Meal induced changes in hepatic and splanchnic circulation: a noninvasive Doppler study in normal humans

  • M. Dauzat
  • M. Lafortune
  • H. Patriquin
  • G. Pomier-Layrargues
Article

Summary

The haemodynamic effects of a meal on the splanchnic and hepatic circulation were evaluated in 30 healthy volunteers, using Doppler ultrasonography. The resistance index (RI) of the superior mesenteric artery and of the left and right intrahepatic arteries, the portal vein blood flow as well as the ratio between maximal velocity in the left and right intrahepatic arteries and the adjacent portal vein were measured initially, then 15, 30, 45, and 60 min after the ingestion of a standard balanced liquid meal. Postprandial haemodynamic changes were maximal 30 min after the meal; at that time, mesenteric artery RI decreased significantly [mean −11% (SEM 14%)] whereas portal vein blood flow increased markedly [mean +79% (SEM 14%)]; a significant increase in hepatic artery RI was observed in both liver lobes. The ratio between maximal velocities of the intrahepatic artery and the intrahepatic portal vein was reduced significantly; this ratio decreased more markedly in the right lobe of the liver. These findings would suggest that there was an adaptation of hepatic artery to portal vein blood flow after a meal. The subsequent increase in intrahepatic portal vein flow velocity was found to be greater in the right lobe of the liver.

