1960 Volume 24 Issue 9 Pages 1018-1031
While the subject of hypoxia associated with liver diseases is drawing an increasing interest of medical investigators these days, no large body of informations is yet available on the effect of hypoxia on the blood circulation through, and gas metabolism in, the liver. Particularly, such informations are practically nil in man. The author attempted to evaluate the role of the liver in the organism's regulatory response to an induced hypoxemia in a variety of conditions e.g., in the convalescent stage of hepatitis, in chronic hepatitis or cirrhosis of the liver and pulmonary tuberculosis.Methods and Subjects : Each patient was subjected to the venous catheterization; arterial blood was obtained from the femoral artery and the venous blood was drawn through the catheter. The hepatic blood flow was estimated by the B.S.P. method of Bradley and, at the same time, various parameters of the blood circulation and gas metabolism in the liver were measured, e.g., hepatic vein wedge pressure, hepatic-portal vascular resistance, splanchnic O2 extraction and splanchnic O2 consumption. After a course of measurment during a resting state was over and another course of measurement (of the hepatic blood circulation and hepatic gas metabolism) was made during the 15th-20th minute interval of the hypoxemia test, which was induced by Levy's method with 10% O2 gas. The cardiac output was measured by direct the Fick's method in a resting state and at the 20th minute of the hypoxemia test.Subjects examined were 28 cases in total and they consisted of 5 groups.Group I : normal subjects (6 cases)Group II : patients with pulmonary tuberculosis who were scheduled to be operated on for surgical treatment (10 cases). This group consisted of 2 subgroups; subgroup A represents those who gave no abnormal liver function tests, and subgroup B represented those who gave abnormal liver function tests.Group III : convalescent patients with acute hepatitis (4 cases). This group covered the stage of the disease between the 37th and 114th day after the onset of the disease; liver function tests and liver biopsy findings were nearly normal in all cases.Group IV : Chronic hepatitis (4 cases). This group covered the stage of the disease between the 4th and 21st month since the onset of acute hepatitis; liver biopsy revealed the degenerasion of hepatic cells, round cell infiltration and slight fibrosis.Group V : Cirrhosis of the liver (4 cases). This group represented those in whom signs of hepatic insufficiency (ascites, jaundice, etc., ) have subsided to a considerable extent.Results : The observed effect of hypoxemia was as follows.(1) Systemic circulation and gas metabolism : The observed response was nearly the same in all groups with regard to the artery blood pressure, cardiac output, arterial blood O2 contents and total O2 consumption of the body. The artery blood pressure was reduced by about 15 % and the cardiac output was either unchanged or slightly reduced : the arterial blood O2 contents were reduced by 30-40 % and the total O2 consumption was slightly reduced (by about 20%).(2) Hepatic vein wedge pressure : This was measured in 2 normal subjects and 7 cases with liver diseases (acute hepatitis in convalescence and chronic hepatitis). It was increased by 18 % in normal subjects and increased by 28% in patients with liver disease.(3) Estimated hepatic bloood flow : It was increased markedly in Group I, by +68% ; it was also increased in Group II, by +31%; within this group the pressure was different between the two subgroups, the increase being marked in subgroup A (+50%) but nil in subgroup B. No increase was found in groups III, IV and V. Furthermore, the blood flow was decreased in groups III (-26%) and V (-30%). [the rest omitted]
