THE EFFECTS OF CHRONIC DISEASE OF THE LIVER ON THE COMPOSITION AND PHYSICOCHEMICAL PROPERTIES OF BLOOD: CHANGES IN THE SERUM PROTEINS; REDUCTION IN THE OXYGEN SATURATION OF THE ARTERIAL BLOOD
Authors: Albert M. Snell
Journal: Annals of Internal Medicine (1935)

Article1 December 1935THE EFFECTS OF CHRONIC DISEASE OF THE LIVER ON THE COMPOSITION AND PHYSICOCHEMICAL PROPERTIES OF BLOOD: CHANGES IN THE SERUM PROTEINS; REDUCTION IN THE OXYGEN SATURATION OF THE ARTERIAL BLOODALBERT M. SNELL, M.D., F.A.C.P.ALBERT M. SNELL, M.D., F.A.C.P.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-9-6-690 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThere are many problems in connection with chronic parenchymatous disease of the liver which have never been satisfactorily explained on an anatomic basis alone. For instance, it is difficult to understand why certain individuals with moderate or advanced degrees of nodular cirrhosis have minimal symptoms or none at all; cirrhosis is frequently discovered at operation or necropsy in cases in which there have not been any symptoms of it, and this has given rise to much discussion as to what compensatory processes are involved. While it is true that the liver possesses extraordinary powers of regeneration and a large functional...Bibliography1. ABRAMIROBERT-WALLICH P: Modifications du sérum sanguin au cours des cirrhoses du foie avec ascite. Inversion du rapport sérines-globulines, Compt.-rend. Soc. de biol., 1929, ci, 291-293. Google Scholar2. ATCHLEYLOEBBENEDICTPALMER DWRFEMWW: Physical and chemical studies of human blood serum. III. A study of miscellaneous disease conditions, Arch. Int. Med., 1923, xxxi, 616-621. CrossrefGoogle Scholar3. AUSTINCULLENHASTINGSMCLEANPETERSVAN SLYKE JHGEABFCJPDD: Studies of gas and electrolyte equilibria in blood. I. Technique for collection and analysis of blood, and for its saturation with gas mixtures of known composition, Jr. Biol. Chem., 1922, liv, 121-147. CrossrefGoogle Scholar4. BARCROFT J: The respiratory function of the blood. Part I. Lessons from high altitudes, 1925, Cambridge University Press, 200 pp. Google Scholar5. BARCROFT J: The respiratory function of the blood. Part II. Hemoglobin, 1928, Cambridge University Press, 200 pp. Google Scholar6. BARKERKIRK MHEJ: Experimental edema (nephrosis) in dogs in relation to edema of renal origin in patients, Arch. Int. Med., 1930, xlv, 319-346. CrossrefGoogle Scholar7. BARNETTJONESCOHN CWRBRB: The maintenance of a normal plasma protein concentration in spite of repeated protein loss by bleeding, Jr. Exper. Med., 1932, lv, 683-693. CrossrefGoogle Scholar8. BENNETTDODDSROBERTSON TIECJD: A study of plasma-protein loss with edema but without proteinuria and its bearing on the concept of nephrosis, Lancet, 1930, ii, 1006-1008. CrossrefGoogle Scholar9. BOLLMAN JL: Studies on the experimental production of ascites. (Unpublished data.) Google Scholar10. BRUCKMANPETERS FSJP: The plasma proteins in relation to blood hydration. V. Serum proteins and malnutritional or cachectic edema, Jr. Clin. Invest., 1930, viii, 591-595. CrossrefGoogle Scholar11. BUTTERFIELD EE: Über die Lichtextinktion, das Gasbindungsvermögen und den Eisengehalt des menschlichen Blutfarbstoffs in normalen und Krankhaften Zuständen, Ztschr. f. phys. Chem., 1909, lxii, 173-225. CrossrefGoogle Scholar12. CAMPBELL JA: Concerning the problem of Mount Everest, Lancet, 1928, ii, 84-86. CrossrefGoogle Scholar13. CHABROLCOLLET EJ: La curabilité de l'ascite dans les cirrhoses atrophiques du foie, Bull. et mem. Soc. méd. d. hôp. de Par., 1934, iii, 700-701. Google Scholar14. FELLINGERKLIMA KR: Lebercirrhose und Anämen, Ztschr. f. klin. Med., 1934, cxxvi, 547-567. Google Scholar15. FIESSINGERGOTHIE NS: L'évolution de l'équilibre albumine-globuline du sérum après l'hépatectomie totale et le fistula d'Eck chez le chien, Compt.