[Protein-calorie malnutrition and degree of hepatic failure in chronic hepatopathy]. / Malnutrición calórico-protéica y grado de insuficiencia hepática en hepatopatías crónicas.

BACKGROUND: Malnutrition is often associated with chronic liver disease, particularly in alcoholics. Its objective assessment by means of methods which are useful and accessible to daily clinical practice is nowadays considered to be necessary for an adequate diagnosis and treatment of these problems, being also a necessary requirement in the selection of the candidates for a liver transplant. Besides, the still insufficiently known relation between nutritional status and the degree of liver dysfunction is of great interest, which has given rise to the present study. PATIENTS AND METHODS: The level of malnutrition and of hepatic function of 48 patients suffering from chronic liver disease hospitalized in Internal Medicine is evaluated, by means of the Ratio of Protein-Caloric Malnutrition proposed by Pomar et al and the Ratio obtained from Clinical and Laboratory data proposed by Orrego et al, respectively. RESULTS: All the patients showed different levels of malnutrition, 27% of the cases being severe, 69% moderate and the remaining 4% mild. The serum albumin and the response to cutaneous antigens were the most frequently altered tests, while the brachial muscular extent was the less altered parameter. A lineal correlation between the degree of malnutrition and that of liver dysfunction (r = 0.3998, p < 0.01) is also made evident. CONCLUSIONS: Malnutrition is often associated with chronic liver disease, is of mixed characteristics (marasmus and Kwashiorkor disease), and seems to aggravate with the progression of the liver dysfunction.

[Hemodynamic impact of tension ascites and evacuatory paracentesis]. / Repercusiones hemodinámicas de la ascitis a tensión y de la paracentesis evacuadora.

Cardiac function is studied with regular hemodynamic determinations and 2D-doppler echocardiography, in 22 patients with massive ascites. Patients were divided in two groups: 1. Hepatic cirrhosis (n = 12) and 2. Peritoneal carcinomatosis (n = 10). Patients with carcinomatosis showed lowered heart-beat volume, cardiac output, ventricular work and ejection fraction in comparison with cirrhotic patients. In cirrhotic patients the hemodynamic study was done before and after an evacuatory paracentesis, following which an improvement in cardiac function was shown, with significant increments in heart-beat volume, cardiac output, ventricular work, and ejection fraction. 42% of the cirrhotic patients showed an hyperdynamic circulatory status in the baseline study, but after paracentesis this hyperkinetic status was present in 100% of the patients. It is suggested that tension ascites influences negatively in cardiac function because it difficult the venous return. This depression in the ventricular function is more obvious in patients with carcinomas that in cirrhotic patients due to the fact that the former do not have a previous circulatory status.

[Somatostatin and ventricular function in liver cirrhosis]. / Somatostatina y función ventricular en cirrosis hepática.

Left ventricular function is studied in cirrhotic patients and in patients with alcoholic hepatitis by means of isotopic ventriculography (Tc99m) both in basal conditions and after the i.v. injection of a somatostatin bolus (250 mcg). The results obtained are compared to those of conventional hemodynamics. Basal ventricular function is normal in both groups and somatostatin induces a significant decrease (p less than 0.001) in heart rate (74 + 12 vs 67 + 11 bpm), ejection fraction (60 + 6 vs 57 + 65) and maximal ejection rate (-3.3 + 0.4 vs -2.0 + 0.3) in patients and normal controls respectively. The hormone induces a significant increase (p less than 0.01) in telediastolic pressure of the left ventricle (8.1 + 4 vs 21 + 7 mmHg) with no change in systemic resistance. The results suggest that somatostatin has a negative inotropic effect on the heart as well as causing bradycardia.