Document Detail

Arterial ammonia levels in cirrhosis are determined by systemic and hepatic hemodynamics, and organs function: a quantitative modelling study.
MedLine Citation:
PMID:  24134128     Owner:  NLM     Status:  Publisher    
AIMS: Hyperammonaemia is a common complication of chronic liver failure. Two main factors are thought to underlie this complication: a loss of hepatic detoxification function and the development of portosystemic shunting. However few studies have tried to quantify the importance of portosystemic shunting. Here we used a theoretical approach to test the hypothesis that the development of portosystemic shunting is sufficient to cause hyperammonemia in cirrhosis.
METHODS: Two mathematical models are developed. The first one describes the main vascular resistances of the circulation and is used to provide scenarios for the distributions of organ blood flow in cirrhosis, which are necessary to run the second model. The second model predicts arterial ammonia levels resulting from ammonia metabolism in gut, liver, kidney, muscle and brain, and the distribution of organ blood flow.
RESULTS: The fraction of gastrointestinal blood flow shunted through collaterals was estimated to be 41% in mild cirrhosis, 69% in moderate and 85% in severe cases. In the second model, the redistribution of organ blood flow associated with severe cirrhosis was sufficient to cause hyperammonemia even when the hepatic detoxification function and the ammonia production were set to normal.
CONCLUSIONS: The model indicates that the development of portosystemic shunting in cirrhosis is sufficient to cause hyperammonemia. Interventions that reduce the fraction of shunting may be future targets of therapy to control severity of hyperammonemia.
L Noiret; S Baigent; R Jalan
Related Documents :
14724338 - Regulatory mechanisms of hepatic microcirculation.
15754418 - The effect of hepatic blood inflow occlusion on hepatic cancer treated with diode-laser...
8006408 - Effect of clonidine on liver oxygen extraction during alcohol withdrawal in man.
3932078 - Linear pharmacokinetics of intravenous ergotamine tartrate.
22946918 - Dried matrix on paper disks: the next generation dbs microsampling technique for managi...
20150578 - The association of mitochondrial content with prevalent and incident type 2 diabetes.
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-10-17
Journal Detail:
Title:  Liver international : official journal of the International Association for the Study of the Liver     Volume:  -     ISSN:  1478-3231     ISO Abbreviation:  Liver Int.     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-10-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101160857     Medline TA:  Liver Int     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
CoMPLEX, University College London (UCL).
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Four-Way Junction-Driven DNA Strand Displacement and Its Application in Building Majority Logic Circ...
Next Document:  TYPE 2 DIABETES IN ASIA: Like COPD, a threat to human health and wellbeing.