Portal hemodynamics after meal in normal subjects and in patients with chronic liver disease studied by echo-Doppler flowmeter

Abstract

Changes of portal, superior mesenteric, and splenic venous flows after a meal were studied with the duplex ultrasonic Doppler flowmeter in normal subjects, in patients with chronic active hepatitis, and in those with cirrhosis for 2 h after ingestion of a liquid meal (14% protein, 56% lipid, 30% carbohydrate, 300 kcal). Portal and superior mesenteric venous flows increased significantly throughout the experiment, whereas no significant change occurred in splenic venous flow after the meal in all three groups. The extent of the increase in portal venous flow was significantly lower in patients with cirrhosis, compared with normal subjects and patients with chronic active hepatitis, whereas superior mesenteric venous flow increased to the same extent in all three groups. The sum of superior mesenteric and splenic venous flows was less than the estimated portal venous flow in both normal subjects and patients with chronic active hepatitis; however, this value was greater than the portal venous flow in patients with cirrhosis. The difference widened during postprandial mesenteric hyperemia, indicating an increase of blood flow into the portal-systemic shunts. In conclusion 1) postprandial hyperemia occurs in the intestine, but not in the spleen, to the same extent in patients with chronic active hepatitis or with cirrhosis, as in normal subjects, and 2) a considerable amount of postprandial mesenteric hyperemia bypasses the liver into the systemic circulation of patients with cirrhosis but not in patients with chronic active hepatitis and normal subjects.