Liver Cardiac insufficiency

Most of the herbal drugs that are used medicinally are comprised in these five groups of indications. Relative few are employed in a limited number of other areas occasionally in skm remedies, liver remedies, coronary remedies, blood circulation remedies, and in other groups of medicines. Summarizing, it can be said that the possibilities of treatment with herbal drugs are limited for a number of reasons for a series of illnesses like severe cardiac insufficiency, tumours, infectious diseases, diabetes, etc., herbal drugs arc not adequate remedies, even though, in contravention of the law, such claims are made in many publications. In a series of further cases, they only find use in support of the actual medical treatment they are nevertheless of value. 

Dinretics are widely used in medicine for very diverse pathologies, primarily for relieving edema, treating hypertension, cardiac insufficiency, hypercalcinuria, glaucoma, and a few forms of epilepsy, liver cirrhosis, and nephrosis. 

Bumetanide is used for relieving edema associated with cardiac insufficiency, for liver and kidney diseases including nephrotic syndrome, for ascites, and hypertension. Synonyms of this drug are bumex and others. 

Treatment If it is possible, elective resection is indicated. (98) However, due to cardiac or (increasing) hepatic insufficiency, invasive techniques cannot usually be attempted. External irradiation may be used in an effort to minimize the tumour. Ligature or embolization of the afferent hepatic artery is sometimes indicated. Steroid therapy has proved unsuccessful. The use of interferon-a is a new therapeutic approach tumour regression is accelerated and cardiac insufficiency is compensated. (103) Liver transplantations have also been carried out successfully. This infantile, benign tumour may regress with increasing age. 

In AMI, GGT activity is usually normal. If there is a rise, it occurs at about the fourth day, reaches a maximum value in another 4 days, and probably implies liver damage secondary to cardiac insufficiency. 

Contraindications for metformin include renal insufficiency, liver disease, alcehel abuse, cardiac insufficiency, metabolic acidosis or any hypoxia-related conditien. An additional consideration is that chronic metformin therapy can decrease oral absorption and subsequent serum concentrations of cyanocobalamin (vitamin B12) nevertheless, this effect, which is seen in approximately one in four patients, dees not appear to result in anemia. 

Impaired liver function, either due to primary disease or secondary to cardiac failure, may cause drug accumulation (Tl). Renal insufficiency may have two effects changes in the binding properties of plasma protein secondary to uremia can occur (R6, SI 6), or the drug and its metabolites may accumulate owing to impaired urinary excretion. 

Accumulation of metformin can occur in patients with renal insufficiency, and interference with pyruvate metabolism can lead to severe lactic acidosis. Lactic acidosis is more likely in situations associated with anaerobic metabolism, and metformin should not be given to patients with renal disease, liver disease, or severe pulmonary or cardiac disease predisposing to hypoxia. It is recommended to switch patients taking metformin to another oral hypoglycaemic prior to cardiac or other major surgery. 

Pancreatic toxicity is common. Hypoglycemia due to inappropriate insulin release often appears 5-7 days after onset of treatment, can persist for days to several weeks, and may be followed by hyperglycemia. Reversible renal insufficiency is also common. Other adverse effects include rash, metallic taste, fever, gastrointestinal symptoms, abnormal liver function tests, acute pancreatitis, hypocalcemia, thrombocytopenia, hallucinations, and cardiac arrhythmias. Inhaled pentamidine is generally well-tolerated but may cause cough, dyspnea, and bronchospasm. 

Impaired liver function, whether due to primary cellular insufficiency or to low liver blood flow as in cardiac failure, may both delay elimination and allow higher peak plasma concentrations of both types of local anaesthetic. This is likely to be important only with large or repeated doses or infusions. These considerations are important in the management of cardiac arrhythmias by i.v. infusion of lignocaine (lidocaine) (see p. 502). 

The hepatic blood flow is decreased in chronic heart insufficiency, and there is disturbed venous outflow, i. e. cardiac output is diminished. There is also a pressure increase in the splanchnic nerve area with subsequent blood pooling as a result of the rise in CVP. The markedly reduced hepatic blood flow at first evokes an increase in oxygen extraction, but after its elimination, hypoxia with centrilobular cell necroses follows. The elevated CVP extends as far as the central veins, so that dilatation and hyperaemia of the sinusoids occur. Pericentral atrophy in the liver cell trabeculae develops at a later stage, (s. tab. 39.1) (s. fig. 39.3)... 

Water retention due to sodium chloride (salt) is a common manifestation that leads to weight gain. Edema is also found in patients with cardiac heart failure, renal insufficiency, liver cirrhosis, and hypo-proteinemia. When large doses are used to treat neoplastic diseases, compounds with 17-alkyl substitutions can cause cholestatic hepatitis at high doses, jaundice is the most common clinical feature with accumulation of bile in the bile capillaries. Jaundice usually develops after 2-5 months of therapy. It can be detected by increases in plasma aspartate aminotransferase and alkaline phosphatase. 

Fig. ll.lla,b. Dynamic liver MDCT in a patient with severe right-sided cardiac failure and renal insufficiency, a Intense reflow of the iodinated contrast agent within the hepatic veins is seen shortly after the i.v. injection in the arm vein, with severe delay of aortic enhancement, b Mottled appearance of the liver parenchyma in the later phase of liver enhancement due to stagnation of iodinated contrast material within hepatic sinusoids. There is a hypodense area on the splenic parenchyma corresponding to a local infarction... 

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