Energy deficit in surgery on the examples of cholestasis and massive liver resection

Abstract

The paper is dedicated to the energy processes associated with diseases in living organisms. Experiments involved 151 rats. Liver tissue was taken to determine its energy state in cholestasis (common bile duct ligation) and after resection of 60% and 80% of the parenchyma (without cholestasis). Adenine nucleotides (ATP, ADP, and AMP) and activity of gluconeogenesis enzymes were studied in cholestasis every 3 days for 15 days and after liver resection – every 6 hours for 3 days. Particular attention was paid to the energy deficit in liver tissue. A certain level of energy deficit n agent of metabolic stress. The experiments revealed that the energy deficit in the liver tissue increased by 15% by day 6 of cholestasis and by 48–50% of the initial energy level by days 12–15. The increase in energy deficit in liver tissue inversely correlated with the decrease in the activity of gluconeogenesis enzymes – by day 15 glucose-6- phosphate dehydrogenase reduced by 44% and isocitrate dehydrogenase – by 48% of the initial energy level. Decompression after 15 days from the onset of cholestasis was followed by an increase in energy deficit by 15%, as compared to the initial energy level, within 3–5 days. No development of metabolic stress was evidenced by a decrease in the activity of gluconeogenesis enzymes. After 12 hours after resection of 60% and 80% of the liver parenchyma, the liver energy deficit in both groups accounted for 50% of the initial energy level. After resection of 60% of the liver parenchyma, the energy deficit decreased rapidly: after 24 hours to 30%, after 72 hours to 11%; 2 rats out of 30 died during this period. After 12 hours after resection of 80% of the liver parenchyma, the energy deficit rose sharply: after 24 hours to 70% of the initial energy level. This led to the death of 26 animals out of 31. Both groups of animals demonstrated an inverse relationship between the decreased amount of energy used for hepatocyte function and the increased activity of key enzymes of gluconeogenesis. The obtained results suggest that in both groups of animals, metabolic stress developed after liver resection, however, after resection of 80% of the organ parenchyma, it “choked” due to the deficit of remnant hepatocytes. Most of the energy was spent for the development of regeneration. Metabolic stress and regeneration develop simultaneously. A deficit of 50% of energy in liver tissue with a further increase may indicate a critical condition, both in cholestasis and after a massive resection. The research into energy changes in cholestasis and after massive liver resections reveals new patterns of internal processes of the body.