct.) ) 1949.Crossref 11. Frank, H. A.: Present Day Concepts of Shock , New England J. Med. 249:445 ( (Sept. 10) ) 1953.Crossref 12. Fairlie, C. W.; Barss, T. P.; French, A. B.; Jones, C. M., and Beecher, H. K.: Metabolic Effects of Anesthesia in Man: IV. A Comparison of the Effects of Certain Anesthetic Agents on the Normal Liver , New England J. Med. 244:615 ( (April 26) ) 1951.Crossref 13. French, A. B.; Barss, T. P.; Fairlie, C. B.; Bengle, A. L., Jr.; Jones, C. M.; Linton, R. R., and Beecher, H. K.: Metabolic Effects of Anesthesia in Man: V. A Comparison of the Effects of Ether and Cyclopropane Anesthesia on the Abnormal Liver , Ann. Surg. 135:145 ( (Feb.) ) 1952.Crossref 14. Forsham, P. H.; Thorn, G. W.; Prunty, F. T. G., and Hills, A. G.: Clinical Studies with Pituitary Adrenocorticotropin , J. Clin. Endocrinol. 8:15 ( (Jan.) ) 1948.Crossref 15. Sayers, G.; Burns, T. W.; Tyler, F. H.; Jager, B. V.; Schwartz, T. B.; Smith, E. L.; Samuels, L. T., and Davenport, H. W.: Metabolic Actions and Fate of Intravenously Administered Adrenocorticotropic Hormone in Man , J. Clin. Endocrinol. 1:593 ( (July) ) 1949.Crossref 16. Thorn, G. W., and Forsham, P. H.: Metabolic Changes in Man Following Adrenal and Pituitary Hormone Administration in Pincus, G., Editor: Recent Progress in Hormone Research: Proceedings of the Laurentian Hormone Conference , New York, Academic Press, Inc., 1949, Vol. 4, Pt. 2, pp. 229. 17. Adlersberg, D.; Schaefer, L. E., and Drachman, S. R.: Development of Hypercholesteremia During Cortisone and ACTH Therapy , J. A. M. A. 144:909 ( (Nov. 11) ) 1950.Crossref 18. Sprague, R. G.; Power, M. H., and Mason, H. L.: Physiological Effects of Cortisone and Pituitary Adrenocorticotropic Hormone (ACTH) in Man , J. A. M. A. 144:1341 ( (Dec. 16) ) 1950.Crossref 19. Sprague, R. G.; Power, M. H.; Mason, H. L.; Albert, A.; Mathieson, D. R.; Hench, P. S.; Kendall, E. C.; Slocumb, C. H., and Polley, H. F.: Physiologic Effects of Cortisone and ACTH in Man , Arch. Int. Med. 85:199 ( (Feb.) ) 1950.Crossref 20. Conn, J. W.; Vogel, W. C.; Louis, L. H., and Fajans, S. S.: Serum Cholesterol: A Probable Precursor of Adrenal Cortical Hormone , J. Lab. & Clin. Med. 35:504 ( (April) ) 1950. 21. Thorn, G. W., and others: Medical Progress: Clinical Usefulness of ACTH and Cortisone , New England J. Med. 242:824 ( (May 25) ) 1950. 22. Havens, W. P., Jr.; Myerson, R. M., and Carroll, I. N.: Effect of ACTH, Cortisone and Progesterone on Patients with Chronic Hepatic Disease , Metabolism 1:172 ( (March) ) 1952. 23. Bernfeld, P.; Bonner, C. D., and Homburger, F.: ACTH and Plasma Proteins , in Mote, J. R., Editor: Proceedings of Second Clinical ACTH Conference , New York, The Blakiston Company, 1951, Vol. 1, p. 282. 24. Flink, E. B., and Williams, C. F.: The Treatment of Chronic Liver Disease with Pituitary Adrenocorticotropic Hormone (ACTH) , J. Lab. & Clin. Med. 36:822 ( (Nov.) ) 1950. 25. Colbert, J. W., Jr.; Holland, J. P.; Heissler, I., and Knowlton, M.: The Use of ACTH in Acute Viral Hepatitis , in Mote, J. R., Editor: Proceedings of Second Clinical ACTH Conference , New York, The Blakiston Company, 1951, Vol. 1, p. 371. 