Arterial-venous shunting in liver cirrhosis

Controversial data exist in the literature about the presence and clinical relevance of hepatic arterial-venous shunting. An interesting opportunity for reconsidering the problem has been provided by the use, in the study of liver function, of D-sorbitol, a substance whose first-pass hepatic extract...

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Bibliographic Details
Published in:Digestive diseases and sciences 1998, Vol.43 (1), p.51-55
Main Authors: MOLINO, G, BAR, F, BATTISTA, S, TORCHIO, M, NIRO, A. G, GARELLO, E, AVAGNINA, P, FAVA, C, GROSSO, M, SPALLUTO, F
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Biological Availability
Female
Gastroenterology. Liver. Pancreas. Abdomen
Hepatic Artery
Humans
Liver Circulation - physiology
Liver Cirrhosis - physiopathology
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Other diseases. Semiology
Sorbitol - metabolism
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Summary:Controversial data exist in the literature about the presence and clinical relevance of hepatic arterial-venous shunting. An interesting opportunity for reconsidering the problem has been provided by the use, in the study of liver function, of D-sorbitol, a substance whose first-pass hepatic extraction is very high in normal subjects, while being directly related to circulatory alterations in liver cirrhosis. Because of this property, the systemic bioavailability of D-sorbitol during hepatic arterial infusion can be assumed to reflect arterial-venous shunting. Thirteen biopsy-proven cirrhotic patients (ages 35-66 years), who required diagnostic arterial catheterization, entered the study. Patients were studied on two subsequent days, in which a sterile pyrogen-free solution (1.5%) of D-sorbitol was administered by direct low-rate infusion (15 mg/min for 20 min) into the hepatic artery and the systemic circulation, respectively. Urine samples were spontaneously collected for 8-hr periods before and during/after each infusion. The hepatic arterial bioavailability of D-sorbitol was calculated as the ratio between the net cumulative urinary outputs of D-sorbitol after infusions into the hepatic artery and the systemic vein. Observed values confirm the existence and the large variability (0-88.7%) of hepatic arterial-venous shunting in cirrhotic patients.
ISSN:0163-2116
1573-2568
DOI:10.1023/A:1018867819339