Hepatic encephalopathy and light and electron micrographic changes of the baboon liver after portal diversion

Six baboons of varying weights and estimated ages had complete portal diversion. All animals became emaciated and lost hair. Five of the 6 developed hepatic encephalopathy so serious that it either killed them or required their sacrifice after an average of 109 days. One exceptional animal which lived for 208 days without encephalopathy had markedly elevated blood ammonia levels. In one brain that was examined, greatly increased numbers of Alzeheimer's type II astrocytes were diffusely distributed in the cerebral cortex. Changes in liver function tests were similar to those reported by many authors in dogs. The 6 baboons' livers underwent striking atrophy during the 49 to 208 days of postoperative observation. With some variations in degree, the same light and electron microscopic changes were observed that have now also been seen after completely diverting portacaval shunt in rats, dogs and humans. Thus the hepatic injury of Eck fistula is common to all species so far studied although most of the metabolic consequences of the procedure seem to selectively spare rats and man.