Splanchnic and systemic hemodynamics in early abstinence and after ethanol administration in non-cirrhotic alcoholic patients.
Thirteen asymptomatic chronic alcoholic patients were studied to investigate the early stages of portal hypertension in alcoholic liver disease and the effects of withdrawal and ethanol on hepatic function and hemodynamic variables. None of the patients presented clinical signs of decompensated liver disease, and their liver biopsies showed normal liver or moderate alterations only. In basal conditions and after an intravenous ethanol infusion (1 g/kg body weight), hepatic venous pressure gradient and hepatic blood flow using indocyanine green were measured through hepatic vein catheterization. Hepatic sinusoidal vascular resistance and indocyanine green intrinsic clearance were also calculated. Portal blood flow measurements were obtained by Doppler ultrasound. No correlation was observed between hepatic venous pressure gradient and histologic features, (steatosis, necrosis, fibrosis, inflammation and hepatocyte surface area). In basal conditions, portal hypertension was not found in any case. After ethanol, portal pressure increased significantly (p < 0.001); in four cases it rose to or above 5 mmHg. Portal blood flow, hepatic blood flow and hepatic vascular resistance also increased significantly. Intrinsic indocyanine green clearance decreased slightly but significantly. No significant correlations were found between portal pressure, hepatic resistance and the histologic parameters. It was concluded that alcoholic patients, without clinical or laboratory evidence of liver failure and with minimal or moderate histologic alterations, have normal portal pressures. After an intravenous ethanol load, however, four out of 13 patients (31%) reached levels of 5 mmHg or more, irrespective of their liver histology.
Silva
G
G
Department of Medicine, Hospital San Borja-Arriarán, University of Chile, Santiago.
Fluxá
F
F
Bresky
G
G
Backhouse
C
C
Palma
M
M
Ruiz
M
M
Hirsch
S
S
Iturriaga
H
H
D000328:Adult; D000437:Alcoholism / Q000503:physiopathology*; D000431:Ethanol / Q000009:adverse effects*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006975:Hypertension, Portal / Q000139:chemically induced; D007262:Infusions, Intravenous; D008099:Liver / Q000473:pathology; D008104:Liver Cirrhosis, Alcoholic; D008297:Male; D008875:Middle Aged; D013152:Splanchnic Circulation / Q000187:drug effects*; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology*; D013997:Time Factors
D000431:Ethanol