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Post pranial changes in portal venous pressure in cirrhotic and non-cirrhotic patients with portal hypertension
WP-D1
POST PRANDIAL CHANGES IN PORTAL VENOUS PRESSURE IN CIRRHOTIC AND NON-CIRRHOTIC PATIENTS WITH PORTAL HYPERTENSION. P. A. McCormick, John E. Hegarty. Gastroenterology and Liver Unit, St. Vincent's Hospital, Dublin 4., and University College Dublin.
In normal subjects splanchnic blood flow and portal venous pressure increase following a meal. The post prandial changes in portal pressure in patients with cirrhosis and portal hypertension have not been extensively studied and such changes may have important implications when assessing the effects of pharmacological agents used to lower portal venous pressure. The purpose of the present study was to assess the magnitude of these physiological changes in portal pressure in patients with cirrhotic and non-cirrhotic portal hypertension. The porto-systemic venous gradient (PSG; wedged hepatic venous pressure minus free hepatic venous pressure) was measured in 16 patients with portal hypertension (10 cirrhotic; 6 noncirrhotic) in the supine fasted state and over a 50 minute period following a 600Kcal liquid meal containing 80grms of protein, 40grms of carbohydrate and 12grms of fat. In 15 of the 16 patients there was a sustained increase (mean 36%) in the PSG which rose From a mean of 13.2mmHg+ S.D. 7.7 to 18mmHg+ S.D. 8.9 after the meal (P(O.01) Wilcoxons Rank Sum Test). The PSG in'creased (mean 38%) f-{om 15.gmmHg+ S.D. 8.48 to 21.9mmHg+ S.D. 8.93 in the patients with cirrhosis (P(O.01) and increased (29%) from 8.83mmHg+ S.D. 7.28 to 11.36mmHgz S.D. 3.39 in the patients with non-cirrhotic portal hypertension (NS). These data indicate that there is a significant increase in the PSG in patients with portal hypertension following a protein meal and that measurement of portal hypertension in the basal fasting state may be inappropriate in assessing the effects of pharmacological agents on portal haemodynamics.
WP-D 2
EFFECT OF CONTINUOUS INFUSION AND BOLUS INJECTIONS OF SOMATOSTATIN (SMT) ON AZYGOS BLOOD FLOW AND HEPATIC AND SYSTEMIC HEMODYNAMICS IN PATIENTS WITH PORTAL HYPERTENSION. COMPARISON WITH VASOPRESSIN. R. Mastai, J. Bosch, M. Navasa, G. Silva, D. Kravetz, J. Bruix, C. Viola, J. Rod,s. Hospital Clfnic i Provincial de Barcelona.
SMT was introduced in the treatment of variceal bleeding because of its ability to reduce portal pressure (PP) without the adverse systemic effects of vasopressin (VP). However, th~ effects of SMT on the esophageal collaterals, as evaluated by measurement of azygos blood flow (AzBF), and the best way of SMT administration have not been studied so far. The present study addressed these questions. PP(WHVP-FHVP), AzBF (local thermaldilution), hepatic blood flow (ICG, infusion) and cardiac output (CO, thermaldilution) were measured in 29 patients with portal hypertension in baseline conditions and after vasopressin infusion (0.4 U/min, i0 pts), somatostatin injection (i ug/kg IV, 9 pts) and somatostatin infusion (I ug/kg + 7.5 ug/min, i0 pts). Bolus injections of SMT had a similar effect on PP than VP infusion (-39+5% vs -41+4%, ns). However, SMT caused a greater reduction of AzBF (-43+4% vs -26+4%). A preferential effect of SMT on collateral blood flow was also observed after SMT infusion. This caused a moderate reduction of PP (-13+3%, p
$53
POST PRANDIAL CHANGES IN PORTAL VENOUS PRESSURE IN CIRRHOTIC AND NON-CIRRHOTIC PATIENTS WITH PORTAL HYPERTENSION. P. A. McCormick, John E. Hegarty. Gastroenterology and Liver Unit, St. Vincent's Hospital, Dublin 4., and University College Dublin.
In normal subjects splanchnic blood flow and portal venous pressure increase following a meal. The post prandial changes in portal pressure in patients with cirrhosis and portal hypertension have not been extensively studied and such changes may have important implications when assessing the effects of pharmacological agents used to lower portal venous pressure. The purpose of the present study was to assess the magnitude of these physiological changes in portal pressure in patients with cirrhotic and non-cirrhotic portal hypertension. The porto-systemic venous gradient (PSG; wedged hepatic venous pressure minus free hepatic venous pressure) was measured in 16 patients with portal hypertension (10 cirrhotic; 6 noncirrhotic) in the supine fasted state and over a 50 minute period following a 600Kcal liquid meal containing 80grms of protein, 40grms of carbohydrate and 12grms of fat. In 15 of the 16 patients there was a sustained increase (mean 36%) in the PSG which rose From a mean of 13.2mmHg+ S.D. 7.7 to 18mmHg+ S.D. 8.9 after the meal (P(O.01) Wilcoxons Rank Sum Test). The PSG in'creased (mean 38%) f-{om 15.gmmHg+ S.D. 8.48 to 21.9mmHg+ S.D. 8.93 in the patients with cirrhosis (P(O.01) and increased (29%) from 8.83mmHg+ S.D. 7.28 to 11.36mmHgz S.D. 3.39 in the patients with non-cirrhotic portal hypertension (NS). These data indicate that there is a significant increase in the PSG in patients with portal hypertension following a protein meal and that measurement of portal hypertension in the basal fasting state may be inappropriate in assessing the effects of pharmacological agents on portal haemodynamics.
WP-D 2
EFFECT OF CONTINUOUS INFUSION AND BOLUS INJECTIONS OF SOMATOSTATIN (SMT) ON AZYGOS BLOOD FLOW AND HEPATIC AND SYSTEMIC HEMODYNAMICS IN PATIENTS WITH PORTAL HYPERTENSION. COMPARISON WITH VASOPRESSIN. R. Mastai, J. Bosch, M. Navasa, G. Silva, D. Kravetz, J. Bruix, C. Viola, J. Rod,s. Hospital Clfnic i Provincial de Barcelona.
SMT was introduced in the treatment of variceal bleeding because of its ability to reduce portal pressure (PP) without the adverse systemic effects of vasopressin (VP). However, th~ effects of SMT on the esophageal collaterals, as evaluated by measurement of azygos blood flow (AzBF), and the best way of SMT administration have not been studied so far. The present study addressed these questions. PP(WHVP-FHVP), AzBF (local thermaldilution), hepatic blood flow (ICG, infusion) and cardiac output (CO, thermaldilution) were measured in 29 patients with portal hypertension in baseline conditions and after vasopressin infusion (0.4 U/min, i0 pts), somatostatin injection (i ug/kg IV, 9 pts) and somatostatin infusion (I ug/kg + 7.5 ug/min, i0 pts). Bolus injections of SMT had a similar effect on PP than VP infusion (-39+5% vs -41+4%, ns). However, SMT caused a greater reduction of AzBF (-43+4% vs -26+4%). A preferential effect of SMT on collateral blood flow was also observed after SMT infusion. This caused a moderate reduction of PP (-13+3%, p
$53