cholecystokinin and Esophageal-and-Gastric-Varices

In 12 patients with Laennec's cirrhosis conjugated cholic acid was measured by radioimmunoassay simultaneously in the portal vein, the aorta, and the hepatic vein. Furthermore, the concentration was measured for 90 minutes after i. v. injection of cholecystokinin. In the fasting patient the porto-venous extraction ratio was 0.45 (SD 0.23) and the arterio-venous extraction ratio was 0.24 (SD 0,21). 15-30 minutes after cholecystokinin the bile acid concentration significantly increased. In this time the porto-venous extraction ratio rose to 0.71 while the aorto-venous extraction ratio was different. These results agree with the hemodynamics found in cirrhosis. After cholecystokinin the increase in the extraction ratio account for the blood loss by porto venous shunts which corresponds to an increase of the portal compartment.

Topics: Adult; Aged; Aorta, Abdominal; Bile Acids and Salts; Cholecystokinin; Cholic Acids; Esophageal and Gastric Varices; Female; Hepatic Artery; Hepatic Veins; Humans; Hypertension, Portal; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Portal Vein

Exocrine pancreatic function was assessed by the standard test meal method of Lundh in a control group, and 13 patients with nonalcoholic, postnecrotic cirrhosis of the liver. In six of these patients, splenorenal shunts were performed and exocrine pancreatic function was assessed before and three months after operation. In three of the six, the secretin-pancreozymin stimulation test was also performed. An increased volume but normal trypsin output was observed in the unoperated cirrhotic patients. An increase both in volume and in trypsin was found in the cirrhotic patients after shunting using the test meal stimulation. There was no appreciable difference, however, when tested with secretin and pancreozymin. Hypersecretion in cirrhotics, with or without shunts, is probably due to a by-pass of the hepatic degradation of normal pancreatic secretogogues produced by the intestine.

Topics: Adult; Aged; Cholecystokinin; Esophageal and Gastric Varices; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Pancreas; Pancreatic Juice; Secretin; Trypsin