The effect of small intestinal distention upon bile and urine flow—its possible relationship to the hepatorenal syndrome

Abstract

1. Experimental acute intestinal distention in nembutalized dogs caused a reflex inhibition of the bile flow. Intraenteric pressures of 20 and 40 mm. of mercury resulted in a decrease in the bile flow of 7 to 42 per cent below the control level. 2. A decrease in the portal blood flow and oxygen supply to the liver produced by distention of the entire intestine to pressures of 70 mm. of mercury caused a further decrease in bile flow in 4 of our dogs. Oxygen therapy lessened this inhibition in all of the dogs treated. 3. Nervous reflex inhibition of the flow of urine did not occur upon distention of the small intestine to pressures of 20, 40, 60 and 90 mm. of mercury. An increase in urine flow from 11 to 81 per cent occurred. This was attributed to an increased blood flow through the kidneys. 4. The blood pressure was not significantly altered by distention of the small intestine. 5. The depth of respiration was decreased and the rate was increased by distention. Oxygen therapy decreased the respiratory rate and lessened the depression of bile flow produced by distention of the small intestine. 6. Inhibitory nervous reflexes, decreased blood flow and anoxemia probably are factors involved in decreasing liver function and thereby make the liver more susceptible to damage in cases of intestinal distention. 7. Inhibition of liver function probably precedes inhibition of kidney function in the hepatorenal syndrome of intestinal obstruction.