Assessment of renal and hepatic hemodynamics in cirrhosis of liver.

BACKGROUND AND OBJECTIVE: Investigators have documented an increase in renal artery resistance in cirrhotic patients. We studied the hepatic and renal hemodynamics by color Doppler in patients with liver cirrhosis in relation to the presence and severity of ascites. METHODS: A prospective study was carried out in a large public hospital on 33 patients with cirrhosis of liver and 11 healthy control subjects. Eleven patients had no ascites, 12 had diuretic-responsive ascites and 10 had refractory ascites. The resistance index (RI) of the hepatic artery was measured by color Doppler on its main branch and renal artery RI was measured on the main renal, interlobar and cortical arteries of the right kidney. RESULTS: Considering intraobserver variabilities, coefficient of variation for RI was 2.3%-7.8% (mean [SD] 4.2% [1.8%]). Hepatic artery RI were 0.68 (0.07), 0.68 (0.1), 0.81 (0.04), 1.0 (0.12) in control subjects and cirhotics with no ascites, responsive ascites and refractory ascites, respectively. Renal RI was significantly higher than in control subjects at all three levels in patients with responsive and refractory ascites, being higher in those with refractory than responsive ascites. Renal RI decreased from hilum towards the outer parenchyma, in cirrhotics with no ascites and responsive ascites but not in refractory ascites. CONCLUSION: Hepatic artery RI is higher in cirrhotics and is related to presence and severity of ascites. In control subjects and patients with no ascites or responsive ascites the renal RI decreased from hilum to the outer parenchyma.

Assessment of portal hemodynamics by ultrasound color Doppler and laser Doppler velocimetry in liver cirrhosis.

BACKGROUND: Color Doppler is a noninvasive method for assessing portal hemodynamics. Laser Doppler velocimetry is useful in assessment of microcirculatory abnormalities in portal hypertensive gastropathy (PHG). AIMS: To study portal hemodynamics by color Doppler and gastric mucosal blood flow (GMBF) by laser Doppler velocimetry in patients with cirrhosis. METHODS: Twenty-eight patients with cirrhosis of liver (24 men) and 10 healthy subjects (7 men) were studied. Portal venous blood flow (PVBF) and portal flow velocity (PFV) were assessed by color Doppler at the level where the hepatic artery crosses the portal vein, and GMBF was measured by laser Doppler velocimetry. RESULTS: PVBF (379.5 [102.9] mL/min), PFV (5.3 [1.1] cm/sec) and GMBF (3.5 [0.8] volts) were significantly lower in patients with cirrhosis than in controls. PVBF and PFV were significantly lower in patients in Child class B and C than those in class A. Patients with ascites had significantly lower PVBF, PFV and GMBF than those without; values were also lower in patients with PHG than in those without. History of bleeding had no relation with PVBF and PFV. GMBF showed good correlation with PVBF (r=0.58, p<0.001) and with PFV (r=0.48, p<0.01). CONCLUSIONS: In cirrhosis of liver, PVBF, PFV and GMBF are significantly lower, and the changes increase with increasing severity of liver disease.