Cirrhosis liver function tests

When used for detoxification, phenobarbital is given in equal doses four times a day. The maximum daily dose of phenobarbital is 600 mg, but much lower doses are usually sufficient. The phenobarbital dose is lowered (i.e., tapered) by about 20% per day. If the patient is too drowsy, then a dose should be skipped. If breakthrough withdrawal symptoms continue to occur, then the pace of the detoxification should be slowed. Before using phenobarbital, liver function tests should be obtained. All barbiturates depend greatly on the liver to be metabolized. Alcoholics with cirrhosis or other forms of liver impairment may have difficulty clearing phenobarbital. Phenobarbital should not be used in patients with poor liver function. In addition, the barbiturates can worsen a medical condition known as porphyria and should be avoided in those with this disorder. Phenobarbital, as noted, is seldom used today for alcohol detoxification. 

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. 

Liver Methotrexate causes hepatotoxicity, fibrosis, and cirrhosis, but generally only after prolonged use. Acutely, liver enzyme elevations are frequent, usually transient and asymptomatic, and also do not appear predictive of subsequent hepatic disease. Liver biopsy after sustained use often shows histologic changes, and fibrosis and cirrhosis have occurred these latter lesions often are not preceded by symptoms or abnormal liver function tests (see Precautions). For this reason, periodic liver biopsies are usually recommended for psoriatic patients who are under long-term treatment. Persistent abnormalities in liver function tests may precede appearance of fibrosis or cirrhosis in the RA population. 

RA In RA, first use of methotrexate and duration of therapy have been reported as risk factors for hepatotoxicity. Persistent abnormalities in liver function tests may precede appearance of fibrosis or cirrhosis in this population. 

Nausea and mucosal ulcers are the most common toxicities. Progressive dose-related hepatotoxicity in the form of enzyme elevation occurs frequently, but cirrhosis is rare (< 1%). Liver toxicity is not related to serum methotrexate concentrations, and liver biopsy follow-up is only recommended every 5 years. A rare hypersensitivity-like lung reaction with acute shortness of breath is documented, as are pseudolymphomatous reactions. The incidence of gastrointestinal and liver function test abnormalities can be reduced by the use of leucovorin 24 hours after each weekly dose or by the use of daily folic acid, although this may decrease the efficacy of the methotrexate. This drug is contraindicated in pregnancy. 

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. 

Daily administration of colchicine is useful for the prevention of attacks of familial Mediterranean fever (familial paroxysmal polyserositis) and for prevention and treatment of amyloidosis in such patients. Colchicine appears to benefit patients with primary biliary cirrhosis in terms of improvement of liver function tests and perhaps of survival. Colchicine also has been employed to treat a variety of skin disorders, including psoriasis and Behcet s syndrome. 

Diagnosis of alcoholic cirrhosis of the liver was made based on Mrs MW s clinical features, liver function tests, abdominal ultrasound, CT scan and liver biopsy. 

This occurs typically in alcoholic steatosis. Macrovesicular steatosis has less effect on the function of the hepatocyte and liver function tests are usually only minimally abnormal. The accumulation of fat within the hepatocyte may trigger an inflammatory response this inflammation within the hepatocyte, or hepatitis related to steatosis, is termed steatohepatitis. Continued inflammatory responses further damage hepatocytes, and the liver disease may then progress to fibrosis and cirrhosis. 

Shresta, R., McKinley, C., Showalter, R., Wilner, K., Marsano, L., Vivian, B.R., Everson, G.T. Quantitative liver function tests define the functional severity of liver disease in early stage cirrhosis. Liver Transplant. Surg. 1997 3 166-173... 

Parenchjmal hver damage can occur in patients taking tiabendazole and abnormal liver function tests have been documented (9). There have been well-studied cases of bile duct injury, which can lead to micronodular cirrhosis (10), and a case in which these various forms of liver disorder co-existed and hver transplantation proved necessary (11). 

Liver damage due to vitamin A is not always irreversible one patient, after prolonged intake of excessive amounts of vitamin A for treatment of psoriasis (90 000 micrograms RE/day), had not only reversible chronic intoxication, but reversible portal hypertension and deranged liver function tests without any histological signs of cirrhosis (44). In a similar case, portal hypertension disappeared after 6 months on a low vitamin A diet. The fact that there was no reduction in Ito cells either in size or number suggests that lipid venous obstruction is unlikely to be the only mechanism responsible for portal hypertension in vitamin A-induced liver disease (45). 

The use of liver function tests in the diagnosis and management of cirrhosis is discussed in the following sections. It may be useful to group the tests into two broad categories markers of hepatocyte damage such as the transaminases and markers of hepatocellular synthetic function, prothrombin time and albumin. 

Elevated liver enzymes may occur in up to 15% of patients cirrhosis is rare. Liver function tests, aspartate aminotransferase (AST) or alanine aminotransferase (ALT), should be performed periodically. Methotrexate should be discontinued if these test values show sustained results greater than twice the upper limits of normal. Serum albumin levels also should be checked periodically, as signs of liver toxicity in some patients may not have liver inflammation manifested by AST or ALT elevation. Liver biopsy is now recommended before beginning methotrexate therapy only for patients with a history of excessive alcohol use, ongoing hepatitis B or C infection, or recurring elevation of AST. Biopsies during methotrexate therapy are recommended only for patients who develop consistently abnormal liver function tests. ... 

Z2. Zieve, L., and Hill, E., An evaluation of factors influencing the discriminative effectiveness of a group of liver function tests. III. Relative effectiveness of hepatic tests in cirrhosis. Gastroenterology 28, 785-802 (1955). 

Cll. Cates, H. B., Relation of liver function to cirrhosis of the liver and to alcoholism. Comparison of results of liver function test with degree of organic change in cirrhosis of liver and with results of such tests in persons with alcoholism but without cirrhosis of liver. A.M. A. Arch. Internal Med. 67, 383-398 (1941). 

WIO. Welin, G., Needle biopsy and liver function tests in acute hepatitis and cirrhosis of the liver. Acta Med. Scand. Suppl, 268, 1 (1952). 

Diphenoxylate is an opiate (schedule V) with antidiarrheal properties. It is usually dispensed with atropine and sold as Lomotil. The atropine is added to discourage the abuse of diphenoxylate by narcotic addicts who are tolerant to massive doses of narcotic but not to the CNS stimulant effects of atropine. Diphenoxylate shonld be used cautiously in patients with obstructive jaundice because of its potential for hepatic coma, and in patients with diarrhea cansed by pseudomembranous colitis because of its potential for toxic megacolon. In addition, it should be used cautiously in the treatment of diarrhea caused by poisoning or by infection by Shigella, Salmonella, and some strains of E. coli because expulsion of intestinal contents may be a protective mechanism. Diphenoxylate should be used with extreme caution in patients with impaired hepatic function, cirrhosis, advanced hepatorenal disease, or abnormal liver function test results, because the drug may precipitate hepatic coma. Because diphenoxylate is structurally related to meperidine, it may cause hypertension when combined with monoamine oxidase inhibitors. As a narcotic, it will augment the CNS depressant effects of alcohol, hypnotic-sedatives, and numerous other drugs, such as neuroleptics or antidepressants that cause sedation. 

Kaneko, H., Y. Otsuka, M. Katagiri, T. Maeda, M. Tsuchiya, A. Tamura, T. Ishii, S. Takagi, and T. Shiba. 2001. Reassessment of monoethylglycinexybdide as preoperative liver function test in a rat model of liver cirrhosis and man. Clinical and Experimental Medicine 1 19-26. 

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