26. Bongiovanni, A. M., and Eisenmenger, W. J.: Observations During the Administration of ACTH to Patients with Chronic Liver Disease , in Mote, J. R., Editor: Proceedings of Second Clinical ACTH Conference , New York, The Blakiston Company, 1951, Vol. 1, p. 390. 27. Gyorgy, P., and Bluemle, I. W., Jr.: The Treatment of Chronic Inflammatory Liver Disease with ACTH and Cortisone , in Mote, J. R., Editor: Proceedings of Second Clinical ACTH Conference , New York, The Blakiston Company, 1951, Vol. 1, p. 386. 28. Thorn, G. W.; Jenkins, D.; Laidlaw, J. C.; Gortz, F. C.; Dingiman, J. F.; Arons, W. L.; Streeten, D. H. P., and McCracken, B. H.: Pharmacologic Aspects of Adrenocortical Steroids in Man , New England J. Med. 248:369 ( (April 2) ) 1954. 29. Peters, J. P., and Van Slyke, D. D.: Determinations of Plasma Nitrogen , in Quantitative Clinical Chemistry , Vol. II, Methods, Baltimore, Williams & Wilkins, Company, 1932, pp. 291-393. 30. Sperry, W. M., and Webb, M. A.: A Revision of the Schoenheimer-Sperry Method for Cholesterol Determination , J. Biol. Chem. 187:97 ( (Nov.) ) 1950. 31. Bodansky, A.: Notes on Determination of Serum Inorganic Phosphate and Serum Phosphatase Activity , Am. J. Clin. Path. (Tech. Supp.) 7:51 ( (Sept.) ) 1937. 32. Malloy, H. T., and Evelyn, K. A.: Determination of Bilirubin with the Photoelectric Colorimeter , J. Biol. Chem. 119:481 ( (July) ) 1937. 33. Ducci, H.: Thymol Test of Maclagen: Standardization and Adaptation to Evelyn Photoelectric Colorimeter , J. Lab. & Clin. Med. 32:1266 ( (Oct.) ) 1947. 34. Aggeler, P. M.; Howard, J.; Lucia, S. P.; Clark, W., and Astoff, A.: Standardization of the Quick Prothrombin Test , Blood , 1:220 ( (May) ) 1946. 35. King, E. J., and Aiken, R. S.: An Intravenous Galactose-Tolerance Test , Lancet 2:543 ( (Nov. 2) ) 1940. 36. Colcher, H.; Patek, A. J., Jr., and Kendall, F. E.: Galactose Disappearance from the Blood Stream: Calculation of Galactose Removal Constant and Its Application as a Test for Liver Function , J. Clin. Invest. 25:768 ( (Sept.) ) 1946. 37. Raymond, A. L., and Blanco, J. G.: Blood Sugar Determination and Separation of Sugars with Live Yeast , J. Biol. Chem. 79:649 ( (Oct.) ) 1928. 38. Benedict, S. R.: The Determination of Blood Sugar II , J. Biol. Chem. 76:457 ( (Feb.) ) 1928. 39. Snell, A. M.; Greene, C. H., and Rowntree, L. G.: Diseases of the Liver: Further Studies in Experimental Obstructive Jaundice , Arch. Int. Med. 40:471 ( (Oct.) ) 1927. 40. Carr, J. L., and Foote, F. S.: Progressive Obstructive Jaundice: Changes in Certain Elements of Blood and Their Relation to Coagulation , Arch. Surg. 29:277 ( (Aug.) ) 1934. 41. Tanturi, C. A.; Canepa, J. F.; Bay, R., and Banfe, R. F.: Experimental Study on Liver Function Tests , Surg., Gynec. & Obst. 83:171 ( (Aug.) ) 1946. 42. Robscheit-Robbins, F. S., and Whipple, C. H.: Hemoglobin Production Factors in the Human Liver: II. Liver Degeneration, Cancer, Cirrhosis and Hepatic Insufficiency , J. Exper. Med. 57:653 ( (April) ) 1933.

Journal

A.M.A. Archives SurgeryAmerican Medical Association

Published: Sep 1, 1955

References