EFFECT OF DISEASE OF THE LIVER AND BILIARY TRACT UPON THE PHOSPHATASE ACTIVITY OF THE SERUM

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Abstract
The phosphatase activity of the serum was detd. in 358 patients with disease of the liver or biliary tract. The Bodansky method of determining phosphatase activity was used and 1 to 4 Bodansky units per 100 c.cm. of serum was considered normal. 123 of these cases were previously reported. Of 79 adults with proven common bile duct obstruction, 72 had phosphatase levels in the serum of more than 10 Bodansky units. 82 of 107 adults, in which a diagnosis of "hepatitis" was made, had phosphatase levels less than 10 Bodansky units. Of 69 patients with so-called "catarrhal" jaundice, 62 had phosphatase levels of less than 10 units. Of 38 patients with jaundice developing after exposure to hepatotoxic drugs, chiefly arsphen-amine, 20 had phosphatase values below 10 units. 34 of 44 patients with advanced cirrhosis of the liver had phosphatase values below 9 units. 47 patients with proven neoplastic involvement of the liver showed a wide dispersion of serum phosphatase levels, depending on the extent and location of the metastases. Hemolytic jaundice and chronic passive congestion of the liver were not associated with an increase in the serum phosphatase activity. In patients with liver abscesses there was a distinct rise in phosphatase activity. The serum phosphatase was evidently of limited but distinct value in the differentiation of obstructive from the hepatogenous type of jaundice. A serum phosphatase value of less than 10 Bodansky units per cc. of serum tended to rule out an obstructive type of jaundice. The serum phosphatase levels were found to be of value in the diagnosis of cholangitis after operations upon the biliary tract and in the early diagnosis of metastatic liver involvement in patients known to have malignancy.