Alcoholism cirrhosis and

Milk thistle has shown promise in improving liver function parameters in various hepatotoxic situations, such as alcoholic cirrhosis and mushroom poisoning. It is still unclear whether it will offer protection against viral hepatitis and various nephrotoxic agents. 

A 68-year-old man with alcoholic cirrhosis and small esophageal varices (degree of severity classified as Child 1) started bleeding after taking sildenafil 25 mg for the first time (28). 

Six of 12 females with normal renal function experienced at least a 10% decrease in GFR following a 3-day course of indomethacin (25 mg four times daily) (p<0.05). When misoprostol was added, four of these six NSAID-sensitive patients experienced no change in GFR. Misoprostol also blunted indomethacin-induced decreases in creatinine clearance and natriuresis in another at-risk group, patients with alcoholic cirrhosis and ascites [181]. 

There is no question that alcohol abuse contributes significantly to liver-related morbidity and mortality in the United States. Long-term alcohol use is the leading cause of illness and death from liver disease. There are three phases of alcohol-induced liver damage, alcoholic fatty liver, which is usually reversible with abstinence alcoholic hepatitis or inflammation and alcoholic cirrhosis or scarring of the liver. Patients with both alcoholic cirrhosis and hepatitis have a death rate of more than 60% over a 4-year period. The prognosis is bleaker than the outlook for many types of cancers. As many as 900 000 people in the United States suffer from cirrhosis and some 26 000 of these die each year. The risk for liver disease is related to how much a person drinks the risk is low at levels of alcohol consumption but steeply increases with higher levels of consumption. Because effects of alcohol are dose-related and because of the steepness at which the adverse effects are... 

Vertemati M, Minola E, Goffredi M, et al. Computerized morphometry of the cirrhotic liver comparative analysis in primary biliary cirrhosis, alcoholic cirrhosis, and posthepatitic cirrhosis. Microsc Res Tech. 2004 65 113-121. 

Hrubec Z Omenn GS (1981) Evidence of genetic predisposition to alcoholic cirrhosis and psychosis twin concordances for alcoholism and its biological end points by zygosity among male veterans. Alcohol Clin Exp Res, 5 207-215. 

The residues were dissolved in concentrated nitric acid (0.25 mL, Aristar grade), the voiume was made to 10 mL with water and the zinc and magnesium content measured by flame MS. Liver samples were obtained from patients with alcoholic cirrhosis and from patients undergoing elective surgery who formed a control group. 

Saadatmand F, Stinson FS, Grant FB, et al Liver cirrhosis mortality in the United States, 1970-94 (Surveillance Report No 45). Rockville, MD, National Institute on Alcohol Abuse and Alcoholism, 1997... 

Johansson, V., Johnsson, F., Joelsson, B., Beiglund, M. and Akesson, B. (1986). Selenium status in patients with liver cirrhosis and alcoholism. Br. J. Nutr. 55, 227-233. 

Progression of alcoholic liver disease moves through several distinct phases from development of fatty liver to the development of alcoholic hepatitis and cirrhosis. Fatty liver and alcoholic hepatitis may be reversible with cessation of alcohol intake, but cirrhosis itself is irreversible. Although the scarring of cirrhosis is permanent, maintaining abstinence from alcohol can still decrease complications and slow development to end-stage liver disease.22 Continuing to imbibe speeds the advancement of liver dysfunction and its complications. 

Non-cholestatic cirrhosis (e.g., alcoholic cirrhosis, postnecrotic cirrhosis, and drug-induced cirrhosis)... 

ALAD, an enzyme occurring early in the heme pathway, is also considered a sensitive indicator of lead effect (Hemberg et al. 1970 Morris et al. 1988 Somashekaraiah et al. 1990 Tola et al. 1973). Because there is no well-defined blood lead threshold at which inhibition of ALAD does not occur, it allows measurement of the effect on the general population at environmental lead levels and does not require high exposure levels as with occupational workers (Hemberg et al. 1970). However, ALAD activity may also be decreased with other diseases or conditions such as porphyria, liver cirrhosis, and alcoholism (Somashekaraiah et al. 1990). 

The problems of alcohol dependence and alcoholism are dealt with in Chapter 10. Suffice it to say here that problem drinkers risk numerous psychological problems, such as anxiety and depression, and may experience physical withdrawal symptoms. There are also numerous medical problems related to heavy, chronic alcohol consumption these include increased risk of coronary heart disease, liver cirrhosis, impotence and infertility, cancer and stroke (Chapter 10). It is estimated that alcohol plays a part in up to 33,000 deaths per year in the UK (DoH, 2001). Within the last year 1 in 4 adults will have experienced loss of memory following an alcoholic binge, injured themselves or... 

