Evidence of a gastro-hepatic osmoregulation in humans and the influence of vagotomy on its activity

Innervation of the liver: morphology and function

Although it has been known for many years that the liver receives a nerve supply, it is only with the advent of immunohistochemistry that this innervation has been analysed in depth. It is now appreciated not only that many different nerve types are present, but also that there are significant differences between species, especially in the degree of parenchymal innervation. This has stimulated more detailed investigation of the innervation of the human liver in both health and disease. At the same time, functional studies have been underlining the important roles that these nerves play in processes as diverse as osmoreception and liver regeneration. This article briefly reviews current understanding of the morphology and functions of the hepatic nerve supply.

Plasma arginine vasopressin response to oral, gastric, and intravenous water load in patients with cirrhosis

BACKGROUND/AIMS

Hepatic osmoreceptors are sensitive to changes in portal blood osmolality and cause variations in plasma antidiuretic hormone and water diuresis, which prevent major systemic osmotic changes. Insensitivity of hepatic osmoreceptors might contribute to maintaining increased plasma levels of antidiuretic hormone and negative free water clearance after oral hydration in some cirrhotic patients.

METHODS

We measured free water clearance and plasma arginine vasopressin levels in basal conditions and after oral, intravenous, and intragastric water overload in control subjects (group I) and patients with cirrhosis (some with a positive [group II] and some a negative [group III] free water clearance).

RESULTS

In groups I and II, no significant differences in plasma arginine vasopressin levels were found regardless of the route used for hydration. In group III, plasma levels were significantly higher between 0 and 75 minutes after intragastric hydration than after oral or intravenous hydration. No significant changes in plasma osmolality were detected between minute 0 and 20 after the end of oral or intragastric hydration, although plasma arginine vasopressin decreased significantly only 5 minutes after the oral hydration. Group III patients showed evidence of autonomic neuropathy. However, this dysfunction was unrelated to the insensitivity to gastric hydration.

CONCLUSIONS

Hepatic osmoreceptors seem to be disturbed in some cirrhotic patients, although this dysfunction may be compensated for by normally functioning oropharyngeal and hypothalamic osmoreceptors.

Osmosensitive vagal receptors in the small intestine of the cat

In anesthetized cats, the unitary activity of 66 sensory vagal neurones was recorded with extracellular glass microelectrodes implanted in the nodose ganglia. These neurones had non-medullated afferent fibres with conduction velocities between 0.8 and 1.2 m/s, as do most of the intestinal vagal fibres, and were silent or fired at low frequencies before any simulation. They were activated by perfusion of the small intestine (duodenum and first part of jejunum) with tap water and various solutions (glucose, NaCl and mannitol, in particular) having osmotic pressures ranged between 4 and 1100 mOsm. In general, hypotonic solutions and tap water induced the more marked responses, but differences were observed according to the solution used. Most of these neurones were also excited by other forms of stimulation including stroking of the mucosa and perfusion with warm (39-55 degrees C) and acid (HCl at pH 1) solutions. Therefore they must be considered to be polymodal receptors sensitive to osmotic pressure. The short latency of responses elicited by osmotic stimulations, the marked sensitivity to mucosal stroking and the disappearance of nervous activity after local anesthesia indicate that these receptors are located close to the epithelium. The role of these osmosensitive endings is discussed. Analysis of their general characteristics suggests that they may be involved in the inhibitory entero-gastric reflex modulating gastric emptying.

Plasma expansion does not precipitate the fall in plasma vasopressin in humans drinking isotonic fluids

In a group of healthy humans, plasma vasopressin (AVP) levels fell on drinking either Tyrode or mannitol solutions isosmotic with plasma. Both the timing and magnitude of the fall were appropriate to account for the transient diuresis which followed the drinking. Although plasma expansion follows drinking Tyrode solution it occurred too late to account for the fall in plasma AVP. It was also too small to inhibit AVP secretion. Even though plasma volume tended to contract on drinking isosmotic mannitol solution a fall in plasma AVP and a diuresis occurred, similar to those found after drinking Tyrode solution. These findings appear to eliminate plasma volume expansion as the stimulus for the fall in plasma AVP and the associated diuresis on drinking isotonic fluids. In a further group of human subjects, bypassing the oropharynx by intragastric infusion resulted in a slower onset of diuresis after a water load. We suggest that receptors, as yet undefined, in the upper gastrointestinal tract contribute to the early stages of a water diuresis and account for the apparently inappropriate transient diuresis which follows the drinking of isotonic fluids.