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Correction of amino-acid imbalance in postoperative portosystemic shunts. 1985

P Carda, and A Sastre, and F Laroche, and V Morales, and J M Marcos

We report on 22 cirrhotic patients suffering from portal hypertension and bleeding esophageal varices. Sixteen of them underwent H mesocaval shunt with internal jugular vein graft and 6 spleno-renal shunts. Mortality was 13.2%. All the patients were treated postoperatively with parenteral and oral nutritional support with solutions containing no aromatic amino-acids, following Fischer's formula. We determined Fischer's index (formula; see text); normal value 2.67 +/- 0.22) on the day of operation (1.6 +/- 0.22), on the 8th postoperative day (2.32 +/- 0.49), and on the 15th postoperative day (1.85 +/- 0.37). Only 1 patient suffered from hepatic encephalopathy in the immediate postoperative period. Three months after operation Fischer's index was 1.20 +/- 0.11 and only 2 patients with an index below 1 suffered from chronic encephalopathy. We conclude that there is a correlation between Fischer's index and the presence of post-shunt hepatic encephalopathy. The proposed policy of parenteral nutrition improves the values of Fischer's index in the immediate postoperative period and we believe that nutritional support should be included routinely as an adjuvant therapy in portosystemic shunts in cirrhotic patients.

UI MeSH Term Description Entries
D006975 Hypertension, Portal Abnormal increase of resistance to blood flow within the hepatic PORTAL SYSTEM, frequently seen in LIVER CIRRHOSIS and conditions with obstruction of the PORTAL VEIN. Cruveilhier-Baumgarten Disease,Cruveilhier-Baumgarten Syndrome,Cruveilhier Baumgarten Disease,Cruveilhier Baumgarten Syndrome,Disease, Cruveilhier-Baumgarten,Portal Hypertension,Portal Hypertensions,Syndrome, Cruveilhier-Baumgarten
D008103 Liver Cirrhosis Liver disease in which the normal microcirculation, the gross vascular anatomy, and the hepatic architecture have been variably destroyed and altered with fibrous septa surrounding regenerated or regenerating parenchymal nodules. Cirrhosis, Liver,Fibrosis, Liver,Hepatic Cirrhosis,Liver Fibrosis,Cirrhosis, Hepatic
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010289 Parenteral Nutrition, Total The delivery of nutrients for assimilation and utilization by a patient whose sole source of nutrients is via solutions administered intravenously, subcutaneously, or by some other non-alimentary route. The basic components of TPN solutions are protein hydrolysates or free amino acid mixtures, monosaccharides, and electrolytes. Components are selected for their ability to reverse catabolism, promote anabolism, and build structural proteins. Hyperalimentation, Parenteral,Intravenous Hyperalimentation,Nutrition, Total Parenteral,Parenteral Hyperalimentation,Total Parenteral Nutrition,Hyperalimentation, Intravenous
D011170 Portasystemic Shunt, Surgical Surgical venous shunt between the portal and systemic circulation to effect decompression of the portal circulation. It is performed primarily in the treatment of bleeding esophageal varices resulting from portal hypertension. Types of shunt include portacaval, splenorenal, mesocaval, splenocaval, left gastric-caval (coronary-caval), portarenal, umbilicorenal, and umbilicocaval. Portosystemic Shunt, Surgical,Portasystemic Shunt,Portosystemic Shunt,Shunt, Surgical Portasystemic,Shunt, Surgical Portosystemic,Surgical Portasystemic Shunt,Surgical Portosystemic Shunt,Portasystemic Shunts,Portasystemic Shunts, Surgical,Portosystemic Shunts,Portosystemic Shunts, Surgical,Shunt, Portasystemic,Shunt, Portosystemic,Shunts, Portasystemic,Shunts, Portosystemic,Shunts, Surgical Portasystemic,Shunts, Surgical Portosystemic,Surgical Portasystemic Shunts,Surgical Portosystemic Shunts
D011182 Postoperative Care The period of care beginning when the patient is removed from surgery and aimed at meeting the patient's psychological and physical needs directly after surgery. (From Dictionary of Health Services Management, 2d ed) Care, Postoperative,Postoperative Procedures,Procedures, Postoperative,Postoperative Procedure,Procedure, Postoperative
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D004932 Esophageal and Gastric Varices Dilated blood vessels in the ESOPHAGUS or GASTRIC FUNDUS that shunt blood from the portal circulation (PORTAL SYSTEM) to the systemic venous circulation. Often they are observed in individuals with portal hypertension (HYPERTENSION, PORTAL). Esophageal Varices,Gastric Varices,Esophageal Varix,Gastric Varix,Varices, Esophageal,Varices, Gastric,Varix, Esophageal,Varix, Gastric
D006471 Gastrointestinal Hemorrhage Bleeding in any segment of the GASTROINTESTINAL TRACT from ESOPHAGUS to RECTUM. Hematochezia,Hemorrhage, Gastrointestinal,Gastrointestinal Hemorrhages,Hematochezias
D006501 Hepatic Encephalopathy A syndrome characterized by central nervous system dysfunction in association with LIVER FAILURE, including portal-systemic shunts. Clinical features include lethargy and CONFUSION (frequently progressing to COMA); ASTERIXIS; NYSTAGMUS, PATHOLOGIC; brisk oculovestibular reflexes; decorticate and decerebrate posturing; MUSCLE SPASTICITY; and bilateral extensor plantar reflexes (see REFLEX, BABINSKI). ELECTROENCEPHALOGRAPHY may demonstrate triphasic waves. (From Adams et al., Principles of Neurology, 6th ed, pp1117-20; Plum & Posner, Diagnosis of Stupor and Coma, 3rd ed, p222-5) Encephalopathy, Hepatic,Portosystemic Encephalopathy,Encephalopathy, Hepatocerebral,Encephalopathy, Portal-Systemic,Encephalopathy, Portosystemic,Fulminant Hepatic Failure with Cerebral Edema,Hepatic Coma,Hepatic Stupor,Hepatocerebral Encephalopathy,Portal-Systemic Encephalopathy,Coma, Hepatic,Comas, Hepatic,Encephalopathies, Hepatic,Encephalopathies, Hepatocerebral,Encephalopathies, Portal-Systemic,Encephalopathies, Portosystemic,Encephalopathy, Portal Systemic,Hepatic Comas,Hepatic Encephalopathies,Hepatic Stupors,Hepatocerebral Encephalopathies,Portal Systemic Encephalopathy,Portal-Systemic Encephalopathies,Portosystemic Encephalopathies,Stupor, Hepatic,Stupors, Hepatic

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