-rend. Soc. de biol., 1933, cxii, 1053-1055. Google Scholar16. FOLEY MP: Unpublished data. Google Scholar17. FOSTERWHIPPLE DPGH: Blood fibrin studies. IV. Fibrin values influenced by cell injury, inflammation, intoxication, liver injury, and the Eck fistula. Notes concerning the origin of fibrinogen in the body, Am. Jr. Physiol., 1922, lviii, 407-431. CrossrefGoogle Scholar18. GILBERTCHIRAY AM: Diminution des substances albumineuses du sérum sanguin chez les cirrhotiques ascitiques, Compt.-rend. Soc. de biol., 1907, lxiii, 487-488. Google Scholar19. GOLDSCHMIDTRAVDINLUCKÉ SISB: The effect of oxygen in prevention of hepatic necrosis produced by volatile anesthetics, Arch. Path., 1934, xviii, 593-594. Google Scholar20. GRENET H: Diminution des albumines du sérum sanguin chez les hepatiques, Compt.-rend. Soc. de biol., 1907, lxiii, 552-553. Google Scholar21. HARROP GA: The oxygen and carbon dioxide content of arterial and of venous blood in normal individuals and in patients with anemia and heart disease, Jr. Exper. Med., 1919, xxx, 241-257. CrossrefGoogle Scholar22. HARROP GA: Polycythemia, Medicine, 1928, vii, 291-344. Google Scholar23. HEATHKING CWEF: The Takata-Ara test in the diagnosis of liver disease, New Eng. Jr. Med., 1934, ccxi, 1077-1081. CrossrefGoogle Scholar24. HITZENBERGER K: Über Störungen des Bewusstseins bei Kreislaufkranken infolge Sauerstoffmangels, Wien. klin. Wchnschr., 1933, xlvi, 865-869. Google Scholar25. HOLMANMAHONEYWHIPPLE RLEBGH: Blood plasma protein regeneration controlled by diet. I. Liver and casein as potent diet factors, Jr. Exper. Med., 1934, lix, 251-267. CrossrefGoogle Scholar26. HOLMANMAHONEYWHIPPLE RLEBGH: Blood plasma protein given by vein utilized in body metabolism. II. A dynamic equilibrium between plasma and tissue proteins, Jr. Exper. Med., 1934, lix, 269-282. CrossrefGoogle Scholar27. KERRHURWITZWHIPPLE WJSHGH: Regeneration of blood serum proteins. I. Influence of fasting upon curve of protein regeneration following plasma depletion, Am. Jr. Physiol., 1918, xlvii, 356-369. CrossrefGoogle Scholar28. KERRHURWITZWHIPPLE WJSHGH: Regeneration of blood serum proteins. II. Influence of diet upon curve of protein regeneration following plasma depletion, Am. Jr. Physiol., 1918, xlvii, 370-378. CrossrefGoogle Scholar29. KERRHURWITZWHIPPLE WJSHGH: Regeneration of blood serum proteins. III. Liver injury alone: liver injury and plasma depletion: the Eck fistula combined with plasma depletion, Am. Jr. Physiol., 1918, xlvii, 379-392. CrossrefGoogle Scholar30. KROGH M: The diffusion of gases through the lungs of man, Jr. Physiol., 1915, xlix, 271-300. CrossrefGoogle Scholar31. LANDIS EM: Micro-injection studies of capillary permeability. III. The effect of lack of oxygen on the permeability of the capillary wall to fluid and to the plasma proteins, Am. Jr. Physiol., 1928, lxxxiii, 528-542. CrossrefGoogle Scholar32. LINDERLUNDSGAARDVAN SLYKE GCCDD: The concentration of the plasma proteins in nephritis, Jr. Exper. Med., 1924, xxxix, 887-920. CrossrefGoogle Scholar33. LOEBBOCKFITZ RFAVR: Acute nitrobenzol poisoning with studies on the blood in two cases, Am. Jr. Med. Sci., 1921, clxi, 539-546. CrossrefGoogle Scholar34. LOEWY A: Über das Verhalten der Leber unter Luftverdünnung, Biochem. Ztschr., 