Disturbance of intestinal fat absorption and overload of lymphatic system in patient of the liver cirrhosis were mentioned by many investigators, so this study was carried out to apply MCT which was easily absorbed, transported not via lymphatic routs, but mainly via portal vein as free fatty acid, to liver cirrhosis. Experimental study Intestinal absorption and liver metabolism of 1-14C-Trioctanoin or 1-14C-Tripalmitin in cirrhotic rats (chronic CCL4 injury) were studied. Absorption rate of 1-14C-Trioctanoin was extremely higher than that of 1-14C-Tripalmitin and no difference was found between control and cirrhotic rats (85-86%), whereas marked decrease was observed in cirrhotic rats (26.4%) in the case of 1-14C-Tripalmitin (control 45.9%). Intraluminal hydrolysis of 1-14C-Trioctanoin was nearly complete and no difference was observed between both groups. Liver uptake of the absorbed lipids was about 3 times higher with 1-14C-Tripalmitin than 1-14C-Trioctanoin. Metabolism of 1-14C-Octanoic acid or 1-14C-Palmitic acid by liver slices in vitro, was studied. 14CO2 production was 16-17% by 1-14C-Octanoic acid in normal and cirrhotic liver slices, but the uptake as liver storage lipids was trace, contrarily 14CO2 production was trace and liver uptake was increased in 1-14C-Palmitic acid, this inclination was profound in cirrhotic liver. Transportation phase was studied in dogs. Thoracic lymph, portal and femoral blood were obtained after administration of 1-14C-Trioctanoin or 1-14C-Triolein into the duodenum. Radioactivity of 1-14C-Trioctanoin was found both in lymph and portal blood equally. In lymph the radioactivity was found about 45% in Triglyceride; TG (long chain), about 20% in TG (medium chain) and in portal blood 95% in fatty acid; FA, whereas the radioactivity of 1-14C-Triolein was found only in lymph and about 95% in TG (long chain). Clinical study Control 8, liver cirrhosis without ascites 8 and with ascites 6 patients were administered. MCT pouder (replaced 80% of the dietary fats) for 3-4 weeks and Triglyceride; TG, Total Cholesterol; Ch, Phospholipid; PL and Total fatty acid fraction in fasting blood plasma were studied. Although TG increased in all groups, relatively high level was observed in cirrhosis with ascites. There were no remarkable changes in Ch. and PL level in control, but significantly decreased in cirrhosis, especially ascitic group. Decrease of polyunsaturated fatty acids was not detected in all groups, exclusively a few cases of cirrhotic patients.
There are many unsolved problems on the pathogenesis of acute stress ulcer or gastric hemorrhage. In this study the microcirculatory changes in the stomach after the restraint were investigated with biomicroscope and by the analyses of the local blood. Gastric hemorrhages or erosions were developed in 9 of 10 wistar strain male rats after 3-hour restraint. Biomicroscopic observation disclosed the dilatation and the increase in permeability of the microvessels in the gastric mucosa after the restraint. The analyses of the local blood revealed several interesting changes after the restraint as follows: hemoconcentration and the decrease in serum albumin, which might be due to the increase in vascular permeability, and the increase in plasmin activity of whole blood and the fall of plasma fibrinogen level, which might be occurred after the intravascular thrombosis or the alterations of blood coagulation system. These results suggest that the microcirculatory system in the gastric mucosa can play an important role in the pathogenesis of restraint-induced gastric hemorrhage.