Abstract
Quantiative measurement is required to define the severity of chronic liver disease and the effects of therapy on its complications. This paper presents a method of such assessment based on measurement of hepatocyte function, liver volume, functional liver blood flow, portal perfusion and cardiac output. Data are presented on 54 patients evaluated prior to, and one year after DSRS for variceal bleeding. Preoperative testing showed that alcoholics (n=24) had significantly (p<0.05) larger liver and smaller spleen volumes than nonalcoholic cirrhotics (n=22) and patients with portal vein thrombosis (n=8), but that the other parameters were not significantly different by etiologies. At one year after DSRS: all groups showed a significant (p<0.01) reduction of 41 per cent in spleen size: liver volume was significantly (p<0.05) reduced in cirrhotics: there was a significantly (p<0.01) greater loss of portal perfusion in alcoholic cirrhosis: liver blood flow showd a significant (p<0.05) rise in alcoholics when compared to nonalcoholics and portal vein thrombosis patients: cardiac output ros in alcoholic cirrhosis: hepatocyte function was not significantly different in any group. This study shows that in patients all doing well clinically one year after DSRS, there are markedly different hemodynamic responses. Further studies on cirrhosis aimed at improving therapy for its complications should include some objective, quentitative assessment, first to define the study population, and second to measure the effect of the therapy.
Similar content being viewed by others
References
Zeppa R. (Ed). Progress symposium in portal hypertension. World J Surg 1984; 1: 625–752.
Tygstrup N. The galactose elimination capacity in control subjects and in patients with cirrhosis of the liver. Acta Med Scand 1964: 175: 281–289.
Henderson JM, Fales FW. Continuous flow fluorometry of low galactose concentrations in blood and plasma. Clin Chem 1980; 26: 282–284.
Henderson JM, Heymsfield SB, Horowitz J, Kutner MH. Measurement of liver and spleen volume by computed tomography. Radiology 1981; 141: 525–527.
Henderson JM, Kutner MH, Bain RP. First-order clearance of plasma galactose: the effect of liver disease. Gastroenterology 1982; 83: 1090–1096.
Henderson JM, Pearson TC, Millikan WJ, Warren WD. Galactose clearance as a measure of effective liver blood flow. Gastroenterology (Abstr.) 1985; 88: 1664.
Feigenbaum H. Clinical applications of echocardiography. Progr Cardiovas Dis 1972; 14: 531.
Scholz PM, Rerych SK, Moran JF, Newman GE, Douglas JM, Sabiston DC, Jones RH. Quantitative radionuclide angiocardiography. Catheterization and cardiovascular Diagnosis 1980; 6: 265–283.
Nordlinger BM, Nordlinger DE, Millikan WJ, Fulenwider JT, Sones PJ, Kutner MH, Steele R, Bain R, Warren WD. Angiography in portal hypertension. Clinical significance in surgery. Am J Surg 1980; 159: 132–141.
Dixon WG, Brwon MB. (Eds.). Biomedical Computer Programs. University of California Press, Berkeley, 1981.
Millikan WJ, Warren WD, Henderson JM, Smith RB, Salam AA, Galambos JT, Kutner MH, Keen JH. The emory prospective randomized trial. Selective vs nonselective shunt to control variceal bleeding. Ten year follow-up. Ann Surg 1985; 201: 712–722.
Langer B, Taylor BR, MacKenzie DR, Gilas T, Stone RM, Blendis L. Further report of a prospective randomized trial comparing distal splenorenal shunt with end-to-side portacaval shunt. An analysis of encephalopathy, survival, and quality of life. Gastroentrology 1985; 88: 424–429.
Reichle FA, Fahmy WF, Golsorkhi M. Prospective comparative clinical trial with distal splenorenal and measocaval shunts. Am J Surg 1979; 137: 13–21.
Conn HO, Resnick RH, Grace ND, et al. Distal splenorenal shunt vs portal-systemic shunt: Current status of a controlled trial. Hepatology 1981; 1: 151–160.
Fischer JE, Bower RH, Atamian S, Welling R. Comparison of distal and proximal splenorenal shunts. A randomized prospective trial. Ann Surg 1981; 194: 531–544.
Villamil F, Redeker A, Reynolds T, Yellin A. A controlled trial of distal splenorenal and portacaval shunts. (Abstr.) Hepatology 1981 1: 557.
Zeppa R, Hensley GT, Levi JU, et al. The comparative survival of alcoholics versus nonalcoholics after distal splenorenal shunt. Ann Surg 1978; 187: 510–514.
Warren WD, Millikan WJ, Henderson JM et al. Ten years portal hypertensive surgery at Emory. Results and new perspectives. Ann Surg 1982; 195: 530–542.
Henderson JM, Millikan WJ, Wright-Bacon L, Kutner MH, Warren WD. Hemodynamic differences between alcoholic and nonalcoholic cirrhotics following distal splenorenal shunt—effect on survival? Ann Surg 1983; 198: 325–334.
Henderson JM, Gong-Liang J, Galloway J, Millikan WJ, Sones PJ, Warren WD Portal prival collaterals following distal splenorenal shunt. Incidence, magnitude and associated portal perfusion changes. J of Hepatol 1985; 1: 649–661.
Inokuchi K, Beppu K, Koyanagi N, Nagamine K, Hashizume M, Sugimachi K. Exclusion of nonisolated splenic vein in distal splenorenal shunt for prevention of portal malcirculation. Ann Surg 1984. 200: 711–717.
Isomatsu T. Loss of selectivity of Warren shunt in long-term observation. Jpn J Surg 1983; 13: 202–206.
Warren WD, Millikan WJ, Henderson JM, Rasheed ME, Salam AA. Selective variceal decompression after splenectomy or splenic vein thrombosis—with a note on splenopancreatic disconnection. Ann Surg 1984; 199: 694–702.
Conn HO. Endoscopic sclerotherapy. An analysis of variants. Hepatology 1983; 2: 641–644.
Paquet KJ, Fleig WE. Sclerotherapy of esophageal varices. In Papp JP, ed. Endoscopic control of gastrointestinal hemorrhage. Boca Raton: Florida CRC Press, 1981; 65–72.
MacDougall BRD, Westaby D, Theodossi A, Dawson JC, Williams R. Increased long term survival in variceal hemorrhage using injection sclerotherapy. Results of a controlled trial. Lancet 1982; i: 124–127.
Warren WD, Henderson JM, Millikan WJ, Galambos JT, Brooks WS, Riepe SP, Salam AA, Kutner MH. Distal splenorenal shunt versus endoscopic sclerotherapy for long term management of variceal bleeding. Annals Surg 1986: In press.
Millikan WJ, Henderson JM, Potts JR, Warren WD, Galambos J, Brooks WS, Riepe S. Liver function and hemodynamic status 1 year into sclerotherapy for variceal bleeding. Gastroenterology (Abstr.) 1984; 86: 1184.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Henderson, J.M., Warren, W.D. A method of measuring quantitative hepatic function and hemodynamics in cirrhosis: The changes following distal splenorenal shunt. The Japanese Journal of Surgery 16, 157–168 (1986). https://doi.org/10.1007/BF02471088
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF02471088