Cirrhosis A liver disease commonly associated with chronic alcohol misuse and characterised by the replacement of once-healthy hepatocytes with abnormal connective tissue. 

Yamauchi M, Maezawa Y, Mizuhara Y et al. Polymorphisms in alcohol metabolizing enzyme genes and alcoholic cirrhosis in Japanese patients. Hepatology 1995 22 1136-1142. 

Cirrhosis has many causes (Table 21-1). In the United States, excessive alcohol intake and chronic viral hepatitis (types B and C) are the most common causes. 

Lp(a) is synthesized mainly, probably only, in the liver. This is supported by the fact that patients with hepatic dysfunction due to cirrhosis and alcoholic hepatitis exhibit low plasma Lp(a) concentrations (F6, G22, U10). 

Theophylline is a narrow therapeutic index drug with significant difference in bioavailability following oral administration. The half-life of the drug is increased by heart failure, cirrhosis and viral infections, in elderly patients, and by certain drugs, such as cimetidine, ciprofloxacin, oral contraceptives and fluvoxamine. The half-life is decreased in smokers, chronic alcoholism, and by certain drugs, such as phenytoin, rifampicin and carbamazepine. 

There are major consequences of alcoholism, from child abuse to domestic or public violence to traffic accidents and from cirrhosis to hypertension. Mean life expectancy of alcohol abusers is around 55 years. Alcohol seems involved in several hundred thousand deaths each year in Europe, with considerable added social and health care costs. This is in clear contrast with the little attention paid to the treatment of alcohol dependence and abuse. It is important to note that there is an increasing knowledge of similar effects on driving etc. from other psychoactive substances, particularly from the seda-tive/tranquillizer drugs and antihistamines. 

Acute fresh bleeding from the upper gastrointestinal tract is a mandatory cause of hospital referral. About half of all cases are due to peptic ulceration, and variceal bleeding accounts for a varying, but generally minor component of the remainder depending on the frequency of alcoholic cirrhosis or of hepatitis B-induced cirrhosis in the population. 

Except for one case/° recent clinically oriented MRS studies of human liver have been at 1.5T. Several studies applied in vivo MRS to diffuse liver disease. ° °" The PDE intensity was lower in cirrhosis than in controls ° and served to distinguish the alcoholic, viral, and cholestatic etiologies of diffuse liver disease. ° However, there was no difference between patients with non-alcoholic fatty liver disease (NAFLD) and controls. Sharma et al., using the relative PME intensity as a measure of altered gluconeogenesis (this peak can contain glucose-6-P and 3-phos-phoglycerate in addition to PC and PE), found that hepatic gluconeogenesis was altered in both obese and non-obese Asian Indians with NAFLD, relative to non-obese subjects without NAFLD. 

Liver disease is the most common medical complication of alcohol abuse an estimated 15-30% of chronic heavy drinkers eventually develop severe liver disease. Alcoholic fatty liver, a reversible condition, may progress to alcoholic hepatitis and finally to cirrhosis and liver failure. In the United States, chronic alcohol abuse is the leading cause of liver cirrhosis and of the need for liver transplantation. The risk of developing liver disease is related both to the average amount of daily consumption and to the duration of alcohol abuse. Women appear to be more susceptible to alcohol hepatotoxicity than men. Concurrent infection with hepatitis or C virus increases the risk of severe liver disease. 

II years of treatment without metastasis he was switched to treatment with an LH-RH analogue, which was regarded as safer, but at this time his liver function tests were found to be seriously deranged. Biopsy showed established cirrhosis with steatohepati-tis. He had no history of excessive alcohol intake, and it seemed likely that the diethylstilbestrol was the cause of the liver disorder. 

However, in a double-blind study in 100 patients with compensated non-alcoholic liver cirrhosis and type 2 diabetes, acarbose for 28 weeks did not alter liver function (64). The number of hypoglycemic episodes was reduced. 

Milk thistle has been used to treat acute and chronic viral hepatitis, alcoholic liver disease, and toxin-induced liver injury in human patients. Milk thistle has most often been studied in the treatment of alcoholic hepatitis and cirrhosis. In both of these disorders, outcomes have been mixed and reports include significant reductions in markers of liver dysfunction and in mortality, as well as no effect. In acute viral hepatitis, studies have generally involved small sample sizes and have shown mixed outcomes of improved liver function (eg, aminotransferase values, bilirubin, prothrombin time) or no effect. Studies in chronic viral hepatitis and toxin-induced injury have also been of small size but have reported mostly favorable results. Parenteral silybin is marketed and used in Europe as an antidote in Amanitaphalloides mushroom poisoning, based on favorable outcomes reported in case-control studies. 

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