Chronic hepatitis and cirrhosis

Cucumis melo L. Gua Di (Cantaloupe) (pedicel) Melotoxin, cucurbitacin B, cucurbitacin E, sterol33351 Produce vomiting for drug intoxication, treat toxic and chronic hepatitis and cirrhosis of the liver. 

The hepatitis D virus, also known as the Delta virus, is replication defective in humans it can only replicate in the presence of HBV, and is acquired in the same way. Infection may occur at the same time as the hepatitis B infection (co-infection) or an individual infected with hepatitis B may acquire hepatitis D at a later date (superinfection). The combination of hepatitis B with hepatitis D significantly increases the risk of progression to chronic hepatitis and cirrhosis. 

Shiffman, M.L., Luketic, V.A., Sanyal, A.J., Duckworth, P.F., Purdum, RR, Contas, M.J., Scott Mills, A., Edinboro, L.E., PokUs, A. Hepatic lidocaine metabolism and liver histology in patients with chronic hepatitis and cirrhosis. Hepatology 1994 19 933-940... 

In genetically (autosomal dominant) induced ai-anti-chymotrypsin deficiency, this inhibitor of serine proteases is not secreted in sufficient quantities from the hepatocytes or alveolar macrophages. Therefore tti-antichymotrypsin is stored in these cells. The deposits can be detected as cellular inclusions by light microscopy. Patients suffering from this condition may develop chronic hepatitis and cirrhosis. (157-159)... 

Marti-Bonmati, L., Talens, A., del Olmo, X, del Val. A., Serra, M., Rodrigo, XM., Fernandez, A., Torres, V., Rayon, M. Chronic hepatitis and cirrhosis. Evaluation by means of MR imaging with histological correlation. Radiology 1993 188 37-43... 

Since HCC is prevalent in a certain population (such as those with chronic hepatitis and cirrhosis), and geographical region of the world (Fig. 

Sailer R et al The use of silymarin In the treatment of liver diseases. Drugs 2001 61(14) 2035-2063. [PMID 11735632] (Review Of the literature on the efficacy and safety of silymarin tor treatment of chronic hepatitis and cirrhosis.)... 

Depending on referral patterns the proportion of patients presenting with liver disease alone varies from 20 to 46%. Liver disease may mimic any forms of common liver conditions, ranging from asymptomatic transaminasania to acute hepatitis, fulminant hepatic failure (about one out of six patients with hepatic presentation), chronic hepatitis, and cirrhosis (about one out of three patients) with all of its complications. 

A commercial name hypatin of total flavonoid extract from Hypericum patulum Thunb. ex Murray had the hepatoprotective effect, antioxidant and the inhibitory effect against the progression of chronic hepatitis and cirrhosis induced by intravenous injection and subcutaneous administration of carbon tetrachloride (CCI4) for prolonged period in mice. 

HBV infection remains a major worldwide public health problem. The World Health Organization estimates that there are still 350 million chronic carriers of the vims, who are at risk of developing chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. The success of IFN-a treatment - mainly performed as combined treatment with adenine-arabinoside - has been measured by the normalization of liver enzymes, loss of HBe antigen and of detectable viral DNA in the serum of patients. It has been estimated from several clinical trials that as many as 40% of treated HBV patients would respond to therapy with IFN-a or combined treatment with nucleoside analogues and IFN-a. 

Ben Yahia M, Mavier P, Metreau JM, et al. Chronic active hepatitis and cirrhosis induced by wild germander. 3 cases. Gastroenterol Clini Biol 17(12) 959—962, 1993. 

Hepatic - Methotrexate has the potential for acute (elevated transaminases) and chronic (fibrosis and cirrhosis) hepatotoxicity. Chronic toxicity is potentially fatal it generally occurs after prolonged use (generally 2 years or more) and after a total dose of at least 1.5 g. 

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. 

UGT activity is modulated by various hormones. Excess thyroid hormone and ethinyl oestradiol (but not other oral contraceptives) inhibit bilirubin glucuronidation. In contrast, the combination of progestational and oestrogenic steroids results in increased enzyme activity. Bihrubin glucuronidation can also be inhibited by certain antibiotics (e.g. novobiocin or gentamicin, at serum concentrations exceeding therapeutic levels) and by chronic hepatitis, advanced cirrhosis and Wilson s disease. 

Approximately 3-10% of patients with inflammatory bowel disease have some degree of liver abnormality. The spectrum of liver dysfnnction associated with inflammatory bowel disease ranges from fatty changes to pericholangitis, sclerosing cholangitis, chronic active hepatitis and cirrhosis. Ulcerative colitis is more commonly associated with liver abnormality than Crohn s disease. 

