Biochemical tests for hepatobiliary disease

Experimental DMNA induced hepatic necrosis: early course of haemostatic disorders in the rat

The course of haemostasis defects was investigated in dimethylnitrosamine (DMNA) acute liver necrosis. Before 18 hr there was no evidence of disseminated intravascular coagulation (DIC) nor of abnormal fibrinolysis. At 12 hr the level of the vitamin-K-dependent factors (factors II, VII, IX and X) was reduced to 25-63% of control. Factors V and VIII:C levels decreased to about 10 and 20% by 12 hr. Factor V was the only molecule which decreased significantly by 6 hr. The rapid decrease of these proteins might be related to an early parenchymal functional impairment attested by early structural lesions observed in the endoplasmic reticulum and nucleus. The isolated decrease of factor V in the absence of any significant change in serum transaminase (SGOT and SGPT) levels is proposed, at least in the rat, as an early criterion of hepatic failure.

[Theory and practice of perioperative trauma-adapted parenteral feeding]

In this paper we introduce a new perioperative infusion regime. We will discuss problems associated with the water and electrolyte metabolism and show the influence of pre- and postoperative beginning of an intravenous nutrition support on metabolic and hormonal changes after trauma. We also will show the influence of hypercaloric and trauma-adapted nutritional support on hormonal, metabolic and liver-specific enzyme changes after trauma.

[Enzymatic changes and protein metabolism in the early and late postoperative phase during intravenous feeding]

119 metabolically healthy surgical patients, who had to undergo elective intraabdominal surgery, were separated into upper - cholecystectomy, gastric resection - and lower - colonic and sigma surgery - intraabdominal procedures and divided into 8 groups with different infusion regimens. During the early postoperative period, patients with upper abdominal surgery had significantly higher postoperative enzyme changes compared with patients with lower abdominal surgery. Patients with cholecystectomy had the significantly highest postoperative enzyme changes. On postoperative day 6 the enzyme changes showed a significant dependence from the duration of total parenteral nutrition, the chosen calorie-nitrogen ratio, and the chosen energy substrate, Xylitol or glucose. We could show a significant negative correlation between the extent of the stimulation of hepatic lipid synthesis and the protein parameters. Of all chosen infusion regimens, Xylitol in a dosis of 0.11 g/kg BW x h together with the high amino acid infusion rate of 1.76 g/kg BW x day had the most favourable effect on the extent of stimulation of hepatic lipid synthesis, the late postoperative enzyme changes, and the synthesis rate of visceral proteins. This study could demonstrate that different intraabdominal surgical procedures need a more specific nutritional therapy.