Cholemia

Cholemia, accumulation in the blood and tissues of components of bile, serves primarily as a manifestation of mechanical disruption of bile flow into the intestine. Previously, the concepts of cholemia and hepatic coma were equated. At present, under cholemia is understood intoxication of the organism by bile acids, while hepatic coma is considered a complex disorder caused by disruption of numerous functions of the liver (see Liver) and auto-intoxication by products of hepatic autolysis. The symptoms of cholemia and hepatic coma may combine, especially in cases where coma occurs as a terminal phenomenon in prolonged mechanical jaundice. The main manifestations of cholemia are bradycardia, skin itching, and decreased blood clotting. The pathogenesis of the first two symptoms is insufficiently studied, but apparently it is not exhausted by the influence of merely the retention of bile acids on the endings of sensory nerves and the vagus nerve (see Jaundice). The decrease in blood clotting depends in part on the increase of bile acids in the blood, and in part apparently on the change in fibrinogen content in the blood, i.e., on disruption of liver function in protein metabolism. The listed symptoms of cholemia are not constant and not always parallel to the intensity of jaundice. Often bradycardia and skin itching appear at the beginning of the development of cholemia, only to disappear in the further course of the disease. The decrease in blood clotting usually increases in proportion to the duration of cholemia and is its most ominous sign. Bleeding in cholemia differs from that in hepatic coma in that in the latter damage to the vascular wall is observed, while in cholemia the vessels are not affected, and the hemorrhagic symptom complex resembles hemophilia.