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The Eck fistula in animals and humans
Current Problems in Surgery
|November 1, 1983
Summary
Portacaval shunts alter liver structure and function by diverting nutrient-rich blood, impacting biosynthetic processes. This procedure can treat metabolic disorders but may degrade liver function when used for portal hypertension.
Area of Science:
- Hepatology
- Surgical Gastroenterology
- Metabolic Diseases
Background:
- Portacaval shunt surgery diverts portal venous blood away from the liver.
- This diversion impacts liver morphology and function due to reduced exposure to hepatotrophic substances like insulin.
- The liver's rough endoplasmic reticulum (RER) is particularly vulnerable, affecting cellular biosynthesis.
Observation:
- Portacaval shunts induce consistent liver changes: hepatocyte atrophy, fatty infiltration, and RER disorganization.
- Biosynthetic processes are depressed secondary to RER damage.
- Diversion of portal blood deprives the liver of essential hepatotrophic factors, primarily insulin.
Findings:
- The liver injury from Eck's fistula in animals can be prevented by insulin infusion.
- Portacaval shunting can palliate inborn errors of metabolism like glycogen storage disease, familial hypercholesterolemia, and alpha 1-antitrypsin deficiency.
- Complete portal diversion for portal hypertension is detrimental, increasing risks of hepatic failure and encephalopathy.
Implications:
- Selective shunts may reduce hepatic encephalopathy compared to conventional shunts for variceal hemorrhage, though survival rates are similar.
- The efficacy of portacaval shunting for metabolic diseases depends on the completeness of the diversion.
- Understanding these effects is crucial for optimizing surgical interventions and managing liver-related conditions.