The hemodynamic response to a 800 kcal liquid meal was investigated in 24 patients (study group) with cirrhosis and two control groups. One control group of six cirrhotic patients (volume control) had a calorie-free equivolumic electrolyte solution. The second control group (normal control) of six patients with normal hepatic function had the same test meal. Cardiac index, mean arterial pressure, heart rate, hepatic venous pressures, hepatic blood flow and azygos blood flow (only measured in the study group) were measured before and 30 and 60 min after the meal. Systemic circulatory responses were generally absent. Hepatic blood flow and wedged hepatic venous pressure increased significantly in both cirrhotic patients and normal controls; however, cirrhotic patients tended to have a quicker response (peaks at 30 min) than normals (peaks at 60 min). Azygos blood flow showed large postprandial variability, but overall did not change significantly. These results demonstrate that the splanchnic circulation of the patient with cirrhosis reacts differently from normals to the physiologic stimulus of a meal, and in particular appears to have precocious vasoactive reactivity.
Hemodynamic responses to feeding have been extensively studied in normal animals and humans (1-8). In contrast, postprandial responses in patients with liver disease have been virtually unstudied. One investigation in patients with cirrhosis showed a postprandial increase in estimated hepatic blood flow (9); another documented augmentation of wedged hepatic venous pressure (10).
No previous study has examined the systemic postprandial circulatory response in cirrhosis. Moreover, description of mesenteric vascular phenomena in these patients is further complicated by the existence of the extensive portosystemic collaterals: the splanchnic inflow has two routes of venous drainage (via the portal vein or the collaterals). Thus, measurement of only hepatic blood