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Portal scintigraphy is a useful non-invasive method for the determination of portosystemic shunts in patients with liver cirrhosis. Several procedures have been reported for its execution in clinical practice but most of them failed to show sufficient sensitivity for the diagnosis of portosystemic shunt. In the present study, we evaluated whether summation of radioisotope counts obtained during intrarectal or intraduodenal administration of 201thalium chloride is useful for increasing the diagnostic yield of porto-systemic shunts in patients with chronic liver disease.Seven patients with chronic viral hepatitis and 8 with liver cirrhosis secondary to viral hepatitis were enrolled in this study. Following the conventional protocol, 201thalium chloride was administered per rectum and the 60-second-heart-to-liver uptake (conv-H/L-R) ratio was calculated after 20 min. Continuous measurement of the radioactivity signals during 20 min were also done and the summated heart-to-liver uptake (sum-H/L-R) ratio from the total radioactivity count were calculated. Measurement of the conventional heart-to-liver uptake (conv-H/L-D) ratio and the summated (sum-H/L-D) ratio were also done as described above after the intraduodenal administration of 201thalium chloride by endoscopy.All ratios (conv-H/L-R, conv-H/L-D, sum-H/D-R, sum-H/L-D) were significantly higher in patients with liver cirrhosis than in those with chronic hepatitis. Among all heart/liver ratios, only the sum-H/L-R ratio was significantly different between patients with and without esophageal varices. Serum hyaluronate level and other liver function tests were found to be significantly correlated with all heart-to-liver ratios, but they were more strongly correlated with the sum-H/D-R and sum-H/L-D ratios than with the conv-H/L-R and conv-H/L-D ratios.The results of this study showed that the heart-to-liver ratio calculated by summation of radioactivity is better than the conventional method for the diagnosis of portosystemic shunt in patients with chronic liver disease.

In patients with liver cirrhosis, there were various symptoms in decompensated state, but not in compensated state. Most of symptoms were due to liver cell dysfunction and portal hypertension. Jaundice, ascites, edema, bleeding tendency and endocrinological symptoms were due to liver cell dysfunction. Hepatic encephalopathy, esophageal varices and splenomegaly were related to portal hypertension. Vascular spiders and palmar erythema were found in patients with alcoholic liver cirrhosis more frequently than in patients with viral liver cirrhosis. Jaundice was a sign of poor prognosis. There were no difference in clinical symptoms between aged patients and young patients. Careful observation of the symptoms is important to care the patients with liver cirrhosis.

In patients with liver cirrhosis, there were many abnormalities in laboratory tests. Serum GOT, GPT and LDH were elevated due to the liver cell necrosis. The value of ICG tests reflected the decrease of effective hepatic blood flow and the increase of intrahepatic shunt flow. White blood cell counts and the number of platelet were decreased due to the hypersplenism. Serum albumin and cholineesterase levels were decreased more remarkably in patients with alcoholic liver cirrhosis than in patients with viral liver cirrhosis. Raised GOT and GPT levels were lower in aged patients than in young patients. Serial laboratory tests were important for the management of patients with liver cirrhosis.

The histopathology of the liver in idiopathic portal hypertension (IPH) associated with autoimmune disease (15 cases), was examined and compared with that of IPH without autoimmune disease (31 cases). It was found that hepatic histopathology was heterogeneous in the cases with autoimmune disease. That is, the hepatic histopathology in 7 cases was similar to that of classic IPH without autoimmune disease, and the remaining 8 cases disclosed unusual lesions such as focal non-suppurative cholangitis, nodular parenchymal hyperplasia, moderate portal inflammation, and intrahepatic ductopenia. These unusual lesions, which frequently coexisted in the same case, were not typical ones for making other diagnoses such as primary biliary cirrhosis or nodular regenerative hyperplasia of the liver. These findings suggest that unusual histologic lesions in the livers of IPH patients with autoimmune disease may represent an accentuated immunologic reaction inherent in IPH, or that such cases may be an abortive or incomplete form of primary biliary cirrhosis or nodular regenerative hyperplasia of the liver.