Skip to main content
SpringerLink
Log in

A dynamic study of rectally absorbed ammonia in liver cirrhosis using [13N] ammonia and a positron camera

  • Original Articles
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

[13N] Ammonia produced by the cyclotron was instilled intrarectally in patients with cirrhosis and other liver diseases to study the turnover of rectally absorbed [13N] ammonia. A positron camera connected to an on-line computer system was used for the measurement of sequential changes of13N activity in blood and for coincidence positron imaging of the liver and heart.13N activity over the head was also recorded. Chromatographic analysis of13N-labeled substances in blood was carried out using a Dowex 50Wx8 column at varying times after the administration. In the control, [13N] ammonia was absorbed quickly and visualized the liver, whereas in patients with cirrhosis, the lungs and heart were first visualized, and13N activity over the head was also higher. It was suggested that a large proportion of absorbed [13N] ammonia bypassed hepatocytes and reached peripheral tissues in cirrhosis. The heart/liver ratio of13N and13N over the head were correlated with various indices of portal hypertension. The relative proportion of nonammonia13N metabolites in blood was lower at 5 and 15 min after administration in cirrhosis, suggesting a reduced capacity of the liver to remove and metabolize ammonia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Summerskill WHJ, Wolpert E: Ammonia metabolism in the gut. Am J Clin Nutr 23:633–639, 1970

    Google Scholar 

  2. Shaldon S, Chiandussi L, Guevara L, Caesar J, Sherlock S: The estimation of hepatic blood flow and intrahepatic shunted blood flow by colloidal heat denatured human serum albumin labelled with131I. J Clin Invest 40:1346–1354, 1961

    Google Scholar 

  3. McDermott WV Jr, Adams RD: Episodic stupor associated with an Eck fistula in the human with particular reference to the metabolism of ammonia. J Clin Invest 33:1–9, 1954

    Google Scholar 

  4. Breen KJ, Schenker S: Hepatic coma: Present concepts of pathogenesis and therapy.In Progress in Liver Diseases, H Popper, F Schaffner (eds). New York, Grune & Stratton, 1972, pp 301–312

    Google Scholar 

  5. Turner MD, Sherlock S, Steiner RE: Intrasplenic pressure measurement and splenic venography in the clinical investigation of the portal circulation. Am J Med 23:846–859, 1957

    Google Scholar 

  6. Gonzeles Calbalhaes O: Hepatoportografia por via umbilical. Rev Sanid Mil 12:42–48, 1959

    Google Scholar 

  7. Lunderquist A, Vang J: Transhepatic catheterization and obliteration of the coronary vein in patients with portal hypertension and esophageal varice. N Engl J Med 291:646–649 1974

    Google Scholar 

  8. Okuda K, Suzuki K, Musha H, Arimizu N: Percutaneous transhepatic catheterization of the portal vein for the study of portal hemodynamics and shunts. Gastroenterology 73:279–284, 1977

    Google Scholar 

  9. Kashiwagi T, Kameda T, Abe H: Dynamic studies on the portal hemodynamics by scintiphotosplenoportography: the visualization of portal venous system using99mT. Gastroenterology 67:668–673, 1974

    Google Scholar 

  10. Deterling RA, Powers SR, Bhonslay SB: The use of radioactive sodium in the evaluation of patency of portacaval shunts. Surg Forum 5:193–200, 1954

    Google Scholar 

  11. Castell DO, Grace ND, Wennar MH, Chalmers TC, Moore EW: Evaluation of portal circulation in hepatic cirrhosis. Gastroenterology 57:533–541, 1969

    Google Scholar 

  12. Triger DR, Boyer TD, Redeker AG, Reynolds TB, Waxman AD: Differences in intrahepatic portal-systemic shunting in alcoholic and nonalcoholic liver disease as assessed by liver scan, portal pressure, andE. coli antibodies. Dig Dis Sci 24:509–513, 1979

    Google Scholar 

  13. Gelbard AS, Clarke LP, McDonald JM, Monahan WG, Tilbury RS, Kuo TYT, Laughlin JS: Enzymatic synthesis and organ distribution studies with13N-labeledl-glutamine andl-glutamic acid. Radiology 116:127–132, 1975