Key words

Meal Hepatic artery Superior mesenteric artery Portal vein Blood flow 

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References

  1. Adamson SL, Langille BL (1992) Factors determining aortic and umbilical blood flow pulsatility in fetal sheep. Ultrasound Med Biol 18:255–266Google Scholar
  2. Alvarez D, Mastai R, Lennie A, Soifer G, Levi D, Terg R (1991) Noninvasive measurement of portal venous blood flow in patients with cirrhosis: effects of physiological and pharmacological stimuli. Dig Dis Sci 36:82–86Google Scholar
  3. Barbara L (1990) The value of Doppler US in the study of hepatic haemodynamics. Consensus conference. Bologna, Italy, 2 September 1989. J Hepatol 10:353–355Google Scholar
  4. Bendsten F, Simonsen L, Henriksen JH (1992) Effect on haemodynamics of a liquid meal alone and in combination with propranolol in cirrhosis. Gastroenterology 102:1017–1023Google Scholar
  5. Brandt JL, Castleman L, Ruskin HD, Greenwald J, Kelly JJ, Jones A (1955) The effect of oral protein and glucose feeding on splanchnic blood flow and oxygen utilization in normal and cirrhotic subjects. J Clin Invest 34:1017–1021Google Scholar
  6. Brown BP, Heistad DD (1986) Capacitance of the rabbit portal vein and inferior vena cave. J Physiol 381:417–425Google Scholar
  7. Burns PN, Jaffe CC (1985) Quantitative flow measurement with Doppler ultrasound: techniques, accuracy, and limitations. Radiol Clin North Am 23:641–657Google Scholar
  8. Chou CC (1983) Splanchnic and overall cardiovascular haemodynamics during eating and digestion. Fed Proc 42:1658–1661Google Scholar
  9. Dauzat M, Pomier-Layrargues G (1989) Portal vein blood flow measurements using pulsed Doppler and electromagnetic flowmetry in dogs: a comparative study. Gastroenterology 96:913–919Google Scholar
  10. De Vries PJ, Van Hattum J, Hoekstra JBL, de Hooge P (1991) Duplex Doppler measurements of portal venous flow in normal subjects. Inter and intra-observer variability. J Hepat 13:358–363Google Scholar
  11. Doi R, Inoue K, Kogire M, Sumi S, Takaori K, Suzuki T, Tobe T (1988) Simultaneous measurement of hepatic arterial and portal venous flows by transit time ultrasonic volume flowmetry. Surg Gynecol Obstet 167:65–69Google Scholar
  12. Gaiani S, Bolondi L, Li Bassi S, Sand V, Zironi G, Barbara L (1989) Effect of meal on portal haemodynamics in healthy humans and in patients with chronic liver disease. Hepatology 9:815–819Google Scholar
  13. Gallavan RH, Chou CC, Kvietys PR, Sit SP (1980) Regional blood flow during digestion in the conscious dog. Am J Physiol 238 [Heart Circ Physiol 7]:H220-H225Google Scholar
  14. Garcia JE, Atkins F (1985) A low right to left hepatic lobe ratio. Is streamlining of ethanol to the right lobe of the liver the cause? Clin Nucl Med 10:807–809Google Scholar
  15. Gates GF, Dore EK (1973) Streamline flow in the human portal vein. J Nucl Med 14:79–83Google Scholar
  16. Gill RW (1982) Accuracy calculations for ultrasonic pulsed Doppler flow measurements. Aust Phys Eng Sci Med 5:237–247Google Scholar
  17. Gill RW (1985) Splanchnic blood flow measurement. In: Altobelli SA, Voyles WIT, Greene ER (eds) Cardiovascular ultrasonic flowmetry. Elsevier, New York, pp 369–389Google Scholar
  18. Goldberg REA, Rada C, Knelson M, Haaga J, Minkin S (1990) The response of the portal vein to an oral glucose load. J Clin Ultrasound 18:691–695Google Scholar
  19. Hernandez LA, Kvietys PR, Granger DN (1986) Postprandial haemodynamics in the conscious rat. Am J Physiol 251 [Gastrointest Liver Physiol 14]:G117-G123Google Scholar
  20. Jäger K, Bollinger A, Valli C, Ammann R (1986) Measurement of mesenteric blood flow by duplex scanning. J Vase Surg 3:462–469Google Scholar
  21. Kawasaki T, Carmichael FJ, Saldivia V, Roldan L, Orrego H (1990) Relationship between portal venous and hepatic arterial blood flows:spectrum of reponse. Am J Physiol 259 (Gastrointest Liver Physiol 22):G1010-G1018Google Scholar
  22. Lafortune M, Madore F, Patriquin H, Breton G (1991) Segmental anatomy of the liver: a sonographic approach to the Couinaud nomenclature. Radiology 181:43–448Google Scholar
  23. Lautt WW (1985) Mechanism and role of intrinsic regulation of hepatic arterial blood flow: hepatic arterial buffer response. Am Physiol (Gastrointest Liver Physiol 12) 249:G549-G556Google Scholar
  24. Lautt WW, Legare DJ, Ezzatt WR (1991) Quantitation of the hepatic arterial buffer response to graded changes in portal blood flow. Gastroenterology 100:1024–1028Google Scholar
  25. Lee SS, Hadengue A, Moreau R, Sayegh R, Hillon P, Lebrec D (1988) Postprandial haemodynamic responses in patients with cirrhosis. Hepatology 8:647–651Google Scholar
