III. BLOOD PLASMA CHOLESTEROL : FLUCTUATIONS DUE TO LIVER INJURY AND BILE DUCT OBSTRUCTION.

Hypocholesteremia with dissociation of the normal ratio of esterified to total cholesterol is related to chronic liver injury caused by chloroform. Hypercholesteremia may develop after prolonged biliary obstruction. The hypercholesteremia of chronic biliary obstruction may be promptly reduced below normal by chloroform poisoning or bile duct infection. Acute injury of liver due to chloroform anesthesia may cause no change in blood plasma cholesterol. Absence of bile in the intestine with faulty fat absorption does not cause the development of hypocholesteremia with dissociation of the ester ratio. Poor food consumption or short periods of fasting may cause no change in blood plasma cholesterol. Liver cells injured by chloroform may subsequently become resistant to chloroform. After prolonged biliary obstruction, the liver is apparently more sensitive to small doses of chloroform by mouth. Analysis of blood plasma cholesterol may have a clinical application in differentiation between simple obstructive and parenchymatous lesions of the liver.