It is less likely in other forms of liver disease, such as acute hepatitis and cirrhosis. Cirrhosis may actually protect against atherosclerosis [5, 8, 9]. The reasons for this are not clear. Secondary hypercholesterolaemia frequently occurs in cholestatic conditions, but usually does not require treatment [10]. Other risk factors for hyperlipidaemia and cardiovascular disease should be assessed, as their presence may independently indicate a need for medical intervention [9]. In PBC, patients with severe, chronic disease do not appear to have an increased cardiovascular risk as a result of their hypercholesterolaemia this may be due to the presence of cirrhosis. In contrast, in less severe PBC... 

The concentration of acid mucopolysaccharides in serum, and their excretion in urine, are increased in patients with rheumatoid arthritis (D7), lupus erythematosus (D6), diabetes (C7), and leukemia (R2, SIO) and other malignant diseases (R2). The daily urinary excretion of acid mucopolysaccharides was within the normal range in cases of acute hepatitis, but was usually increased in chronic hepatitis and in florid cirrhosis (K5). A decrease in the amount of acid mucopolysaccharides excreted was found in primary hepatoma, whereas in most cases of obstructive jaundice the amount was markedly increased (K5). 

In acute viral hepatitis C, the HCV RNA usually clears from the serum once the infection is over — although the anti-HCV test remains positive for a long time after this. However, the combination of increased GPT and a positive anti-HCV test of the first generation nearly always points to infectious HCV. Subsequent to the EIA test, 95% of the positive sera demonstrated cRNA by PCR, so that infectivity could be confirmed. Eor this reason, neither anti-HCV-positive blood donors nor blood units can be released for transfusion. As a check for hepatitis B-negative patients with liver cell carcinoma, the EIA test displayed positivity in 83% of cases. In patients with aetiologically unresolved cirrhosis, the EIA test was positive in 62% of cases, i. e. a large number of the cryptogenic chronic cases of hepatitis and cirrhosis were probably caused by HCV infection. 

The morphological spectrum may therefore range from steatosis, acute hepatitis, fulminant course, chronic hepatitis, aggressive episodes in chronic hepatitis and liver fibrosis through to micronodular cirrhosis. Complete cirrhosis can already exist in children aged 4-5 years. The development of hepatocellular carcinoma is extremely rare (360) it is assumed that copper has a protective effect against malignant transformation. (391,393)... 

Tab. 34.1 Schematized morphological classification of chronic hepatitis and its potential to develop into fibrosis and cirrhosis...

The availability of the hepatitis C antibody test has also emphasized the relation between chronic hepatitis C, liver cirrhosis, and hepatocellular carcinoma in Japan, 58 patients with chronic hepatitis C were followed for 7 years 10 of them developed hepatocellular carcinoma, 14 developed cirrhosis, 30 continued with chronic hepatitis, and in 4 there was improvement of their hepatitis (172). 

Hepatitis delta When they occur with any frequency, hepatitis delta infections pose a problem, since the hepatitis tends to be more severe than hepatitis B infection alone and is more likely to progress to chronic hepatitis. Hepatitis delta virus is a defective RNA virus that can replicate only in the presence of hepatitis B virus. It has a unique hybrid structure consisting of a delta inner core encapsulated by the surface antigen of hepatitis B virus. Delta superinfection can transform asjmptomatic or mild chronic hepatitis B infection to severe progressive active hepatitis and cirrhosis, and contributes substantially to fulminant hepatitis B (173,174). 

Sho-saiko-to is a so-called kampo medicine, a mixture of herbs, including Chinese date, ginger root, and licorice root. It is reportedly contraindicated in patients taking interferons, patients with liver cirrhosis or hepatoma, and patients with chronic hepatitis and a platelet count of 100 X 10 /1 (http //www.kamponews.com). Sho-saiko-to has repeatedly been imphcated in interstitial or eosinophihc pneumonias. 

Scientific reports address a risk of liver and renal dysfunction. Hepatic failure, hepatitis, and cirrhosis have been reported with chronic use. The most common side effect from chronic, large doses of kava is a scaly skin rash called kava dermopathy. 

Hepatocellutar Disease. Most forms of acute or chronic hepatocellular disease, including acute viral hepatitis and cirrhosis with jaundice, are associated with decreased levels of Hp, possibly caused in part by altered estrogen metabolism. Increased red cell breakdown secondary to erythrocyte membrane lipid alterations may also play a role, although this has never been documented with turnover studies. In contrast, biliary obstruction is also associated with significant lipid alterations but with increased Hp levels, in the absence of severe hepatocellular disease. 

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