1927, clxxxv, 287-319. Google Scholar35. LUNDSGAARDVAN SLYKE CDD: Cyanosis, Medicine, 1923, ii, 1-76. CrossrefGoogle Scholar36. MACĚLASELIŠKAR IA: The influence of temperature on the equilibrium between oxygen and haemoglobin of various forms of life, Jr. Physiol., 1925, lx, 428-442. CrossrefGoogle Scholar37. MACCALLUM AB: Quoted by Rich. Google Scholar38. MEAKINS JC: Observations on the gases in human arterial blood in certain pathological pulmonary conditions, and their treatment with oxygen, Jr. Path. and Bacteriol., 1921, xxiv, 79-90. CrossrefGoogle Scholar39. MYERSKEEFER WKCS: Relation of plasma proteins to ascites and edema in cirrhosis of the liver, Arch. Int. Med., 1935, lv, 349-359. CrossrefGoogle Scholar40. MYERSTAYLOR WKFH: Hypoproteinemia probably due to deficient formation of plasma proteins: a study of one case, Jr. Am. Med. Assoc., 1933, ci, 198-200. CrossrefGoogle Scholar41. PELLEGRINI G: L'azione della sostanza tiroidea sulle proteine e sulla pressione colloidoosmotica del sangue e sulla diuresi nella cirrosi epatica con ascite, Arch. di Patolog. e Clin. Medica, 1934, xiii, 413-438. Google Scholar42. PETERSEISENMAN JPAJ: The serum proteins in diseases not primarily affecting the cardiovascular system or kidneys, Am. Jr. Med. Sci., 1933, clxxxvi, 808-833. CrossrefGoogle Scholar43. PETERSVAN SLYKE JPDD: Quantitative clinical chemistry. Volume I. Interpretations, 1931, Williams and Wilkins, Baltimore, 1264 pp. Google Scholar44. RAY GB: Chemical studies on the spleen. II. Changes in hemoglobin following removal of the spleen, Am. Jr. Physiol., 1928, lxxxvi, 138-144. CrossrefGoogle Scholar45. RAYSTIMSON GBBB: Observations on the chemical activity of the spleen. I. The relation of the spleen to methemoglobin in the blood, Am. Jr. Physiol., 1927, lxxxi, 62-73. CrossrefGoogle Scholar46. RAYTHOMASSTRONG GBCIJE: The oxygenation of concentrated versus normal bloods, Jr. Clin. Invest., 1933, xii, 1051-1062. CrossrefGoogle Scholar47. RICH AR: The pathogenesis of the forms of jaundice, Bull. Johns Hopkins Hosp., 1930, xlvii, 338-377. Google Scholar48. RICHRESNIK ARWH: On the mechanism of jaundice following pulmonary infarction in patients with heart failure, Bull. Johns Hopkins Hosp., 1926, xxxviii, 75-76. Google Scholar49. RICHARDSSTRAUSS DWML: Oxy-hemoglobin dissociation curves of whole blood in anemia, Jr. Clin. Invest., 1927, iv, 105-126. CrossrefGoogle Scholar50. ROBSCHEIT-ROBBINSWHIPPLE FSGH: Hemoglobin production factors in the human liver. II. Liver degeneration, cancer, cirrhosis, and hepatic insufficiency, Jr. Exper. Med., 1933, lvii, 653-670. CrossrefGoogle Scholar51. ROSIN A: Morphologische Organveränderungen beim Leben unter Luftverdünnung, Beitr. z. path. Anat. u. z. allg. Path., 1928, lxxx, 622-639. Google Scholar52. ROWE AH: The albumin and globulin content of human blood serum in health, syphilis, pneumonia, and certain other infections, with the bearing of globulin on the Wassermann reaction, Arch. Int. Med., 1916, xviii, 455-473. CrossrefGoogle Scholar53. RÜHL A: über Störungen des Sauerstoffdurchtritts in der Lunge, Arch. f. exper. Path. u. Pharmakol., 1930, clviii, 282-303. CrossrefGoogle Scholar54. SALVESEN HA: Variations in the plasma protein in non-renal conditions, Acta med. Scandin., 1929, lxxii, 113-123. Google Scholar55. SAWADA T: Biochemical investigation of the blood in cases of experimental disturbance of liver function. Report II. Liver function and protein metabolism, Japan Jr. Gastro-Enterol., 1931, iii, 38-45. Google Scholar56. SNELLROTH AMGM: The lactic acid of the blood