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Hepatic function after porto-systemic shunt.

C V Godellas1, P J Fabri, T H Knierim

  • 1Surgical Service, James A. Haley Veterans Hospital, Tampa, Florida 33612.

The Journal of Surgical Research
|February 11, 1992
PubMed
Summary
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This study introduces noninvasive methods to accurately measure true liver function, revealing impaired hepatocyte transport and conjugation in patients undergoing portacaval shunt surgery.

Area of Science:

  • Hepatology
  • Surgical Gastroenterology
  • Biochemical Engineering

Background:

  • Current liver function tests (SGOT, SGPT, GGT, LDH) are insensitive indicators of actual liver function.
  • Advanced hepatic injury is often diagnosed late through irreversible signs like jaundice and encephalopathy.
  • There is a need for accurate, noninvasive methods to assess true liver function.

Purpose of the Study:

  • To prospectively evaluate true liver function in patients undergoing portacaval shunt (PCS) surgery.
  • To assess effective hepatic blood flow (EHBF), hepatocyte transport, and hepatic conjugation ability.
  • To determine if noninvasive methods can detect changes in liver function post-PCS.

Main Methods:

  • Measured effective hepatic blood flow (EHBF) using low-dose galactose clearance.

Related Experiment Videos

  • Assessed hepatocyte transport by measuring theophylline levels at 24 hours.
  • Evaluated hepatic conjugation ability via acetaminophen metabolism (glucuronide and sulfate conjugates) and remaining acetaminophen at 24 hours (A24).
  • Compared measurements in normal males (NL) with pre- and post-operative PCS patients.

    • Main Results:

    • Effective hepatic blood flow (EHBF) showed no significant change after PCS.
    • Hepatocyte transport was significantly decreased in both pre-operative and post-operative PCS patients.
    • Hepatic conjugating ability was compromised pre-operatively (increased A24) and severely compromised post-operatively (increased A24, decreased (S + G)/A ratio).

    Conclusions:

    • Noninvasive methods accurately measure changes in liver function.
    • Porto-systemic shunt surgery significantly alters hepatocyte transport and hepatic conjugation ability.
    • These findings highlight the impact of PCS on critical liver functions beyond traditional markers.