A method of measuring quantitative hepatic function and hemodynamics in cirrhosis: the changes following distal splenorenal shunt.

Quantitative measurement is required to define the severity of chronic liver disease and the effects of therapy on its complications. This paper presents a method of such assessment based on measurement of hepatocyte function, liver volume, functional liver blood flow, portal perfusion and cardiac output. Data are presented on 54 patients evaluated prior to, and one year after DSRS for variceal bleeding. Preoperative testing showed that alcoholics (n = 24) had significantly (p less than 0.05) larger liver and smaller spleen volumes than nonalcoholic cirrhotics (n = 22) and patients with portal vein thrombosis (n = 8), but that the other parameters were not significantly different by etiologies. At one year after DSRS: all groups showed a significant (p less than 0.01) reduction of 41 per cent in spleen size: liver volume was significantly (p less than 0.05) reduced in cirrhotics: there was a significantly (p less than 0.01) greater loss of portal perfusion in alcoholic cirrhosis: liver blood flow showed a significant (p less than 0.05) rise in alcoholics when compared to nonalcoholics and portal vein thrombosis patients: cardiac output rose in alcoholic cirrhosis: hepatocyte function was not significantly different in any group. This study shows that in patients all doing well clinically one year after DSRS, there are markedly different hemodynamic responses. Further studies on cirrhosis aimed at improving therapy for its complications should include some objective, quantitative assessment, first to define the study population, and second to measure the effect of the therapy.