in hepatic disease, Jr. Clin. Invest., 1932, xi, 957-971. CrossrefGoogle Scholar57. STARLINGERWINANDS WE: Über das Verteilungsverhältnis der zirkulierenden Eiweizkörper im Verlaufe krankhafter Zustände. III. (Erkrankungen der Blut bildenden und zerstörenden Organe und der Leber, bösartige Geschwülste, Leukämie, Granulom, Magendarmgeschwür, Gastro-enteritis, Diabetes, und andere Erkrankungen der innersekretorischen Organe), Ztschr. f. d. ges. exper. Med., 1928, lx, 185-238. Google Scholar58. STIMSON BB: Changes in the oxygen capacity of the blood pigment of rabbits following splenectomy, Jr. Biol. Chem., 1927, lxxv, 95-99. CrossrefGoogle Scholar59. STIMSONHRUBETZ BBMC: Changes in the oxygen capacity of the blood pigment of rabbits following partial hepatectomy, Jr. Biol. Chem., 1928, lxxviii, 413-415. CrossrefGoogle Scholar60. VAN SLYKE DD: Note on a portable form of the manometric gas apparatus and on certain points in the technique of its use, Jr. Biol. Chem., 1927, lxxiii, 121-126. CrossrefGoogle Scholar61. VAN SLYKENEILL DDJM: The determination of gases in blood and other solutions by vacuum extraction and manometric measurement, Jr. Biol. Chem., 1924, lxi, 523-573. CrossrefGoogle Scholar62. WELLSYOUMANSMILLER HSJBDG: A formula and nomogram for the estimation of the osmotic pressure of colloids from the albumin and total protein concentrations of human blood sera, Jr. Clin. Invest., 1933, xii, 1103-1117. CrossrefGoogle Scholar63. WHIPPLE GH: Anemia, liver function, and hemoglobin production, Proc. Calif. Acad. of Med., 1932-1933, 81-102. Google Scholar64. WIENERWIENER JHRE: Plasma proteins, Arch. Int. Med., 1930, xlvi, 236-265. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Rochester, Minnesota*Read at the Philadelphia meeting of the American College of Physicians, May 1, 1935.From the Division of Medicine, The Mayo Clinic, Rochester, Minn.†With the technical assistance of Elizabeth Maclay, B.A. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byHepatopulmonary SyndromeHepatopulmonary syndrome as the first and only manifestation of cirrhosis in a patient with hypopituitarismCentral Nervous System and Pulmonary Complications of End-Stage Liver DiseasePortopulmonary Hypertension and Hepatopulmonary SyndromeThe biological "scrabble" of pulmonary arteriovenous malformations: considerations in the setting of cavopulmonary surgeryQuantitative lung perfusion scintigraphy and detection of intrapulmonary shunt in liver cirrhosisAbernethy malformation: One of the etiologies of hepatopulmonary syndromeHepatopulmonary syndromeThe hepatopulmonary syndromeImaging and Quantification of Hepatobiliary FunctionClinical factors that affect blood gases in non-smoking women with chronic liver diseaseEFFECTS OF HYPOXEMIA ON EARLY POSTOPERATIVE COURSE OF LIVER TRANSPLANTATION IN PEDIATRIC PATIENTS WITH INTRAPULMONARY SHUNTING1Le rapport ventilation/perfusion pulmonaireSTRUCTURAL AND PATHOLOGIC CHANGES IN THE LUNG VASCULATURE IN CHRONIC LIVER DISEASEPrimary biliary cirrhosis complicated by severe hypoxemiaHepatic Venous Blood and the Development of Pulmonary Arteriovenous Malformations in Congenital Heart DiseaseIntrapulmonary shunting in the biliary atresia/polysplenia syndrome: reversal after liver transplantation.Hepatopulmonary SyndromeMechanisms of Impaired Arterial Oxygenation in Patients With Liver Cirrhosis and Severe Respiratory InsufficiencyVENTILATION/PERFUSION AFTER LIVER RANSPLANTATION IN DECOMPENSATED CIRRHOSISIs intrapulmonary arteriovenous shunting and hypoxemia a contraindication for liver transplantation?Pulmonary