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Origin of Fat in Chylous Ascites of Patients with Liver Cirrhosis

1974; Elsevier BV; Volume: 67; Issue: 5 Linguagem: Inglês

10.1016/s0016-5085(19)32739-8

1528-0012

Juan R. Malagelada, Frank L. Iber, Willem G. Linscheer,

Lymphatic Disorders and Treatments

To investigate the origin of fat in chylous ascites of patients with liver cirrhosis, labeled medium and long chain fatty acids ( [ 14 C ]octanoic and [ 3 H]oleic acid, respectively) were fed to 3 cirrhotic patients with chylous ascites as well as to two control groups: patients with cirrhosis and clear ascites and noncirrhotic subjects with chylous ascites.The time of appearance, time interval from ingestion to peak levels, and half-life time of decay of labeled long chain fatty acids in ascitic chylomicrons were similar in all groups of patients.In the cirrhotic patients, the peak activity of long chain fat found in chylous ascites (8% of ingested radioactivity) was much greater than in clear ascites (0.6%).An even greater amount of ingested long chain fat was found in the chylous ascites of noncirrhotic patients (22%).More than 80% of the ingested [ 3 H ]oleic acid present in chylous ascites was incorporated in esterified form in chylomicrons as compared to less than 50% in clear ascitic fluid.This significantly higher (P < 0.01) incorporation of 3 H radioactivity in subjects with chylous ascites when serum levels were identical suggests that intestinal lymph was the main source of ascitic chylomicrons.The appearance, concentration, and decay rate in ascites of [ 14 C ]octanoic acid, not incorporated in the chylomicrons, was similar in cirrhotic patients with clear or chylous ascitic fluid, suggesting a similar pathway of transport of the nonprotein-bound [ 14 C )octanoic acid.Analysis of the relative concentrations of triglycerides, phospholipids, and cholesterol in ascitic fluid revealed a relatively low proportion of triglycerides in clear ascitic fluid which indicates that most of the triglycerides are present in the smaller particles, probably a combination of small chylomicrons, very low, low, and high density lipoproteins.It can be concluded from our studies that only small chylomicrons, probably leaking from the intestinal lymphatics, enter the ascites of cirrhotic patients with clear ascitic fluid.When the number and size of these chylomicrons increases, the ascitic fluid acquires a chylous nature.Whether the underlying pathogenesis involves abnormal permeability or rupture of the lymphatics is unknown, but the process may reverse with improvement of liver function.Chylous ascites is an infrequent feature of decompensated cirrhosis of the liver. 2 -5