Circulation Times in the Splanchnic and Hepatic Beds in Alcoholic Liver Disease

Abstract

In 50 patients with alcoholic liver disease (ALD)—32 with cirrhosis (C) and 18 with cirrhosis and superimposed alcoholic hepatitis (AH)—and 9 normal subjects, splanchnic circulation times were studied by injecting a bolus of I131 serum albumin into the hepatic (HA), superior mesenteric (SMA), and splenic (SA) arteries while hepatic venous blood was withdrawn through a well scintillation counter. The appearance time (AT) and mean transit time (MTT) of albumin was calculated from the isotope dilution curves. In ALD, AT from HA, SMA and SA were significantly shorter than normal. Prehepatic AT, measured by subtracting HA AT from SMA and SA AT, also was significantly shorter in ALD than in normal subjects. MTT from HA and SMA was significantly shorter in ALD, whereas splenic MTT and splenic and mesenteric prehepatic MTT tended to be shorter but the difference from normal was not significant. In AH, hepatic MTT was significantly shorter than in C and hepatic blood flow was significantly higher in AH than in C. It is concluded that hepatic circulation time is usually reduced, and prehepatic circulation time frequently reduced in ALD. The shorter intrahepatic transit was most prominent in patients with alcoholic hepatitis and was due primarily to high hepatic blood flow. The shortened prehepatic circulation times in some patients with portal hypertension and a presumed increase in splanchnic blood volume suggests abnormally high flow in the mesenteric or splenic beds, much of which may be directed into porta-systemic collateral channels.