Aspects of Liver Disease and Liver TransplantationHemodynamic Disturbances and Va/Q Matching in Hypoxemic Cirrhotic PatientsDigital gangrene complicating intraoperative injection sclerotherapyAdequacy and support of physiological functions in the acutely ill cirrhotic patientPulmonary Aspects of Chronic Liver Disease and Liver TransplantationArterial Hypoxemia in Patients With Hepatic CirrhosisAlcohol and the Respiratory TractHypoxemia of cirrhosisAlcohol and the lungHypoxaemia and cirrhosis of the liver.La Sindrome Epato-RenalePulmonary function in alcoholicsA Rational Approach to the Hepatorenal SyndromeClosing volume — A test of small airway function?Porta-pulmonary venous anastomoses in experimental cirrhosis of the liver in ratsO comportam en to da pressão arterial na esquistossomose hepática e outras hepatopatiasCyanosis complicating hepatic cirrhosisHepatopulmonary syndromeHepatopulmonary syndromeHypertrophic osteoarthropathy with arthritis and synovial calcification in a patient with alcoholic cirrhosisCirrhosis, cyanosis and polycythaemia: Multiple pulmonary arteriovenous anastomosesSyndrome of cyanosis, digital clubbing, and hepatic disease in siblingsCase 51-1967Cyanosis with hepatic cirrhosis: A case with pulmonary arteriovenous shuntingCirculatory and respiratory changes in patients with Laennec's cirrhosis of the liverStudies on arterial blood gas and ph in chronic liver diseaseOxyhemoglobin Dissociation in Patients with Hepatic EncephalopathyArterial Changes in the Lungs in Cirrhosis of the Liver — Lung Spider NeviUntersuchungen zur Auswirkung des Pfortaderhochdrucks der Lebercirrhose und porto-cavaler Anastomosenoperationen auf den KreislaufVen�se Beimischung und Lungenkreislauf bei LebercirrhoseSystemic Circulatory Adjustments in Hepatic DiseaseOn Some Liver Functions in Rheumatoid ArthritisSignificance of High γ-Globulin Content in Burmese SerumMultiple Small Pulmonary Arteriovenous FistulasOn Some Liver Functions in Rheumatoid ArthritisThe Problem of Persisting Destructive Disease of the LiverVENO-ARTERIAL SHUNTING OF BLOOD IN CHRONIC LIVER DISEASEArterial Oxygen Unsaturation and the Ventilation-Perfusion Defect of Laënnec's CirrhosisRespiration and Circulation in Patients with Portal Cirrhosis of the LiverVENOARTERIAL SHUNTS IN CIRRHOSIS OF THE LIVERPortal HypertensionÜber Bronchialvenen und ihre Stellung zwischem großen und kleinem KreislaufHyperventilation and arterial hypoxemia in cirrhosis of the liverListerian Oration: THE LIVER AND THE PORTAL CIRCULATIONBiochemical, blood gas and peripheral circulatory alterations in hepatic comaMultiple pulmonary arteriovenous fistulas in juvenile cirrhosisPhysiologische Chemie einzelner Lebensvorgänge und Organe (Fortsetzung)HEPATIC FUNCTION AFTER OPERATIONS FOR PORTAL HYPERTENSIONThe Medical Management of Severe Liver DiseaseSERUM PROTEIN FRACTIONATION IN HEPATITISVerdauungs- und StoffwechselfunktionenSerum protein variations in the course of chronic hepatitisStudies on the Serum Proteins in HepatitisSerum Proteins in Hepatic DiseaseStudies on the Serum Proteins in HepatitisSUBACUTE NECROSIS OF THE LIVER WITHOUT ICTERUSA clinical and laboratory study of plasma lipids in obstructive jaundice and several types of hepatic diseasePreparation of the jaundiced patient for operationBLOOD PLASMA PROTEINS IN RATS FOLLOWING PARTIAL HEPATECTOMY AND LAPAROTOMY 1 December 1935Volume 9, Issue 6Page: 690-711KeywordsBloodChronic liver diseaseCirrhosisLiverOxygenRegenerative medicineSerum proteins Issue Published: 1 December 1935 PDF downloadLoading ...