J.Jpn. Surg. Soc.. 82(5): 483-497, 1981

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Original article

CLINICAL AND EXPERIMENTAL STUDIES ON THE HYPERDYNAMIC STATES IN OBSTRUCTIVE JAUNDICE

Studies on the hyperdynamic state in non-septic obstructive jaundice showed that 13 out of 28 patients had a cardiac index above 3.5 L/min.M². Clinically, ascites and abnormal glucose tolerance test were found more commonly in these patients than normodynamic patients. In addition, hyperdynamic patients had poorer disappearance of serum bilirubin and higher mobidity rate after biliary tract drainage procedures. Characteristic hyperdynamic cardiovascular findings were significant decrease in mean arterial pressure (MAP) and total perlpheral vascular resistance (TPR) with increased cardiac index. Further hemodynamic studies in the dog with chronic (3weeks) bile duct ligation (BDL) showed that significant decrease in MAP and TPR. These data suggested that the decrease in TPR caused by the impaired liver function was one of the important mechanisms which caused the hyperdynamic state in the obstructive jaundice.
To clarify the etiologic factors which induced the decrease of TPR, the sympathetic nervous system activities was examined. The increase in MAP with carotid artery occlusion was significantly less in BDL dogs than in control and the dose respose to tyramine was significantly shifted to the right in BDL dogs, whearas the dose response to exogenous norepinephrine was shifted to the left. These results suggested the diminished endogenous stores of norepinephrine in obstructive jaundice. Additionally, plasma phenylalanine and norepinephrine increased significantly in BDL dogs and these animals showed abnormal sequential cardiovascular patterns after infusion of tyramine.
In summary, decrease in TPR due to impaired sympathetic nervous activities, which appeared to be induced by deranged catecholamine metabolism, may play an important role in the pathogenesis of hyperdynamic state seen in obstructive jaundice. Clinically, preoperative evaluation of hemodynamic state in the patient with obstructive jaundice is useful for selecting the operative timing and its procedure.

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