Abstract

Portal hypertension is almost unavoidable complication of cirrhosis. The physiological stimuli like food intake will affect the splanchnic circulation in cirrhotic patients. Hence the present study has been designed to measure the portal blood flow pressure after ingestion of solid and liquid meal in normal and cirrhotic patients. It is a randomized open label clinical study. The study included 32 male healthy volunteers (52 to 74 years) and 10 clinically proven cirrhotic patients (54-76years). The portal blood flow velocity was measured by Doppler method. The portal flow velocity in the fasting and in post prandial period was measured at the time interval of 15,30,45,60 and 90 minutesafter either solid or liquid meal ingestion. Solid meals include 4 idli’s each weighing 50 gmswith dhal and chutney. The liquid meal includes Ensure healthy mix in 270ml of water. Both the liquid and solid meals’ calorific value is 405. The results indicate that, the basal blood flow velocity in cirrhotic patients is on higher sidein comparison to normal subjects. Intake of solid as well as liquid meals increased the portal velocity in both normal as well as cirrhotic patients and it was found to be high at 45 minutes. In cirrhotic patients the liquid meal itself is able to increase the portal pressure in comparison to normal volunteers. The study can be concluded that being cirrhotic patients are more susceptible to vein puncture through increase in blood flow velocity low food load or liquid food might help them to control the velocity induced blood vessel rupturing. The observation has direct clinical implications and first time we are reporting with such a study in Indian population.

Keywords- Liver, hepatic circulation, pathogenesis, food, color Dopplers, clinical research

1.      Chuo, L. S. Mahmud R. &Salih Q. A. Color Doppler Ultrasound Examination of The Main Portal Vein And Inferior Vena Cava In Normal Malaysian Adult Population: A Fasting And Post Prandial Evaluation .The Internet Journal of Cardiovascular Research. 2005 Volume 2 Number 2

2.      Cioni G, Tincani E, Cristani A, Ventura P, D'Alimonte P, Sardini C, TurriniF,Abbati GL, Romagnoli R, Ventura E. Does the measurement of portal flow velocity have any value in the identification of patients with cirrhosis at risk of digestive bleeding? Liver. 1996 Apr;16(2):84-7.

3.      Groszmann RJ. Hyperdynamic state in chronic liver diseases.Hepatol.1993;17suppl 2

4.      Hansen M.B, Dresner L.S., Wait R.B.; Profile of neurohumoral Agents on mesenteric and intestinal Blood Flow in Health and Disease- Physiological Research : 47:307-327,1998.

5.      Ozdogan O, Atalay, Cimsit C, Tahan V, Tokay S, Giral A - Role  of  echo  Doppler  ultrasonography  in  the  evaluation  of postprandial hyperemia in cirrhotic patients- World Journal of Gastroenterology-2008 January 14; 14(2): 260-264

6.      Peristic MD, Culafic DJ, Kerkez M. Specificity of splenic blood flow in liver cirrhosis. Rom J Intern med, 2005;43(1-2):141-51.

7.      Perko M. J., Nielsen H. B., Skak C., Clemmesen J. O., Schroeder T. V. and Secher N. H. Mesenteric, coeliac and splanchnic blood flow in humans during exercise - Journal of Physiology (1998), 513.3, pp. 907—913

8.      Sabbá C, Ferraioli G, Genecin P, Colombato L, Buonamico P, Lerner E, Taylor KJ, Groszmann RJ. Evaluation of postprandial hyperemia in superior mesenteric artery and portal vein in healthy and cirrhotic humans: an operator-blind echo-Doppler study. Hepatology. 1991;13;4

9.      Sabbá C, Weltin GG, Cicchetti DV, Ferraioli G, Taylor KJ, Nakamura T, Moriyasu F, Groszmann RJ. Observer variability in echo-Doppler measurements of portal flow in cirrhotic patients and normal volunteers. Gastroenterology. 1990;98;6

10.  Schiedermaier P, Koch L, Mojon A, Hermidia R, Layer G Scandinavian journal of Gastronterology  ISSN: 0036-5521,2006 jul; Vol.47pp.826 – 32 PMID.

11.  Sidery M.B, Macdonald I A, Blackshaw P E Superior mesenteric artery blood flow and gastric emptying in human and the differential effects of high fat and high carbohydrate meals. Gut 1994; 35:186-190.

12.  VorobioffJ,Bredfeldt JE, Grosmann RJ .Increased blood flow through the portal system in cirrhotic rats. Gastroenterology,1984;87;5

13.  Yin XY, Lu MD, Huang JF, Xie XY, Liang LJ. Color Doppler velocity
profile assessment of portal hemodynamics in cirrhotic patients with portal hypertension: Correlation with esophageal variceal bleeding. J Clin Ultrasound. 2001 Jan;29:7-13.