  26. Legarth J, Thorup E (1989) Characteristics of Doppler bloodvelocity waveforms in a cardiovascular in vitro model. II. The influence of peripheral resistance, perfusion pressure and blood flow. Scand J Clin Lab Invest 49:459–464Google Scholar
  27. Lilly MP, Harward RS, Flinn WR, Blackburn DR, Astleford PM, Yao JST (1989) Duplex ultrasound measurement of changes in mesenteric flow velocity with pharmacologic and physiologic alteration of intestinal blood flow in man. J Vase Surg 9:18–25Google Scholar
  28. Maulik D, Arbeille P, Kadado T (1992) Haemodynamic foundation of umbilical arterial Doppler waveform analysis. Biol Neonate 62:280–289Google Scholar
  29. Meifort R, Vogel HM, Henning H (1990) Duplexsonographische Pfortaderfllußmessungen bei Lebergesunden und Patienten mit chronnischer Hepatitis nach Verabreichung einer vollresorbierbaren Testmahlzeit. Z Gastroenterol 28:291–294Google Scholar
  30. Moneta GL, Taylor DC, Helton WS, Mulholland MW, Strandness DE (1988) Duplex ultrasound measurement of postprandial intestinal blood flow:effect of meal composition. Gastroenterology 95:1294–1301Google Scholar
  31. Norryd C, Dencker H, Lunderquist A, Lin T, Tylen U (1975) Superior mesenteric blood flow during digestion in man. Acta Chir Scand 141:197–202Google Scholar
  32. O'Brien S, Keogan M, Patchett S, McCormick PA, Afdhal N, Hegarty JE (1992) Postprandial changes in portal haemodynamics in patients with cirrhosis. Gut 33:364–367Google Scholar
  33. Okazaki K, Miyazaki M, Ohnishi S, Ito K (1986) Effects of food intake and various extrinsic hormones on portal blood flow in patients with liver cirrhosis demonstrated by pulsed Doppler with the Octoson. Scand J Gastroenterol 21:1029–1038Google Scholar
  34. Orrego H, Mena I, Baraona E, Palma R (1965) Modifications in hepatic blood flow and portal pressure produced by different diets. New Series 10:239–248Google Scholar
  35. Payen DM, Fratacci MD, Dupuy P, Gatecel C, Vigouroux C, Ozier Y, Houssin D, Chapuis Y (1990) Portal and hepatic arterial blood flow measurements of human transplanted liver by implanted Doppler probes: interest for early complication and nutrition. Surgery 107:417–427Google Scholar
  36. Pourcelot L (1976) Diagnostic ultrasound for cerebral vascular diseases. In: Donald I, Levi S (eds) Present and future of diagnostic ultrasound. Kooyker Science, Rotterdam, pp 141–147Google Scholar
  37. Premen AJ, Kvietys PR, Granger DN (1985) Postprandial regulation of intestinal blood flow: role of gastrointestinal hormones. Am J Physiol 249 [Gastrointest Liver Physiol 12]:G250-G255Google Scholar
  38. Pugliese D, Ohnishi K, Tsunoda T, Sabba C, Albano O (1987) Portal hemodynamics after meal in normal subjects and in patients with chronic liver disease studied by echo-Doppler flowmeter. Am J Gastroenterol 82:1052–1056Google Scholar
  39. Qamar MI, Read AE, Mountford R, Skidmore R, Wells PNT (1984) Effects of carbohydrate, fat and protein on superior mesenteric artery blood flow in man. Gut 25:A1154Google Scholar
  40. Qamar MI, Read AE, Skidmore R, Evans JM, Wells PNT (1986) Pulsatility index of superior mesenteric artery blood velocity waveforms.Ultrasound Med Biol 12:773–776Google Scholar
  41. Shreiner DP, Barlai-Kovach M (1981) Diagnosis of alcoholic cirrhosis with the right-to-left hepatic lobe ratio: concise communication. J Nucl Med 22:116–120Google Scholar
  42. Siregar H, Chou CC (1981) Relative contribution of fat, protein, carbohydrate, and ethanol to intestinal hyperaemia. Am J Physiol [Gastrointest Liver Physiol 5]:G27–G31Google Scholar
  43. Spencer JA, Giussani DA, Moore PJ, Hanson MA (1991) In vitro validation of Doppler indices using blood and water. J Ultrasound Med 10:305–308Google Scholar
  44. Svensson CK, Mauriello PM, Baarde SH, Middleton E, Lalka D (1984) Effects of carbohydrates on estimated hepatic blood flow. Clin Pharmacol Ther 35:660–665Google Scholar
  45. Tsunoda T, Ohnishi K, Tanaka H (1988) Portal hemodynamic responses after oral intake of glucose in patients with cirrhosis. Am J Gastroenterol 83:398–403Google Scholar
  46. Vatner SF, Patrick TA, Higgins CB, Franklin D (1974) Regional circulatory adjustments to eating and digestion in conscious unrestrained primates. J Appl Physiol 36:524–529Google Scholar
  47. Webster J, Osuji PO, White F, Ingram JF (1975) The influence of food intake on portal blood flow and heat production in the digestive tract of sheep. Br J Nutr 34:125–139Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • M. Dauzat
    • 1
  • M. Lafortune
    • 2
  • H. Patriquin
    • 3
  • G. Pomier-Layrargues
    • 4
  1. 1.Vascular LaboratoryUniversity HospitalNîmesFrance
  2. 2.Department of RadiologyHôpital St-LucMontrealCanada
  3. 3.Department of RadiologyHôpital Sainte-JustineMontrealCanada
  4. 4.Liver Unit, Department of MedicineHôpital St-LucMontrealQuebecCanada

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