Hepatic circulation in cirrhosis.

Using the multiple indicator dilution approach, events occurring in the microvascular bed can be characterized and are compatible with the two kinds of anatomical alterations in cirrhotic livers: capillarization and intrahepatic shunts. The combination of these two kinds of alteration contributes to the progressive limitation of the blood-liver exchange. The decreased ability of the liver to clear endogenous and exogenous substrates in cirrhosis is generally thought to result from a reduction of liver cell mass and/or function. Our data suggest that abnormalities in the hepatic uptake of these substrates may also contribute to the impaired liver function in cirrhosis. Capillarization of the hepatic sinusoid is of particular importance in the overall process of elimination while intrahepatic shunts, when present, further exacerbate the functional effects of capillarization.