The estimation of hepatic wedge pressure, hepatic blood flow and intrahepatic shunt in hepatic disease, especially the correlation with liver function tests and histological findings

1970 ◽  
Vol 5 (1) ◽  
pp. 76-76
Author(s):  
I. Kaito ◽  
S. Sato ◽  
K. Takahashi ◽  
M. Ikeda ◽  
H. Sahara ◽  
...  
Keyword(s):  
Blood Flow ◽  
Liver Function ◽  
Hepatic Blood Flow ◽  
Liver Function Tests ◽  
Hepatic Disease ◽  
Histological Findings ◽  
Function Tests ◽  
Wedge Pressure ◽  
Intrahepatic Shunt

scholarly journals Physiologically based modeling of the effect of physiological and anthropometric variability on indocyanine green based liver function tests

2021 ◽  
Author(s):  
Adrian Köller ◽  
Jan Grzegorzewski ◽  
Matthias König
Keyword(s):  
Blood Flow ◽  
Body Weight ◽  
Liver Function ◽  
Indocyanine Green ◽  
Hepatic Blood Flow ◽  
Liver Function Tests ◽  
Individual Variability ◽  
Hepatic Elimination ◽  
Function Tests ◽  
Physiologically Based

Accurate evaluation of liver function is a central task in hepatology. Dynamic liver function tests (DLFT) based on the time-dependent elimination of a test substance provide an important tool for such a functional assessment. These tests are used in the diagnosis and monitoring of liver disease as well as in the planning of hepatobiliary surgery. A key challenge in the evaluation of liver function with DLFTs is the large inter-individual variability. Indocyanine green (ICG) is a widely applied test compound used for the evaluation of liver function. After an intravenous administration, pharmacokinetic (PK) parameters are calculated from the plasma disappearance curve of ICG which provide an estimate of liver function. The hepatic elimination of ICG is affected by physiological factors such as hepatic blood flow or binding of ICG to plasma proteins, anthropometric factors such as body weight, age, and sex, or the protein amount of the organic anion-transporting polypeptide 1B3 (OATP1B3) mediating the hepatic uptake of ICG. Being able to account for and better understand these various sources of inter-individual variability would allow to improve the power of ICG based DLFTs and move towards an individualized evaluation of liver function. Within this work we systematically analyzed the effect of various factors on ICG elimination by the means of computational modeling. For the analysis, a recently developed and validated physiologically based pharmacokinetics (PBPK) model of ICG distribution and hepatic elimination was utilized. Key results are (i) a systematic analysis of the variability in ICG elimination due to hepatic blood flow, cardiac output, OATP1B3 abundance, liver volume, body weight and plasma bilirubin level; (ii) the evaluation of the inter-individual variability in ICG elimination via a large in silico cohort of n=100000 subjects based on the NHANES cohort with special focus on stratification by age, sex, and body weight; (iii) the evaluation of the effect of various degrees of cirrhosis on variability in ICG elimination. The presented results are an important step towards individualizing liver function tests by elucidating the effects of confounding physiological and anthropometric parameters in the evaluation of liver function via ICG.

scholarly journals Physiologically Based Modeling of the Effect of Physiological and Anthropometric Variability on Indocyanine Green Based Liver Function Tests

2021 ◽  
Vol 12 ◽  
Author(s):  
Adrian Köller ◽  
Jan Grzegorzewski ◽  
Matthias König
Keyword(s):  
Blood Flow ◽  
Body Weight ◽  
Liver Function ◽  
Indocyanine Green ◽  
Hepatic Blood Flow ◽  
Liver Function Tests ◽  
Individual Variability ◽  
Hepatic Elimination ◽  
Function Tests ◽  
Physiologically Based

Accurate evaluation of liver function is a central task in hepatology. Dynamic liver function tests (DLFT) based on the time-dependent elimination of a test substance provide an important tool for such a functional assessment. These tests are used in the diagnosis and monitoring of liver disease as well as in the planning of hepatobiliary surgery. A key challenge in the evaluation of liver function with DLFTs is the large inter-individual variability. Indocyanine green (ICG) is a widely applied test compound used for the evaluation of liver function. After an intravenous administration, pharmacokinetic (PK) parameters are calculated from the plasma disappearance curve of ICG which provide an estimate of liver function. The hepatic elimination of ICG is affected by physiological factors such as hepatic blood flow or binding of ICG to plasma proteins, anthropometric factors such as body weight, age, and sex, or the protein amount of the organic anion-transporting polypeptide 1B3 (OATP1B3) mediating the hepatic uptake of ICG. Being able to account for and better understand these various sources of inter-individual variability would allow to improve the power of ICG based DLFTs and move toward an individualized evaluation of liver function. Within this work we systematically analyzed the effect of various factors on ICG elimination by the means of computational modeling. For the analysis, a recently developed and validated physiologically based pharmacokinetics (PBPK) model of ICG distribution and hepatic elimination was utilized. Key results are (i) a systematic analysis of the variability in ICG elimination due to hepatic blood flow, cardiac output, OATP1B3 abundance, liver volume, body weight and plasma bilirubin level; (ii) the evaluation of the inter-individual variability in ICG elimination via a large in silico cohort of n = 100,000 subjects based on the NHANES cohort with special focus on stratification by age, sex, and body weight; (iii) the evaluation of the effect of various degrees of cirrhosis on variability in ICG elimination. The presented results are an important step toward individualizing liver function tests by elucidating the effects of confounding physiological and anthropometric parameters in the evaluation of liver function via ICG.

