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. 1977 Sep-Oct;50(5):497–506.

The Hepatic Vasculature and Its Response to Hepatic Injury: A Working Hypothesis 1

David S Zimmon
PMCID: PMC2595559  PMID: 602259

Abstract

The hepatic circulation is unique in that high volumes of low pressure blood flow are supplied through a dual venous and arterial circulation. This vascular supply is modulated both by the gastrointestinal vascular bed and an intrahepatic microcirculation. This complex vascular system is influenced by pathologic processes within the liver. Alterations in the hepatic circulation reflect hepatic metabolic adaptation and injury. It seems reasonable to assume that in some circumstances hepatic circulatory alterations are inappropriate, exaggerated or inadequate and contribute to the initiation or perpetuation of hepatic injury. This paper attempts to focus on evidence derived from studies of the normal and abnormal hepatic circulation that provide insights into hepatic circulatory responses and their role in the initiation and perpetuation of hepatic injury. A possible relationship of these vascular changes to pathologic processes within the liver is proposed. Ultimately, precise measurement and understanding of hepatic vasculature changes may allow appropriate intervention to offset injury or stimulate maximum effective repair.

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Selected References

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  1. BRADLEY S. E. The circulation and the liver. Gastroenterology. 1963 Apr;44:403–409. [PubMed] [Google Scholar]
  2. BRAUER R. W. Hepatic blood flow and its relation to hepatic function. Am J Dig Dis. 1963 Jul;8:564–576. doi: 10.1007/BF02239455. [DOI] [PubMed] [Google Scholar]
  3. Bircher J., Blankart R., Halpern A., Häcki W., Laissue J., Preisig R. Criteria for assessment of functional impairment in patients with cirrhosis of the liver. Eur J Clin Invest. 1973 Jan;3(1):72–85. doi: 10.1111/j.1365-2362.1973.tb00332.x. [DOI] [PubMed] [Google Scholar]
  4. Burchell A. R., Moreno A. H., Panke W. F., Nealon T. F., Jr Hepatic artery flow improvement after portacaval shunt: a single hemodynamic clinical correlate. Ann Surg. 1976 Sep;184(3):289–302. doi: 10.1097/00000658-197609000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cain G. D., Mayer G., Jones E. A. Augmentation of albumin but not fibrinogen synthesis by corticosteroids in patients with hepatocellular disease. J Clin Invest. 1970 Dec;49(12):2198–2204. doi: 10.1172/JCI106438. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Conn H. O., Lindenmuth W. W., May C. J., Ramsby G. R. Prophylactic portacaval anastomosis. Medicine (Baltimore) 1972 Jan;51(1):27–40. doi: 10.1097/00005792-197201000-00002. [DOI] [PubMed] [Google Scholar]
  7. EDWARDS E. A. Functional anatomy of the porta-systemic communications. AMA Arch Intern Med. 1951 Aug;88(2):137–154. doi: 10.1001/archinte.1951.03810080005002. [DOI] [PubMed] [Google Scholar]
  8. Joly J. G., Marleau D., Legare A., Lavoie P., Bernier J., Viallet A. Bleeding from esophageal varices in cirrhosis of the liver. Hemodynamic and radiological criteria for the selection of potential bleeders through hepatic and umbilicoportal catheterization studies. Can Med Assoc J. 1971 Apr 3;104(7):576–580. [PMC free article] [PubMed] [Google Scholar]
  9. Lundbergh P., Strandell T. The effect of physical exercise on the wedged and free hepatic venous pressure in normal men. Acta Med Scand. 1973;194(3):211–214. doi: 10.1111/j.0954-6820.1973.tb19432.x. [DOI] [PubMed] [Google Scholar]
  10. Lunderquist A., Vang J. Transhepatic catheterization and obliteration of the coronary vein in patients with portal hypertension and esophageal varices. N Engl J Med. 1974 Sep 26;291(13):646–649. doi: 10.1056/NEJM197409262911303. [DOI] [PubMed] [Google Scholar]
  11. Mays E. T., Wheeler C. S. Demonstration of collateral arterial flow after interruption of hepatic arteries in man. N Engl J Med. 1974 May 2;290(18):993–996. doi: 10.1056/NEJM197405022901804. [DOI] [PubMed] [Google Scholar]
  12. McGee J. O., O'Hare R. P., Patrick R. S. Stimulation of the collagen biosynthetic pathway by factors isolated from experimentally-injured liver. Nat New Biol. 1973 May 23;243(125):121–123. [PubMed] [Google Scholar]
