FUNCTIONAL HEPATIC FLOW AND DOPPLER-ASSESSED TOTAL HEPATIC FLOW IN CONTROL SUBJECTS AND IN PATIENTS WITH CIRRHOSIS

Functional hepatic flow and total hepatic flow were determined by non-invasive techniques in 32 patients with cirrhosis and in 32 paired control subjects. Functional hepatic flow was measured by the hepatic clearance of D-sorbitol, while total hepatic flow was determined by pulsed echo-Doppler, as the sum of portal and hepatic arterial blood flow. Functional hepatic flow was significantly reduced in patients with cirrhosis (92+/-314 vs. 1287+/-315; p<0.0001), while total hepatic flow was slightly increased (1511+/-540 vs. 1261+/-321 in controls; p=0.028). In control subjects functional hepatic flow significantly correlated with total hepatic flow (r=0.823; p<0.001), while no correlation was observed in cirrhosis. Functional hepatic flow and the difference between total hepatic flow and functional hepatic flow significantly correlated with the Child-Pugh score in patients with cirrhosis. The data obtained in control subjects support the measurement of functional hepatic flow and total hepatic flow by non-invasive techniques. The finding that in cirrhosis functional hepatic flow is significantly decreased, while Doppler-assessed total hepatic flow is preserved or even increased, confirms that a relevant part of blood flowing through the liver is diverted by intrahepatic shunts. The simultaneous assessment of these two parameters by non-invasive techniques may be proposed as a reliable tool for the study of functional shunting of cirrhosis.