Postprandial augmentation of portal hepatic inflow after prosthetic H-graft portacaval shunt.
Encephalopathy after portasystemic shunting generally occurs after eating. After partial portal decompression, encephalopathy is uncommon, presumably because of associated portal hemodynamics. However, after partial shunting, the changes in portal venous hemodynamics that occur with eating are unknown. With this in mind, 11 nonencephalopathic adults were studied more than 1 year after 8-mm H-graft portacaval shunt (PCS). The studies utilized color flow duplex ultrasound to determine the changes in portal vein (PV) and inferior vena cava blood flow that occur with eating a standardized meal. Following H-graft PCS, there is increased blood flow in the inferior vena cava after eating, particularly cephalad to the H-graft PCS, implying increased flow through the prosthetic shunt. Eating also increases hepatopedal blood flow in the PV distal to the H-graft PCS. Postprandial increases in hepatopedal portal blood flow may play an important role in avoiding encephalopathy after H-graft PCS.
Rosemurgy
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AS
Department of Surgery, Tampa General Hospital, University of South Florida 33606.
McAllister
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Kurto
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HZ
Cates
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JD
D001783:Blood Flow Velocity; D001807:Blood Vessel Prosthesis; D004435:Eating; D005260:Female; D006801:Humans; D008297:Male; D011167:Portacaval Shunt, Surgical / Q000009:adverse effects; D011169:Portal Vein / Q000503:physiopathology*; D012039:Regional Blood Flow; D014682:Vena Cava, Inferior / Q000503:physiopathology