18 - Hepatic Blood Flow and Protein Synthesis
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Publisher SummaryThis chapter discusses the hepatic blood flow and protein synthesis. The hepatic veins constitute a large low-resistance network of poorly scaffolded vessels that are easily compressed by surrounding parenchyma or pressure on the liver itself. Animal data suggests this low-resistance, high-flow arrangement is not fortuitous but serves to supply the liver with the large volume of oxygen and metabolites necessary for its metabolic functions. Total hepatic blood flow is directly proportional to cardiac output in the normal liver. Hepatic clearance of substances from sinusoidal blood is expressed as a proportion, or the percent extraction, of a given substance from blood in a single pass through the liver multiplied by the quantity of hepatic blood flow. Percent extraction is influenced by rate of flow so that it decreases with increased flow and increases with decreasing flow. The complexity of hepatic hemodynamic and cellular dysfunction in advanced human liver disease allows no definite estimate of the role played by fixed pathologic processes as opposed to the potentially reversible consequences of nutrient starvation, hormonal deprivation, or aberrations in blood flow. The favorable human response to ligation of portal vein branches in the treatment of cancer and portacaval shunt for glycogen storage disease or hyper-lipoproteinemia suggests that acute loss of portal flow is accompanied by major hepatic metabolic adjustments but is compatible with normal growth and prolonged survival.

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