Functional disturbance of biliary indocyanine green excretion in rat cerulein pancreatitis followed by endotoxemia: role of the prime and the second attack.

CONTEXT Hepatic injury is considered one of the critical complications associated with acute pancreatitis. It was proposed that initial insults to the liver in the early phase of the attack have an important priming effect, and the subsequent infectious attack (e.g. infectious pancreatic necrosis, bacterial translocation episode) constitutes a second attack on the liver. OBJECTIVE To evaluate the role of priming by induction of cerulein pancreatitis and a following second attack by endotoxemia. MAIN OUTCOME MEASURES Plasma clearance and biliary excretion of indocyanine green (a hepatophillic hydrophobic organic anion). DESIGN A model of acute pancreatitis in rats. SETTING Four groups of rats: untreated control, cerulein pancreatitis, endotoxemia and endotoxemia following the induction of cerulein pancreatitis (pancreatitis + endotoxemia). RESULTS Biliary indocyanine green excretion was significantly disturbed only in the pancreatitis + endotoxemia group. Plasma clearance (a reflection of hepatic uptake) of indocyanine green from the blood was only slightly affected in endotoxemia group. CONCLUSION Biliary secretion is quite sensitive to this hepatic injury model. Both the preceding priming insult and the following second attack are important in the development of hepatic injury.