Cirrhosis evaluation

Dlnis-Rlbeiro, M., Cortez-Pinto, H., Marlnho, R., Valente, A., Ral-mundo, M., Salgado, M.J., Ramalho, F., Alexandrlno, P., Carnelro-de-Moura, M. Spontaneous bacterial peritonitis in patients with hepatic cirrhosis evaluation of a treatment protocol at specialized units. Rev. Espan. Enferm. Dig. 2002 94 478-481... 

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... 

Matsuoka, C., Tanaka, N., Arakawa, Y. Beneficial effects of branched-chain amino acids on altered protein and amino acid metabolism in liver cirrhosis Evaluation in a model of liver cirrhosis induced in rats with carbon tetrachloride. Hepatol. Res. 2003 27 117-123... 

Salerno, F., rroni, G., Moser, R, Sangiovanni, A., Almasio, R, Budil-Ion, G., Capuano, G., Muraca, M., Marchesini, G., Bern di, M., Mar-enco, G., Molino, G., Ross o, L., Solinas, A., Asdone, A. Prognostic value of the galactose test in predicting survival of patients with cirrhosis evaluated for Hver transplantation. J. Hepatol. 1996 25 474-480... 

Caturelli E et al. (2000) Transcatheter arterial chemoemboliza-tion for hepatocellular carcinoma in patients with cirrhosis evaluation of damage to nontumorous liver tissue-longterm prospective study. Radiology 215 123-128 Cauldwell EW et al. (1948) The bronchial arteries. An anatomic study of 150 human cadavers. Surg Gynecol Obstet 86 395 Charnsangavej C (1993) Chemoembolization of liver tumors. 

Ultrasound examination is used routinely to evaluate cirrhosis a small, nodular liver with increased echogenicity is consistent with cirrhosis. Liver biopsy is the only way to diagnose cirrhosis definitively, but it is often deferred in lieu of a... 

Some toxic effects are reversible. Everyone has been exposed to some agent, household ammonia for example, that produces irritation to the skin or eyes. Exposure ends and, sometimes perhaps with a delay, the irritation ends. Some readers have no doubt been poisoned on occasion by the ingestion of too much alcohol. The effects here also reverse. The time necessary for reversal can vary greatly depending upon the severity of the intoxication and certain physiological features of the person intoxicated. But most people also realize that chronic alcohol abuse can lead to a serious liver disorder, cirrhosis, which may not reverse even if alcohol intake ceases. This type of effect is irreversible or only very slowly reversible. It is important in making a toxicological evaluation to understand whether effects are reversible or irreversible, because one is obviously much more serious than the other. 

Premenopausal use There is no indication for premenopausal use of raloxifene. Hepatic function impairment Raloxifene was studied, as a single dose, in Child-Pugh class A patients with cirrhosis and serum total bilirubin ranging from 0.6 to 2 mg/dL. Plasma raloxifene concentrations were approximately 2.5 times higher than in controls and correlated with total bilirubin concentrations. Safety and efficacy have not been evaluated further in patients with severe hepatic insufficiency. Carcinogenesis In long term carcinogenicity studies in animals there was an increased incidence of ovarian tumors, testicular interstitial cell tumors, and prostatic adenocarcinomas. 

Evaluate liver function tests at the start of and during the course of voriconazole therapy. Monitor patients who develop abnormal liver function tests during voriconazole therapy for the development of more severe hepatic injury. Discontinuation of voriconazole must be considered if clinical signs and symptoms consistent with liver disease develop that may be attributable to voriconazole. Hepatic function impairment It is recommended that the standard loading dose regimens be used but that the maintenance dose be halved in patients with mild to moderate hepatic cirrhosis (Child-Pugh class A and B) receiving voriconazole. 

To evaluate the efficacy of postoperative treatment in combination with HBO, assessment of the levels of 4-AAP and N-ac-4AAP in urine is recommended. This is a reliable method of assessing the liver detoxihcation function in patients with liver cirrhosis. 

A small historical study evaluated the effect of DMPA on six patients with either chronic active viral hepatitis or primary biliary cirrhosis. The study showed that DMPA actually improved transaminase levels and the metabolic ability of the liver. The investigators suggested that the immune-modifying properties of medroxyprogesterone may make the hormone a therapeutic alternative [2]. There were limitations in that this was a very small, non-randomised study, and therefore it is difficult to make specific recommendations based on the outcome. Another study of the metabolic effects of DMPA in women who had used the method for five years or more suggested that there was a significant rise in plasma insulin, alkaline phosphatase and morning cortisol levels in the DMPA users [31]. 

Papadakis MA, Arieff AI. Unpredictability of clinical evaluation of renal function in cirrhosis Prospective study. Am J Med 1987 82 945-52. 

Urbain, D., Muls, V., Thys, O., Ham, H.R. Aminopyrine breath test improver long-term prognostic evaluation in patients with alcoholic cirrhosis in Child class A and B. J. Hepatol. 1995 22 179-183... 

Borzlo, M., Borzlo, F., Macchl, R., Croce, A.M., Bruno, S., Ferrari, A., Servida, E. The evaluation of fine-needle procedures for the diagnosis of focal hver lesions in cirrhosis. J. Hepatol. 1994 20 117—121... 

Finned, G., Bellon, S., Merkel, C., Mormino, P, Tirelli, M., Gatta, A., Zuin, R. Evaluation of splanchnic angiography as a prognostic index of survival in patients with cirrhosis. Scand. J. Gastroenterol. 1991 26 951-960... 

Following the administration of 100-200 MBq Tc-sulphur colloid intravenously, liver cirrhosis is characterized by a reduction in the uptake of radioactivity in the liver and an increased uptake by the spleen and bone marrow. Colloidal uptake in the liver is thus a valuable parameter for assessing any functional loss of the hepatic RES and for evaluating the residual parenchyma which is still functioning. It should be noted that the phagocytic capacity of the hepatic RES is closely related to the sinusoidal blood flow, the reduction of which is a result of the development of collaterals in the area of the hepatic... 

Tc-DTPA Arterial perfusion accounts for 20%-40% of the circulation in portal hypertension, cirrhosis causes arterial perfusion to increase to over 60%. In portal vein thrombosis, only an arterial curve is visible. Liver metastasis usually displays relatively high arterial perfusion. In (rare) occlusions of the hepatic artery, only a portal venous curve is visible. When a bolus injection of 400 MBq "Tc-diethylenetriamine pentaacetic acid (DTPA) is applied, scintigraphy is able to reveal a bi-phasic time-activity curve. The initial increase of activity is produced by the arterial influence and the second peak by the portal venous inflow. Both curves can be evaluated quantitatively. (36) Perfusion scintigraphy may be useful in the case of liver trauma, TIPS, hyper-vascularized hepatic tumours and partial liver resection as well as after liver transplantation. 

Mehndiratta, M.M., Sood, G.K., Sarin, S.K., Gupta, M. Comparative evaluation of visual, somatosensory, and auditory evoked potentials in the detection of subclinical hepatic encephalopathy in patients with nonalcoholic cirrhosis. Amer. J. Gastroenterol. 1990 85 799-803... 

Watanabe, A., Tuchida, T., Yata, Y., Kuwabara, J. Evaluation of neuropsychological function in patients with liver cirrhosis with special reference to their driving ability. Metab. Brain Dis. 1995 10 239-248... 

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