Liver assessment

Routine liver assessment tests include alkaline phosphatase, bilirubin, aspartate transaminase, alanine transaminase, and y-glutamyl transpeptidase (GGT). Additional markers of hepatic synthetic activity include albumin and prothrombin time. The substances are typically elevated in chronic inflammatory liver diseases such as hepatitis C, but may be normal in others with resolved infectious processes. 

Powell H, Kitteringham NR, Pirmohamed M, et al. Expression of cytochrome P4502E1 (CYP2E1) in human liver assessment of mRNA, genotype and phenotype. Pharmacogenetics 1998 8 411 -21. 

Milsom, J.W., Jerby, B.L., Kessler, H., Hale, J.C., Herts, B.R., O Malley, C.M. Prospective blinded comparison of laparoscopic ultrasonography vs. contrast-enhanced computerized tomography for liver assessment in patients undergoing colorectal carcinoma surgery. Dis. Colon Rect. 2000 43 44-49... 

Powell, H., N.R. Kitteringham, M. Pirmohamed, D.A. Smith, and B.K. Park (1998). Expression of cytochrome P4502E1 in human liver Assessment by mRNA, genotype and phenotype. Pharmacogenetics 8, 411-421. 

Kamel IR, Bluemke DA (2002) Magnetic resonance imaging of the liver assessing response to treatment. Top Magn Reson Imaging 13 191-200... 

Soyer P, Dufresne AC, Somveille E, Scherrer A (1996b) Focal nodular hyperplasia of the liver assessment of hemodynamic and angioarchitectural patterns with gadolinium chelate-enhanced 3D spoiled gradient-recalled MRI and maximum intensity projection reformatted images. JCAT 20 898-904... 

When administering acetaminophen, the nurse assesses the overall health and alcohol usage of the patient before administration. fatients who are malnourished or abuse alcohol are at risk of developing hepatotoxicity (damage to the liver) with the use of acetaminophen. 

ASSESSMENT OF THE HOSPITALIZED PATIENT The hospitalized patient receiving a female hormone requires careful monitoring. The nurse takes the vital signs daily or more often, depending on the patient s physical condition and the reason for drug use. The nurse observes the patient for adverse drug reactions, especially those related to the liver (the development of jaundice) or the cardiovascular system (thromboembolism). The nurse weighs the patient weekly or as ordered by the primary health care provider. The nurse... 

FAT EMULSIONS. When a fat emulsion is administered, the nurse must monitor the patient s ability to eliminate the infused fat from the circulation. The lipidemia must clear between daily infusions. The nurse monitors for lipidemia through assessing the result of the following laboratory exams hemogram, blood coagulation, liver function tests, plasma lipid profile, and platelet count. The nurse reports an increase in any of these laboratory examinations as abnormal. 

HBD is a biochemical rather than electrophoretic assessment of the LD isoenzyme which is associated with heart. All five isoenzymes of LD exhibit some activity toward cx-hydroxy-butyrate as substrate, but heart LD shows the greatest activity. Serum HBD measurement is not as valuable as the electrophoretic determination of heart LD isoenzyme. High HBD activity has also been found in diseases of the liver. Rises associated with the hepatic effects of congestive heart failure can be disconcerting in the differential diagnosis of myocardial infarction. Wilkinson has used the serum HBD/LD ratio for the differentiation of myocardial disease from other disorders in which HBD activity is elevated, whereas Rosalki has not found the ratio to be helpful (39). 

To assess bioaccumulation in the environment, the levels of trichloroethylene in the tissues of a wide range of organisms were determined (Pearson and McConnell 1975). Species were chosen to represent several trophic levels in the marine environment. The maximum overall increase in concentration between sea water and the tissues of animals at the top of food chains, such as fish liver, sea bird eggs, and sea seal blubber, was less... 

Reynolds SH, Stowers SJ, Patterson RM, et al. 1987. Activated oncogenes in B6C3F, mouse liver tumors Implications for risk assessment. Science 237 1309-1316. 

Burger J, Lord CG, Yurkow EJ, McGrath L, Gaines KF, Brisbin Jr IL, Gochfeld M. 2000b. Metals and metallothionein in the liver of raccoons utility for environmental assessment and monitoring. J Toxicol Environ Health A 60 243-261. 

The matrices to be validated depend on the target/purpose of the study, e.g., blood, urine, muscle, or liver. The latter two may be covered by methods developed for food of animal origin. The method must take into account all relevant compounds used in the assessment of risk to consumers/operators or bystanders. The required LOQ... 

The figures that follow provide examples of some ways in which in vitro clearance data for two series can be compared and assessed to identify key questions, trends, or hypotheses. While the data presented here are for clearance in a human liver microsomal (HLM) incubation, the analysis could be applied in the same way to other data sets - including other experimental ADME or safety end points, or computationally predicted end points. 

Monitor for adequate perfusion of vital organs through assessment of mental status, creatinine clearance, liver function tests, and a stable HR between 50 and 100 beats per minute. Additionally, adequate skin and muscle blood perfusion and normal pH is desirable. 

Ammonia (NH3) is just one of the toxins implicated in HE. It is a metabolic by-product of protein catabolism and is also generated by bacteria in the GI tract. In a normally functioning liver, hepatocytes take up ammonia and degrade it to form urea, which is then renally excreted. In patients with cirrhosis, the conversion of ammonia to urea is retarded and ammonia accumulates, resulting in encephalopathy. This decrease in urea formation is manifest on laboratory assessment as decreased blood urea nitrogen (BUN), but BUN levels do not correlate with degree of HE. Patients with HE commonly have elevated serum ammonia concentrations, but the levels do not correlate well with the degree of central nervous system impairment.20... 

Diagnosing viral hepatitis may be difficult because most infected individuals are asymptomatic. Because symptoms cannot identify the specific type of hepatitis, laboratory serologies must be obtained (Table 21-2). In addition, liver function tests may be obtained to assess the extent of cholestatic and hepatocellular injury. However, the definitive test to determine the amount of damage and inflammation of hepatic cells is a liver biopsy. 

In patients with a history of AED use, a baseline serum concentration may be useful to determine if the drug concentration is below the desired range and if a loading dose is needed. Albumin levels, renal function tests, and liver function tests can also be helpful when assessing antiepileptic therapy. 

It is important to carefully document core ADHD symptoms at baseline to provide a reference point from which to evaluate effectiveness of treatment. Improvement in individualized patient outcomes are desired, such as (1) family and social relationships, (2) disruptive behavior, (3) completing required tasks, (4) self-motivation, (5) appearance, and (6) self-esteem. It is very important to elicit evaluations of the patient s behavior from family, school, and social environments in order to assess the preceding. Using standardized rating scales (e.g., Conners Rating Scales-Revised, Brown Attention-Deficit Disorder Scale, and IOWA Conners Scale) in both children and adults with ADHD helps to minimize variability in evaluation.29 After initiation of therapy, evaluations should be done every 2 to 4 weeks to determine efficacy of treatment, height, weight, pulse, and blood pressure. Physical examination or liver function tests may be used to monitor for adverse effects. 

Prothrombin time PT is performed by adding thromboplastin (tissue) factor and calcium to citrate-anticoagulated plasma, recalcifying the plasma, and measuring the clotting time. The major utility of PT is to measure the activity of the vitamin K-dependent factors II, VII, and X. The PT is used in evaluation of liver disease, to monitor warfarin anticoagulant effect, and to assess vitamin K deficiency. 

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