MULTIPLE TESTS OF HEPATIC FUNCTION IN GASTROENTERIC MALIGNANCY; THE VALUE OF BROMSULPHALEIN, HIPPURIC ACID AND THE VAN DEN BERGH REACTION IN DETECTING HEPATIC METASTASIS, WITH AN EVALUATION OF NORMALITY OF THE HIPPURIC ACID TEST

Abstract

Hippuric acid, bromsulphalein and van den Bergh tests were done on 25 patients with carcinoma of the stomach or colon who had no clinical evidence of metastasis. A correlation was found between gross hepatic metastasis as detd. at subsequent operation and the degree of bromsulphalein retention, although individual exceptions occurred. Xo significant correlation was found between metastasis and the amt. of hippuric acid excreted. However in all 6 cases in which no hippuric acid was found, metastases were present. The van den Bergh was not of diagnostic aid. Owing to the uniformly low levels of hippuric acid excretion found in these cases of carcinoma. 25 patients without signs, symptoms or historic reason for hepatic damage but who were suffering from a wide variety of acute and chronic diseases of comparable age and sex distribution were studied. 16 had abnormal hippuric acid excretion although only 2 of the 25 had abnormal bromsulphalein retention. It is suggested that extreme delicacy in tests of hepatic function may detract from their importance as diagnostic aids by too frequently giving abnormal results in cases where liver damage is slight and is a relatively unimportant part of the general clinical picture. This is. no way invalidates the serial use of liver function tests in following the course of liver disease and differentiating intrahepatic from extrahepatic icterus.