STUDIES ON THE TOTAL BILE : III. ON THE BILE CHANGES CAUSED BY A PRESSURE OBSTACLE TO SECRETION; AND ON HYDROHEPATOSIS.

In bile that is secreted against an abnormally high pressure, as during partial obstruction, the pigment, cholate, and cholesterol outputs are all cut down, and so much more than is the fluid bulk that the concentration of the substances per cubic centimeter of bile is notably lessened. The fluid obtained at the greatest pressure compatible with secretion contains traces only of the typical biliary constituents. The bearing of these alterations in the bile on the consequences of partial biliary obstruction is discussed. An analysis of the liver changes following biliary obstruction brings out their essential likeness to the changes that occur under similar circumstances in glands in general and the kidney in particular. The major physiological factors concerned in the development of hydronephrosis and in the liver changes after biliary obstruction are identical. We would suggest that the term hydrohepatosis as applied to the liver condition would be useful not merely to designate it but to indicate the principles underlying its development. In clinical instances of biliary obstruction, the likeness to hydronephrosis is often hidden because of the activity of the gall bladder to render the stasis bile dark and thick. There is then a concealed hydrohepatosis, differing merely by the character of the duct content, from the manifest hydrohepatosis with "white bile," that is found when the gall bladder fails to act.