This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Citing articles on Web of Science (11)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Results After End-to-Side and Side-to-Side Portacaval Anastomoses

GEORGE D. ZUIDEMA, M.D.; WALTER D. GAISFORD, M.D.; GEORGE RAKOLTA, A.B.; MARGARET M. FLETCHER, M.D.; WILLIAM D. BURTON, B.S.; CHARLES G. CHILD, III, M.D.

AMA Arch Surg. 1962;85(5):776-782.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

Introduction

Neuropsychiatric complications are known to occur in patients with advanced cirrhosis and hemorrhage from gastroesophageal varices. This clinical picture is associated with elevated blood ammonia levels. McDermott,¹ Mann,² and Levine³ also demonstrated blood hyperammonemia following portacaval anastomosis in humans and dogs. These observations have focused attention on the pathophysiology of hepatic coma, and the possible role of ammonia toxicity has been noted by Young et al.⁴ and Welch, Pender, and Kiley.⁵

Patients with cirrhosis show a prompt rise in portal blood ammonia when protein substances or blood is digested within the gastrointestinal tract.^4,5 The normal liver easily detoxifies portal blood ammonia, but the liver whose function is impaired by disease or bypassed by portal systemic shunts is unable to metabolize this product of protein breakdown. Consequently, systemic blood ammonia reaches toxic levels, and neuropsychiatric phenomena occur secondary to central nervous system effects.

Ammonia . . . [Full Text PDF of this Article]

Author Affiliations
ANN ARBOR, MICH.

John and Mary R. Markle Scholar in Medical Science. U.S.P.H.S. Career Development Awardee (Dr. Zuidema).; Department of Surgery, University of Michigan Medical School.

Footnotes
Presented at the 19th Annual Meeting of the Central Surgical Association, Cincinnati, Feb. 21-24, 1962.

Supported in part by U.S.P.H.S. Grant (H-4260-C-2), U.S.P.H.S. Career Development Award AM-K3-13,702, and U.S. Army Contract No. DA-49-007-MD-1016.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?