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Related Experiment Videos

Gamma-scintigraphy and early hepatocellular dysfunction during posttraumatic sepsis

M P McGinty1, R M Stewart, M J Fabian

  • 1Department of Pediatrics (Critical Care Division, Emergency Medicine), LeBonheur Children's Medical Center, Memphis, Tenn.

Surgery
|September 1, 1994
PubMed
Summary

Sepsis impairs liver function, particularly bilirubin metabolism, after trauma. Technetium 99m-mebrofenin (HIDA) scintigraphy reveals occult hepatic dysfunction in septic trauma patients, aiding early diagnosis.

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Area of Science:

  • Hepatology and critical care medicine
  • Sepsis pathophysiology
  • Bilirubin metabolism and hepatic function assessment

Background:

  • Sepsis can alter hepatic conjugation-detoxification functions.
  • Bilirubin metabolism is a key indicator of liver function.
  • Gamma-scintigraphy using a bilirubin analog can assess hepatic function.

Purpose of the Study:

  • To investigate alterations in hepatic conjugation-detoxification function during sepsis.
  • To measure bilirubin metabolism changes using gamma-scintigraphy in a sepsis model.
  • To evaluate the impact of trauma and endotoxin (LPS) on liver function.

Main Methods:

  • Mongrel pigs were subjected to control conditions, endotoxin (LPS) administration, trauma, or trauma plus LPS.
  • Hepatic function was assessed using technetium 99m-mebrofenin (HIDA) scintigraphy to measure bilirubin analog uptake and elimination.

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  • Physiological parameters including cardiac index and systemic vascular resistance were monitored.

    • Main Results:

    • Trauma combined with LPS significantly depressed HIDA uptake and prolonged elimination half-time compared to pre-LPS conditions.
    • Trauma or LPS alone caused less pronounced alterations in HIDA metabolism compared to controls.
    • Changes in HIDA clearance preceded the development of a hyperdynamic circulatory state in septic trauma.

    Conclusions:

    • Resuscitated traumatic shock exhausts hepatic reserve, with LPS unmasking occult dysfunction in bilirubin metabolism.
    • Hepatic dysfunction may contribute to the hyperdynamic circulatory response in sepsis.
    • HIDA clearance is a rapid, reliable method for assessing bilirubin metabolism and detecting occult liver dysfunction in septic trauma.