Journal of hepatology
-
Journal of hepatology · Aug 1995
Analysis of prognostic variables in the prediction of mortality, shunt failure, variceal rebleeding and encephalopathy following the transjugular intrahepatic portosystemic stent-shunt for variceal haemorrhage.
The aim of this study was to analyse prognostic variables predicting mortality, shunt insufficiency, variceal rebleeding and encephalopathy following transjugular intrahepatic portosystemic stent-shunt for variceal haemorrhage. ⋯ The results of this study suggest that patients with severe liver disease and hyponatraemia are liable to die early, and the presence of encephalopathy prior to transjugular intrahepatic portosystemic stent-shunt independently determines long-term survival. Patients in these groups should be considered high risk and worked up for orthotopic liver transplantation early. Shunt function in patients with an initial portal pressure gradient of > 18 mmHg requires close supervision. Encephalopathic patients should have smaller shunts and prophylactic measures to prevent worsening encephalopathy.
-
Journal of hepatology · Aug 1995
Functional loss of cerebral blood flow autoregulation in patients with fulminant hepatic failure.
In management of patients with fulminant hepatic failure, it is recommended that mean arterial pressure should be raised if cerebral perfusion pressure is lower than 50 mmHg, but the influence of such therapy on cerebral blood flow is unknown. We examined cerebral blood flow autoregulation in seven consecutive patients with fulminant hepatic failure during treatment of imminent insufficient cerebral perfusion pressure. Cerebral perfusion was evaluated by transcranial Doppler assessed mean flow velocity in the middle cerebral artery and by the arterio-venous difference for oxygen. ⋯ The mean flow veolocity increased from 68 (30-134) to 108 (48-168) cm s-1 and the arterio-venous difference for oxygen by 46 (10-82)% (p < 0.05). Both mean flow velocity (r = 0.63) and arterio-venous difference for oxygen (r = 0.71) were correlated to mean arterial pressure (p < 0.001), and a lower blood pressure limit of autoregulation could not be identified in any of the patients. These data suggest that the cerebral blood flow is not autoregulated in patients with fulminant hepatic failure and therefore cerebral blood flow should be "clamped" within the normal physiologic range by manipulation of arterial blood pressure in order to avoid cerebral hypoxia and/or hypertensive induced cerebral oedema.
-
Journal of hepatology · Jul 1995
Comparative StudyCharacterization of mechanisms causing hypoalbuminemia in rats with long-term bile duct ligation.
Albumin kinetics and albumin synthesis were studied in rats with chronic bile duct ligation and compared with pair-fed control rats. The plasma albumin concentration was significantly reduced in bile duct ligated rats as compared to control rats, averaging 35 +/- 1 vs 40 +/- 2 g/l after 2 weeks and 28 +/- 3 vs 38 +/- 5 g/l after 4 weeks of bile duct ligation. Two weeks after bile duct ligation, the transcapillary escape rate of albumin was increased by 60% in bile duct ligated rats, whereas the plasma volume was unchanged. ⋯ At this time point, albumin synthesis as a fraction of total liver protein synthesis was decreased by 60% in bile duct ligated rats, and absolute albumin synthesis expressed per 100 g body weight averaged 80 +/- 8 vs 53 +/- 12 mg/(day x 100 g) in control and bile duct ligated rats (p < 0.05). The hepatic steady-state levels of albumin mRNA determined by Northern blot analysis were decreased in bile duct ligated rats at both 2 and 4 weeks after surgery. The studies suggest that reduced plasma albumin concentrations in bile duct ligated rats are caused by increased capillary permeability and lack of compensatory increase in albumin synthesis 2 weeks, and by increased plasma volume and decreased albumin synthesis 4 weeks after surgery.
-
Journal of hepatology · Jun 1995
Comparative StudyEnhanced biliary excretion of canalicular membrane enzymes in estrogen-induced and obstructive cholestasis, and effects of different bile acids in the isolated perfused rat liver.
Canalicular membrane enzymes are normally released into bile by partially known processes. This study was undertaken to investigate whether hepatocellular cholestatis induced in rats by ethynylestradiol or obstructive cholestasis produced by complete biliary obstruction for 24 h is associated with an increased release of alkaline phosphatase and gamma-glutamyl transpeptidase into bile, and to clarify how this process is affected by different bile acids. ⋯ The marked increase in sodium taurocholate and taurochenodeoxycholate-mediated release of alkaline phosphatase and gamma-glutamyl transpeptidase into bile in cholestatic rats suggests an increased lability of these intrinsic membrane proteins to the detergent effects of secreted bile acids. It remains to be elucidated whether this phenomenon, which was particularly intense in ethynylestradiol induced cholestasis, is important in the pathogenesis and perpetuation of bile secretory failure. In contrast, tauroursodeoxycholate administration did not result in enhanced biliary excretion of these membrane enzymes, in either the control group or the ethynylestradiol group, supporting the concept that this bile salt lacks the membrane toxicity of common bile acids.
-
Infection with an identified hepatotrophic virus accounts for 13-50% of acute liver failure (ALF) in Europe, and an additional 16-17% of cases have non-A non-B or indeterminate hepatitis in whom a viral aetiology is presumed. Hepatitis C is rarely responsible for acute liver failure in Europe and North America but accounts for a higher proportion of cases in Japan, and hepatitis E may lead to ALF, particularly in pregnant women. ⋯ Management depends on intensive care support and careful selection of patients likely to benefit from transplantation. Recurrence of hepatitis A and non-A non-B hepatitis has been reported following transplantation for ALF, and hepatitis B recurs less frequently in these circumstances than after transplantation for chronic infection.