cholecystokinin and Hypertension--Portal

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

Serum trypsin concentrations within the portal venous system have been measured in man during transhepatic portal venography in an attempt to determine its source. In eight experiments, mean serum trypsin concentration at the splenic hilum was 180 +/- 25 ng/ml (mean +/- SEM). Trypsin concentration in the rest of the splenic vein was not significantly different. The mean concentrations in the portal vein (210 +/- 32 ng/ml) and within the superior mesenteric vein (233 +/-- 29 ng/ml) were, however, significantly higher than at the hilum (P less than 0.05). Following cholecystokinin-pancreozymin (CCK-PZ) and secretin stimulation, marked increases in serum trypsin concentration were seen within the portal vein (two patients) and deep within the superior mesenteric (two out of three patients). We conclude that circulating serum trypsin is derived, at least in part, from intestinal reabsorption.

Topics: Adult; Aged; alpha 1-Antitrypsin Deficiency; Cholecystokinin; Female; Humans; Hypertension, Portal; Liver Cirrhosis; Male; Mesenteric Veins; Middle Aged; Portal System; Secretin; Trypsin

A normal exocrine pancreatic function was demonstrated by the secretin-pancreozymin-test in five patients with Wilson's disease either without (n = 2) or with cirrhosis of the liver but without portal hypertension (n = 3). In another patient with cirrhosis of the liver without portal hypertension the pancreas was normal at post mortem examination. In two patients with cirrhosis of the liver and portal hypertension bicarbonate (n = 1) and amylase secretion (n = 2) were diminished. The regression of portal hypertension under therapy with penicillamine in one of the latter cases was paralleled by the return to normal of exocrine pancreatic function. It is concluded that exocrine pancreatic insufficiency in Wilson's disease is dependent on the development and the progression of chirrhosis of the liver and not due to a primary manifestation of the disease itself.

Topics: Adolescent; Adult; Amylases; Bicarbonates; Child; Cholecystokinin; Female; Hepatolenticular Degeneration; Humans; Hypertension, Portal; Liver Cirrhosis; Male; Pancreatic Diseases; Secretin