The portal venous system was evaluated by real-time ultrasonography in 100 consecutive cirrhotic patients and 100 pair-matched controls to assess the sensitivity and specificity of ultrasound findings in detecting or excluding cirrhosis. The best discriminant findings were the expiration diameters of the superior mesenteric and the splenic vein and, chiefly. their sum corrected by body surfitce. In cirrhotics the calibers of the splanchnic veins significantly increase in relation to the extent of esophageal varices, but in individual patients this increase cannot predict the extent of varices, which are the main determinant of the bleeding risk. (Key words: liver, cirrhosis of; esophageal varices; portal hypertension; splanchnic vein measurements)Abdominal ultrasonography is being used more extensively in patients with liver cirrhosis. 1 -3 Previous studies have shown that in cirrhotic patients several sonographic findin gs may be observed, including alterations in splanchnic veins such as an increase in the caliber of splanchnic veins, and a diminished response of portal vessels to breathing. ·
-6The diagnostic usefulness of these findings, however, largely depends on the reliability of control data, which have never been obtained in a large series of matched healthy controls. -1-l'l Enlarged splanchnic vessels are possibly caused by portal hypertension, which is also responsible for the development of esophageal varices. Varices are well-known determinants of survival in these patients; large varices increase the risk of gastrointestinal hemorrhage.11 In a previous report, ultrasonography was proposed as a technique to identify patients with a high risk of bleeding.10 However, only the diameter of splanchnic vessels was considered and no detailed information was given regarding breathing.We report a detailed evaluation of the diagnostic
The contribution of hyperammonemia to plasma amino acid imbalance in patients with liver disease was assessed in 10 subjects with chronic hepatitis and in 17 advanced cirrhotics. Insulin, glucagon, and plasma amino acids were determined both in the basal state and 45 min after oral ammonium chloride, at doses used in the ammonia-tolerance test. In cirrhotics, ammonia increased to 3 times basal values, in association with a rise in insulin and, more marked, in glucagon. Aromatic amino acids and free tryptophan further increased, while a significant fall in branched-chain amino acids and glutamate was observed. The increase in ammonia levels strongly correlated with the increase in glucagon (r = 0.707). Two patients, with large esophageal varices, showed signs of disturbed consciousness, in association with a marked rise in ammonia and in the ration of free tryptophan to the sum of neutral amino acids. In patients with chronic hepatitis, whose ammonia levels rose slightly, minor variations in pancreatic glucoregulatory hormones and plasma amino acids were observed, as also happened in 10 healthy subjects following ammonium chloride ingestion. Our data fit with the hypothesis that the plasma amino acid imbalance of cirrhotics may be partly due to ammonia-induced changes in pancreatic hormones.
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