Abstract Although portacaval shunt effectively controls hemorrhage from esophageal varices by control of portal hypertension, liver function does not improve and often deteriorates after diversion of portal blood from the liver. Hepatic failure is the most common cause of the excessively high mortality following portacaval shunt. The etiology of hepatic failure and the reasons for the associated metabolic changes after portacaval shunt are not understood. It has been suggested that deterioration of liver function studies may be related to decreased total hepatic blood flow, diversion of an alleged hepatotrophic factor from the liver, or diversion of oxygen or other nutrients by the portacaval shunt. Recently, alterations in the metabolism of certain amino acids and their related enzymes and metabolites have been described in an effort to elucidate the pathogenesis of postshunt liver failure. Postshunt induction of hepatic histidase and histidine transaminase occurred selectively after portacaval shunt with no change in hepatic References 1. Reichle FA, et al: Histidine metabolism after portacaval shunt in the rat . J Surg Res 8:320-325, 1968.Crossref 2. Fischer JE, Snyder SH: Increased histamine synthesis: A possible final common pathway in gastric acid hypersecretion . Surg Forum 16:331-332, 1965. 3. Kennan AL: Glutamine synthetase activity in rat liver after portacaval shunt . Endocrinology 74:805-806, 1964.Crossref 4. Iber FL: The plasma amino acids in patients with liver failure . J Lab Clin Med 50:417-425, 1957. 5. Baldessarini RJ, Fischer JE: S-Adenosylmethionine following portacaval anastomosis . Surgery 62:311-318, 1967. 6. Reichle FA, et al: Amino acid metabolism after portacaval shunt , Current Topics in Surgical Research . New York, Academic Press Inc., 1969, vol 1, pp 307-314. 7. Spolter PD, Baldridge RC: The metabolism of histidine . J Biol Chem 238: 2071-2074, 1963. 8. Friedemann TE, Haugen GE: Pyruvie acid: II. The determination of keto acids in blood and urine . J Biol Chem 147:415-442, 1943. 9. Spackman, DH, Stein WH, Moore S: Automatic recording apparatus for use in the chromatography of amino acids . Anal Chem 30:1190-1206, 1958.Crossref 10. McDermott WV Jr, et al: Postshunt encephalopathy . Surg Gynec Obstet 126: 585-590, 1968. 11. Marchioro TL, et al: Physiologic requirements for auxiliary liver homotransplantation . Surg Gynec Obstet 121:17-31, 1965. 12. Jagenburg OR: The Urinary Excretion of Free Amino Acids and Other Amino Compounds by the Human . Göteborg, Sweden, Holmqvists, 1959, chap 7 , pp 153-155. 13. Griffith WH, Wade NJ: Choline metabolism: I. The occurrence and prevention of hemorrhagic degeneration in young rats on a low choline diet . J Biol Chem 131:567-577, 1939. 14. Jost J. Khairallah EA, Pitot HC: Studies on the induction and repression of enzymes in rat liver: V. Regulation of the rate of synthesis and degradation of serine dehydratase by dietary amino acids and glucose . J Biol Chem 243:3057-3066, 1968. 15. Ishikawa E, Ninagawa T, Suda M: Hormonal and dietary control of serine dehydratase in rat liver . J Biochem 57:506-513, 1965. 16. Fiegelson M: Estrogenic regulation of hepatic histidase during postnatal development and adulthood . J Biol Chem 243:5080-5093, 1968. 17. Baldridge, RC: The molecular biology of disease and inborn errors of metabolism , in Kisch B (ed): Exp Med Surg Supplement, Transactions of the Second Symposium of the Carl Newberg Society for International Scientific Relations on Drugs, Enzymes and Diseases . New York, Brooklyn Medical Press Inc, March 1965, vol 23, pp 165-171.
Archives of Surgery – American Medical Association
Published: Feb 1, 1970