From the standpoint of eradication of esophageal varices an end-to-side portacaval shunt is the most efficient method of treating portal hypertension.1,2 On the other hand, complete diversion of portal blood from the liver has been demonstrated to result occasionally in neurological abnormalities similar to those occurring spontaneously in patients with severe chronic liver disease, and these changes have been related to the nitrogen content of the diet and to the concentration of "ammonia" in the blood.3-6 The relative importance of portacaval shunts on the one hand and hepatocellular failure on the other in producing the neurological syndrome as- sociated with severe liver disease has been discussed extensively.6,7
Measurements of the changes in blood "ammonia" concentration immediately after portacaval shunts were undertaken to assess the contribution of the shunting of blood to the syndrome of liver failure. It was found that a rise in blood "ammonia" concentration occurred
CHALMERS TC, HUGHES CW, IBER FL. Nitrogen Metabolism After Portacaval Shunts in Patients with Cirrhosis: I. Effects of the Operation upon the Blood "Ammonia" Concentration. AMA Arch Intern Med. 1958;101(2):434–438. doi:10.1001/archinte.1958.00260140266037
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