Serum albumin levels decrease to variable degrees in many severe acute and chronic disorders. Albumin is synthesized in the liver, so most acute or chronic destructive liver diseases of at least moderate severity also result in decreased serum albumin levels. In addition, there may be other serum protein changes. In cirrhosis of moderate to severe degree, there is a decreased albumin level and usually a “diffuse” (“polyclonal”) gamma-globulin elevation, sometimes fairly marked. About 50% of patients with well-established cirrhosis have a characteristic serum protein electrophoretic pattern with gamma-globulin elevation that incorporates the beta area (so-called beta-gamma bridging). However, about 35% of cirrhotic patients show only various degrees of gamma elevation without any beta bridging, and about 10% have normal gamma levels. Hepatitis may also be associated with moderate elevation of the gamma globulins. Biliary obstruction eventually causes elevated beta-globulin levels, since beta globulins carry cholesterol.