Abstract
Attempts to quantitate the blood flow rate through possible intrahepatic shunting versus the flow rate through so-called functioning liver sinusoids by means of measurements of hepatic clearance of a test substance (eg, sorbitol) and measurement of total liver blood flow rate is not possible with current methods. A reduced hepatic extraction fraction can be due to both reduced liver cell function and intrahepatic shunting, the effects of which cannot be separated by any flow or clearance measurements. Direct and individual estimates of the hepatic removal capacity,Vmax, and of the halfsaturation concentration,Km, for the liver cell process involved must be made. Only then can an approximation of a hepatic clearance measurement to liver blood flow rate be evaluated from the values ofVmax,Km, andQ according to the sinusoidal perfusion model.
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