Diagnostic Effectiveness of Biochemical Liver-Function Tests, as Evaluated by Discriminant Function Analysis

1977 ◽  
Vol 23 (4) ◽  
pp. 627-630 ◽  
Author(s):  
Paul Phillip Sher
Keyword(s):  
Alkaline Phosphatase ◽  
Lactate Dehydrogenase ◽  
Discriminant Analysis ◽  
Liver Function ◽  
Function Analysis ◽  
Liver Function Tests ◽  
Diagnostic Value ◽  
Hepatic Disease ◽  
Stepwise Discriminant Analysis ◽  
Function Tests

Abstract I evaluated the diagnostic value of routinely ordered liver-function tests in 175 biopsy-proven cases of hepatic disease by use of stepwise discriminant analysis. The tests studied—total and "direct" bilirubin, alkaline phosphatase, lactate dehydrogenase, and aspartate aminotrans-ferase—correctly classified 45-73% of cases, depending on the homogeneity of the diagnostic groups. Aspartate aminotransferase and alkaline phosphatase were the best discriminators. When all tests were used in the most ho-mogeneous groups (tumors, cirrhosis, and hepatitis), there was a stepwise improvement in diagnostic accuracy from 51 to 73%.

Hepatic function in the critically ill

2016 ◽  
Author(s):  
Andreas Kortgen ◽  
Michael Bauer
Keyword(s):  
Blood Flow ◽  
Liver Function ◽  
Critically Ill ◽  
Liver Blood Flow ◽  
Prognostic Significance ◽  
Liver Function Tests ◽  
Hepatic Function ◽  
Prognostic Information ◽  
Hepatocellular Damage ◽  
Function Tests

The liver with its parenchymal and non-parenchymal cells plays a key role in the organism with manifold functions of metabolism, synthesis, detoxification, excretion, and host response. This requires a portfolio of different tests to obtain an overview of hepatic function. In the critically ill hepatic dysfunction is common and potentially leading to extrahepatic organ dysfunctions culminating in multi-organ failure. Conventional laboratory measures are used to evaluate hepatocellular damage, cholestasis, or synthesis. They provide valuable (differential) diagnostic data and can yield prognostic information in chronic liver diseases, especially when used in scoring systems such as the ‘model for end-stage liver disease’. However, they have short-comings in the critically ill in assessing rapid changes in hepatic function and liver blood flow. In contrast, dynamic quantitative liver function tests measure current liver function with respect to the ability to eliminate and/or metabolize a specific substance. In addition, they are dependent on sinusoidal blood flow. Liver function tests have prognostic significance in the critically ill and may be used to guide therapy.

scholarly journals Comparative study of postoperative hepatic and renal function changes in laparoscopic and open cholecystectomy

2019 ◽  
Vol 6 (4) ◽  
pp. 1194
Author(s):  
Fazle Rab Malik ◽  
Ankur Dutt Tripathi ◽  
Santosh Kumar Singh ◽  
Anish Kola ◽  
Devendra Kumar Shukla
Keyword(s):  
Blood Flow ◽  
Renal Function ◽  
Laparoscopic Cholecystectomy ◽  
Liver Function ◽  
Open Cholecystectomy ◽  
Liver Function Tests ◽  
P Value ◽  
Renal Function Test ◽  
Function Tests ◽  
Function Test

Background: It has been shown that there is a transient elevation of serum liver enzymes after laparoscopic surgeries and major causative factor seemed to be the CO2 pneumoperitoneum. In most of the cases, it does not have any clinical significance in the patient with normal preoperative liver function. However, in patients with deranged liver function, these changes can have great significance.Methods: The present study was designed to determine and compare changes in liver function tests and renal function test following laparoscopic cholecystectomy and open cholecystectomy. This study was conducted on 100 patients admitted to Swaroop Rani Nehru Hospital, Allahabad, India from August 2017 to January 2019 who were having symptomatic cholelithiasis with a history of either acute cholecystitis, biliary colic or chronic cholecystitis. All patients were investigated for complete liver function tests and renal function test including serum bilirubin, SGOT, SGPT, alkaline phosphatase, LDH, S. urea, S. creatinine, S. Na+, S. K+, S. Ca+ and urinary sodium (UNa+). The laboratory tests were carried out in the same laboratory using one type of instrument.Results: In open cholecystectomy, bilirubin decreased by 11% (p value equals 0.191) and remained decreased to the preoperative value on day 1 and day 7. While, laparoscopic cholecystectomy at 14 mmHg pressure, mean bilirubin decreases by 14% immediately postoperatively (p value equals 0.1733) and returns to normal level in 7 days. These changes are clinically insignificant and statistically insignificant.Conclusions: Enzyme elevations could mostly be attributed to the adverse effects of the pneumoperitoneum on the hepatic blood flow and renal blood flow and CO2 absorption in the blood. Though, these changes do not seem to be clinically significant, care should be taken before deciding to perform laparoscopic cholecystectomy. This study suggested that laparoscopic cholecystectomy is a safe operative procedure and have added advantages. The disturbances in the function of the kidney after laparoscopic cholecystectomy are self-limited and not associated with any morbidity in patients with a healthy kidney function.

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