  13. Moreno A. H., Burchell A. R., Rousselot L. M., Panke W. F., Slafsky F., Burke J. H. Portal blood flow in cirrhosis of the liver. J Clin Invest. 1967 Mar;46(3):436–445. doi: 10.1172/JCI105545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Ozawa K., Kitamura O., Yamaoka Y., Kamano T., Mizukami T. Metabolic responses of the liver of human beings and other mammals to deprivation of portal blood supply. Surg Gynecol Obstet. 1973 Oct;137(4):623–628. [PubMed] [Google Scholar]
  15. Popper H. Implications of portal hepatotrophic factors in hepatology. Gastroenterology. 1974 Jun;66(6):1227–1233. [PubMed] [Google Scholar]
  16. Price J. B., Jr, Voorhees A. B., Jr, Britton R. C. Operative hemodynamic studies in portal hypertension. Significance and limitations. Arch Surg. 1967 Nov;95(5):843–852. doi: 10.1001/archsurg.1967.01330170151019. [DOI] [PubMed] [Google Scholar]
  17. REDEKER A. G., GELLER H. M., REYNOLDS T. B. Hepatic wedge pressure, blood flow, vascular resistance and oxygen consumption in cirrhosis before and after end-to-side portacaval shunt. J Clin Invest. 1958 Apr;37(4):606–618. doi: 10.1172/JCI103643. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. ROUSSELOT L. M., MORENO A. H., PANKE W. F. Studies on portal hypertension. IV. The clinical and physiopathologic significance of self-established (nonsurgical) portal systemic venous shunts. Ann Surg. 1959 Sep;150:384–412. doi: 10.1097/00000658-195909000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Salam A. A., Warren W. D., LePage J. R., Viamonte M. R., Hutson D., Zeppa R. Hemodynamic contrasts between selective and total portal-systemic decompression. Ann Surg. 1971 May;173(5):827–844. doi: 10.1097/00000658-197105000-00022. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Sex, ascites and alcoholism in survival of patients with cirrhosis. Effect of prednisone. N Engl J Med. 1974 Aug 8;291(6):271–273. doi: 10.1056/NEJM197408082910602. [DOI] [PubMed] [Google Scholar]
  21. Starzl T. E., Francavilla A., Halgrimson C. G., Francavilla F. R., Porter K. A., Brown T. H., Putnam C. W. The origin, hormonal nature, and action of hepatotrophic substances in portal venous blood. Surg Gynecol Obstet. 1973 Aug;137(2):179–199. [PMC free article] [PubMed] [Google Scholar]
  22. Starzl T. E., Putnam C. W., Chase H. P., Porter K. A. Portacaval shunt in hyperlipoproteinaemia. Lancet. 1973 Oct 27;2(7835):940–944. doi: 10.1016/s0140-6736(73)92599-3. [DOI] [PubMed] [Google Scholar]
  23. Starzl T. E., Putnam C. W., Porter K. A., Halgrimson C. G., Corman J., Brown B. I., Gotlin R. W., Rodgerson D. O., Greene H. L. Portal diversion for the treatment of glycogen storage disease in humans. Ann Surg. 1973 Oct;178(4):525–539. doi: 10.1097/00000658-197310000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Stenson R. E., Constantino R. T., Harrison D. C. Interrelationships of hepatic blood flow, cardiac output, and blood levels of lidocaine in man. Circulation. 1971 Feb;43(2):205–211. doi: 10.1161/01.cir.43.2.205. [DOI] [PubMed] [Google Scholar]
  25. Strandell T., Erwald R., Kulling K. G., Lundbergh P., Marions O., Wiechel K. L. Regional variations in hepatic blood flow and function in man. Acta Med Scand. 1973;194(3):215–218. doi: 10.1111/j.0954-6820.1973.tb19433.x. [DOI] [PubMed] [Google Scholar]
  26. Strandell T., Erwald R., Lundbergh P., Wiechel K. L. Estimations of lobar hepatic blood flows and extractions in severe liver cirrhosis. Preliminary report. Acta Med Scand. 1973;194(3):219–220. doi: 10.1111/j.0954-6820.1973.tb19434.x. [DOI] [PubMed] [Google Scholar]
  27. TYGSTRUP N., WINKLER K., MELLEMGAARD K., ANDREASSEN M. Determination of the hepatic arterial blood flow and oxygen supply in man by clamping the hepatic artery during surgery. J Clin Invest. 1962 Mar;41:447–454. doi: 10.1172/JCI104497. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Winkler K., Larsen J. A., Munkner T., Tygstrup N. Determination of the hepatic blood flow in man by simultaneous use of five test substances measured in two parts of the liver. Scand J Clin Lab Invest. 1965;17(5):423–432. [PubMed] [Google Scholar]
  29. Zimmon D. S., Kessler R. E. The portal pressure-blood volume relationship in cirrhosis. Gut. 1974 Feb;15(2):99–101. doi: 10.1136/gut.15.2.99. [DOI] [PMC free article] [PubMed] [Google Scholar]

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