    Google Scholar 

  14. Tomitani T, Tanaka E, Nohara N: A positron camera by use of a focal detector of hexagonal multi-crystal array. Radio-isotopes 25:693–697, 1976

    Google Scholar 

  15. Wolpert E, Phillips SF, Summerskill WHJ: Ammonia production in the human colon. N Engl J Med 283:159–164, 1970

    Google Scholar 

  16. Dienst SG: An ion exchange method for plasma ammonia concentration. J Lab Clin Med 58:149–155, 1961

    Google Scholar 

  17. Moore S, Stein WH: Procedures for the chromatographic determination of amino acids on four percent cross-linked sulfonated polystyrene resins. J Biol Chem 211:893–906, 1954

    Google Scholar 

  18. Traeger HS, Gabuzda FJ Jr, Ballou AN, Davidson CS: Blood ammonia concentration in liver diseases and liver coma. Metabolism 3:99–109, 1954

    Google Scholar 

  19. Kirk E: Amino acid and ammonia metabolism in liver disease. Acta Med Scand (Suppl) 77:1–147, 1936

    Google Scholar 

  20. Phillips GB, Schwartz R, Gabuzda GJ, Davidson CS: The syndrome of impending hepatic coma in patients with cirrhosis of the liver given certain nitrogenous substances. N Engl J Med 247:239–246, 1952

    Google Scholar 

  21. Conn HO: Ammonia tolerance in the diagnosis of esophageal varices. A comparison of endoscopic, radiologic, and biochemical techniques. J Lab Clin Med 70:442–451, 1967

    Google Scholar 

  22. Castell DO: The ammonia tolerance test: An index of portal hypertension. Gastroenterology 49:539–543, 1965

    Google Scholar 

  23. Conn HO: Ammonia tolerance in assessing the patency of portacaval anastomoses. Arch Intern Med 13:221–226, 1973

    Google Scholar 

  24. Price JB, McCullough W, Peterson L, Britton RC, Voorhees AB: Determination of ammonia tolerance in animals with and without portal systemic shunting. Surgery 60:701–709, 1966

    Google Scholar 

  25. White LP, Phear AE, Summerskill WHJ, Sherlock S: Ammonia tolerance in liver diseases. Observations based on catheterization of the hepatic veins. J Clin Invest 34:158–168, 1955

    Google Scholar 

  26. Harper PV, Lathrop DA, Krizek H, Lembares N, Stark V, Hoffer PB: Clinical feasibility of myocardial imaging with13NH3 J Nucl Med 13:278–280, 1972

    Google Scholar 

  27. Walsh WF, Harper PV, Resnekov L, Fill H: Noninvasive evaluation of regional myocardial perfusion in 112 patients using a mobile scintillation camera and intravenous nitrogen-13-labelled ammonia. Circulation 54:266–275, 1976

    Google Scholar 

  28. Hazenberg HJA, Gips CH, Beekhuis H, Vaalburg W: Rectal administration of13N-ammonia in cirrhosis of the liver. Acta Hepato-Gastroenterol 23:308–318, 1976

    Google Scholar 

  29. Hazenberg HJA, Gips CH, Beekhuis H, Kruizinga K: Rectal13N-ammonia test (13N-liver/heart ratio), hepatic sinusoidal pressure and prevailing portal flow direction in cirrhosis of the liver. Acta Hepato-Gastroenterol 23:319–327, 1976

    Google Scholar 

  30. Walsh WF, Fill HR, Harper PV: Nitrogen-13-labelled ammonia for myocardial imaging. Semin Nucl Med 7:59–66, 1977

    Google Scholar 

  31. Hoop B Jr, Smith TW, Burnham CA, Correll JE, Brownell GL, Sanders CA: Myocardial imaging with13NH3 and a multicrystal positron camera. J Nucl Med 14:181–183, 1973

    Google Scholar 

  32. Harper PV, Schwartz J, Beck RN, Lathrop KA, Lembares N, Krizek H, Hloria I, Dinwoodie R, Mclaughlin A, Stark V, Bekerman C, Hoffer PB, Gottschalk A, Resnekov L, Al-Sadir J, Mayorga A, Brooks HL: Clinical myocardial imaging with nitrogen-13-ammonia. Radiology 108:613–617, 1973

