Portacaval Shunt and Hyperlipidemia

Starzl, Thomas E.; Putnam, Charles W.; Koep, Lawrence J.

doi:10.1001/archsurg.1978.01370130073012

Cited by 32 publications

(24 citation statements)

References 20 publications

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“…The metabolic palliation in these diseases has been ascribed in part to the hepatocyte alterations caused by portal diversion including atrophy, deglycogentation, fat accumulation, increased mitosis, and major ultrastructural disruptions (2,(4)(5)(6)(7)(8)(9). These changes are identical in rats, dogs, and humans (5).…”

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confidence: 99%

Morphologic and Biochemical Changes in Dogs After Portacaval Shunt Plus Bile Fistula or Ileal Bypass: Failure of Bile Fistula or Ileal Bypass to Prevent Hepatocyte Atrophy

et al. 1983

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External biliary fistula (BF) or ileal bypass (IB) was performed in dogs at the time of or 2 weeks after portacaval shunt (PCS). The pathologic changes in the dog livers 2 to 4 weeks later were compared to those caused by PCS alone. Histopathologic differences between PCS alone vs. PCS plus BF or IB could not be found. Thus, the experiments did not confirm recent observations by others in rats that BF prevents or reverses the hepatic injury of PCS. As estimated by plasma mevalonic acid determinations, the increase in hepatic cholesterol synthesis that is characteristic after BF or IB was suppressed in animals with PCS. BF and m reduced but did not eliminate the postprandial elevation in serum bile acid that occurs after PCS. The findings have possible relevance in planning the treatment of patients with familial hypercholesterolemia with the combined use of PCS and lB.Completely diverting portacaval shunt (PCS), also called Eck's fistula, has been used for its effect upon the metabolism of patients with glycogen storage disease (1), familial hypercholesterolemia (2, 3), and aI-antitrypsin deficiency (4). The metabolic palliation in these diseases has been ascribed in part to the hepatocyte alterations caused by portal diversion including atrophy, deglycogentation, fat accumulation, increased mitosis, and major ultrastructural disruptions (2,(4)(5)(6)(7)(8)(9). These changes are identical in rats, dogs, and humans (5). Thus, research with any of these species should be applicable to all in spite of the fact that humans are unusually resistant to the hepatic encephalopathy that may complicate PCS.Balabaud et a1. (10) and Bioulac et a1. (11) have

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confidence: 99%

Morphologic and Biochemical Changes in Dogs After Portacaval Shunt Plus Bile Fistula or Ileal Bypass: Failure of Bile Fistula or Ileal Bypass to Prevent Hepatocyte Atrophy

et al. 1983

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“…10,11 In addition, the use of electron microscopy in recent years has made it possible to develop a clear picture of the organelle changes caused by portacaval shunt in the hepatocytes of previously normal rats, [12][13][14][15] dogs, 10,11, ,16,17 subhuman primates, 17,18 and humans. 19,20 In all of these species the most striking and specific ultrastructural changes were depletion and disruption of the rough endoplasmic reticulum (RER) and reduction in the membranebound polyribosomes (Fig 3). 10,11,[16][17][18]20 Other features were fatty infiltration of the liver cells, a diminution in the number of glycogen granules, and deterioration of the appearance of the mitochondria.…”

Section: The Portacaval Shunt (Eck's Fistula): a Century Of Controversymentioning

confidence: 99%

“…19,20 In all of these species the most striking and specific ultrastructural changes were depletion and disruption of the rough endoplasmic reticulum (RER) and reduction in the membranebound polyribosomes (Fig 3). 10,11,[16][17][18]20 Other features were fatty infiltration of the liver cells, a diminution in the number of glycogen granules, and deterioration of the appearance of the mitochondria. In rats, Oudea and Bismuth 13 noted an increase in smooth endoplasmic reticulum (SER), but this was not prominent in dogs, baboons, or humans.…”

Section: The Portacaval Shunt (Eck's Fistula): a Century Of Controversymentioning

confidence: 99%

“…Since portacaval shunt reduces the serum concentration of cholesterol in animals 17,65 and in humans, 20,66 it was natural to wonder if this peripheral antilipidemic effect could be explained by a reduction in hepatic lipid synthesis. In our initial investigations of this possibility, we demonstrated reductions of more than 80% in canine hepatic cholesterol and triglyceride synthesis.…”

Section: Biochemical Parametersmentioning

confidence: 99%

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The ECK fistula in animals and humans

Starzl¹

1983

Current Problems in Surgery

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“…In rats [17,25], dogs [1][2][3][4][5][6][7][8][9][10][11][12][13]19,22,33,36], pigs [8,9], baboons [28,33], and humans [4,34,35] completely diverting portacaval shunt causes a decrease in serum cholesterol. The mechanism of this antilipidemic effect is, however, a matter of dispute.…”

Section: Introductionmentioning

confidence: 99%

The effect of portacaval shunt upon hepatic cholesterol synthesis and cyclic AMP in dogs and baboons

Francavilla

Jones

Benichou

et al. 1980

Journal of Surgical Research

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Hepatic cholesterol synthesis, hepatic cyclic AMP, and portal and peripheral insulin and glucagon levels were investigated in nine dogs and three baboons after complete portacaval shunt. Cholesterol synthesis as measured with acetate incorporation was reduced in both species. Hepatic cyclic AMP increased in dogs. Changes in portal and systemic insulin were inconsistent, but hyper-glucagonemia occurred regularly. Diminished hepatic cholesterol synthesis is apparently one factor, although probably not the only one, in the antilipidemic effect of portacaval shunt. This altered cholesterol metabolism may be due to a change in the hormonal environment of the liver caused by portal diversion.

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Portacaval Shunt and Hyperlipidemia

Abstract: The use of a completely diverting portacaval shunt for the purpose of lowering the serum concentration of cholesterol and IOw-denslty lipoproteins Is reviewed and a recommendation provided that such a shunt for hyperlipidemia should be consld-tnId for type II Individuals.

Cited by 32 publications

References 20 publications

Morphologic and Biochemical Changes in Dogs After Portacaval Shunt Plus Bile Fistula or Ileal Bypass: Failure of Bile Fistula or Ileal Bypass to Prevent Hepatocyte Atrophy

Morphologic and Biochemical Changes in Dogs After Portacaval Shunt Plus Bile Fistula or Ileal Bypass: Failure of Bile Fistula or Ileal Bypass to Prevent Hepatocyte Atrophy

The ECK fistula in animals and humans

The effect of portacaval shunt upon hepatic cholesterol synthesis and cyclic AMP in dogs and baboons

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