Factors affecting acid base status during hepatectomy in cirrhotic patients

Hasanin, Ashraf S.; Mahmoud, Faten Shafik; Soliman, Hossam M.

doi:10.1016/j.egja.2013.05.003

Cited by 2 publications

(9 citation statements)

References 26 publications

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“…After 75% resection, further changes were observed in arterial measurements. Previous comparisons of acid-base changes between major and minor hepatectomies have been controversial, mainly because they only compared between resections of two and more than two liver segments (4,13). In our study, we compared the changes between 25, 50, and 75% liver resections.…”

Section: Discussionmentioning

confidence: 99%

“…Also, metabolic overload of the remnant liver leads to metabolic insufficiency of hepatocytes (3,18,30). This causes intracellular acidosis (15,16,22) and reduces gluconeogenesis (13,22). As a result, hepatocytes will be in a low-energy status and mainly obtain energy from anaerobic glycolysis (13,18,22,32,33).…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, lactate is overproduced, and lactate clearance is decreased. This increases HCO 3 Ϫ consumption (3,13,22) and causes metabolic acidosis (4,13). A correlation between acidosis and PHLF has already been postulated (4,27,32) but, to the best of our knowledge, has never been studied systematically in large animal or clinical models.…”

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confidence: 98%

“…The prognosis is poor in patients with SFSF and irreversible PHLF; therefore, it is important to predict these conditions to prevent or minimize their occurrence. Blood gas values can be measured quickly and simply during surgery (3,4,13,29). Changes in posthepatectomy RLV affect the balance of metabolic parameters during blood gas analysis (4,13).…”

mentioning

confidence: 99%

“…Blood gas values can be measured quickly and simply during surgery (3,4,13,29). Changes in posthepatectomy RLV affect the balance of metabolic parameters during blood gas analysis (4,13). However, it is unclear whether changes in acid-base equilibrium after liver resection correlate with RLV (4).…”

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confidence: 99%

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Does acid-base equilibrium correlate with remnant liver volume during stepwise liver resection?

Golriz

Abbasi

Fathi

et al. 2017

American Journal of Physiology-Gastrointestinal and Liver Physi

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Small for size and flow syndrome (SFSF) is one of the most challenging complications following extended hepatectomy (EH). After EH, hepatic artery flow decreases and portal vein flow increases per 100 g of remnant liver volume (RLV). This causes hypoxia followed by metabolic acidosis. A correlation between acidosis and posthepatectomy liver failure has been postulated but not studied systematically in a large animal model or clinical setting. In our study, we performed stepwise liver resections on nine pigs to defined SFSF limits as follows: step 1: segment II/III resection, step 2: segment IV resection, step 3: segment V/VIII resection (RLV: 75, 50, and 25%, respectively). Blood gas values were measured before and after each step using four catheters inserted into the carotid artery, internal jugular vein, hepatic artery, and portal vein. The pH, [Formula: see text], and base excess (BE) decreased, but [Formula: see text] values increased after 75% resection in the portal and jugular veins. EH correlated with reduced BE in the hepatic artery. Pco values increased after 75% resection in the jugular vein. In contrast, arterial Po increased after every resection, whereas the venous Po decreased slightly. There were differences in venous [Formula: see text], BE in the hepatic artery, and Pco in the jugular vein after 75% liver resection. Because 75% resection is the limit for SFSF, these noninvasive blood evaluations may be used to predict SFSF. Further studies with long-term follow-up are required to validate this correlation. This is the first study to evaluate acid-base parameters in major central and hepatic vessels during stepwise liver resection. The pH, [Formula: see text], and base excess (BE) decreased, but [Formula: see text] values increased after 75% resection in the portal and jugular veins. Extended hepatectomy correlated with reduced BE in the hepatic artery. Because 75% resection is the limit for small for size and flow syndrome (SFSF), postresection blood gas evaluations may be used to predict SFSF.

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Section: Discussionmentioning

confidence: 99%