    Google Scholar 

  33. Carter CC, Lifton JF, Welch MJ: Organ uptake and blood pH and concentration effects of ammonia in dogs determined with ammonia labelled with 10 minute half lived nitrogen-13. Neurology 23:204–213, 1973

    Google Scholar 

  34. Monahan WG, Tilbury RS, Laughlin JS: Uptake of13N-labelled ammonia. J Nucl Med 13:274–277, 1972

    Google Scholar 

  35. Phelps ME, Hoffman EJ, Coleman RE, Welch MJ, Raichle MZ: Tomographic images of blood pool and perfusion in brain and heart. J Nucl Med 17:603–612, 1976

    Google Scholar 

  36. Lockwood AH, McDonald JN, Reiman RE, Gelbard AS, Laughlin JS, Duffy TE, Plum F: The dynamics of ammonia metabolism in man. J Clin Invest 63:449–460, 1979

    Google Scholar 

  37. Rodwell VM: Protein and amino acid metabolism.In Review of Physiological Chemistry, 16th ed., HA Harper (ed). Los Altos, Lange Med Publications, 1977, pp 337–368

    Google Scholar 

  38. Chamalau RAFM, Tager JM: Nitrogen metabolism in the perfused rat liver. Biochim Biophys Acta 222:109–118, 1970

    Google Scholar 

  39. Davidson S, Sonnenblick EH: Glutamine production by the isolated perfused rat heart during ammonium chloride perfusion. Cardiovasc. Res 9:295–301, 1975

    Google Scholar 

  40. Bessman SP, Bessman AN: The cerebral and peripheral uptake of ammonia in liver disease with an hypothesis for the mechanisms of hepatic coma. J Clin Invest 34:622–628, 1955

    Google Scholar 

  41. Bessman SP, Bradley JE: Uptake of ammonia by muscle: Its implications in ammoniagenic coma. N Engl J Med 253: 1143–1147, 1955

    Google Scholar 

  42. Egense J: Ammonium tolerance test. A diagnostic aid in liver disease. Acta Med Scand 167:53–59, 1960

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Chiba University School of Medicine, Chiba, Japan

    Hirofumi Koen MD, Kunio Okuda MD, Hirotaka Musha MD, Yukio Tateno MD, Nobuo Fukuda MD, Toru Matsumoto MD, Fumio Shisido MD, Tomoyuki Rikitake MD, Takeshi Iinuma PhD, Akira Kurisu MD & Noboru Arimizu MD

  2. Department of Medicine, Chiba University School of Medicine, (280), Chiba, Japan

    Hirofumi Koen MD, Kunio Okuda MD, Hirotaka Musha MD, Yukio Tateno MD, Nobuo Fukuda MD, Toru Matsumoto MD, Fumio Shisido MD, Tomoyuki Rikitake MD, Takeshi Iinuma PhD, Akira Kurisu MD & Noboru Arimizu MD

  3. National Institute of Radiological Sciences, Chiba, Japan

    Hirofumi Koen MD, Kunio Okuda MD, Hirotaka Musha MD, Yukio Tateno MD, Nobuo Fukuda MD, Toru Matsumoto MD, Fumio Shisido MD, Tomoyuki Rikitake MD, Takeshi Iinuma PhD, Akira Kurisu MD & Noboru Arimizu MD

Authors
  1. Hirofumi Koen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kunio Okuda MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hirotaka Musha MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yukio Tateno MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nobuo Fukuda MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Toru Matsumoto MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fumio Shisido MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tomoyuki Rikitake MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Takeshi Iinuma PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Akira Kurisu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Noboru Arimizu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Koen, H., Okuda, K., Musha, H. et al. A dynamic study of rectally absorbed ammonia in liver cirrhosis using [13N] ammonia and a positron camera. Digest Dis Sci 25, 842–848 (1980). https://doi.org/10.1007/BF01338526

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01338526

Keywords

Search

Navigation