Liver acute disease

A wide range of conditions fall into this gronp. They can be roughly categorised further into those causing cholestatic disease, chronic liver disease, acute liver failure/metabolic crisis, storage disorders, disorders of bilirubin metabolism. Table 3.5 snmmarises the types of liver disease that fall into each group. 

In the course of serious liver disease (acute or chronic), the occurrence of HE must always be reckoned with. Various pathogenic factors or mechanisms can interact from case to case in a variety of ways and may spontaneously trigger this occurrence synergistically. For the most part, the pathogenetic and pathophysiological reactions are set in motion or reinforced by trigger factors. It is therefore clinically important to recognize and avoid them as far as possible, (s. tab. 15.2)... 

In endogenous hepatic coma (= due to loss of liver parenchyma), which in most cases develops from an existing chronic liver disease ( acute on chronic ), the prognosis is better than for acute liver failure, but nevertheless remains extremely poor. According to the information available in the relevant literature, 10-20% of patients die in stage I and 40-50% in stage II in stages III and IV, lethality is 80-90%, the same rate as in acute liver failure, (see chapter 20)... 

BuChE is synthesized in the liver and has a replacement time of about 50 days. Its activity is decreased in parenchymal liver disease, acute infections, malnutrition, and chronic debilitating diseases, and is increased in the nephrotic syndrome.20 This enzyme has no known physiological function in blood, but may assist in hydrolyzing certain choline esters. 

Adrenocortical insufficiency Organ transplants Liver disease Adrenogenital syndrome Nephrotic syndrome Acute spinal cord injury Hyp ere alemia Hematologic disorders Myasthenia gravis Neoplastic disease... 

Naltrexone is contraindicated in those with a hypersensitivity to the narcotic antagonists. Naltrexone is contraindicated during pregnancy (Category C). Naltrexone is used cautiously in those with a narcotic addiction in patients with cardiovascular disease, acute hepatitis, liver failure, or depression and in patients who are suicidal. Naltrexone is used cautiously during lactation. 

Acute leukemia, acute lymphoma, short-bowel syndrome, liver disease (decreased clearance), diabetes mellitus, mitochondrial disease, and congenital enzyme deficiencies... 

Pyrazinamide Adults Based on IBW 40-55 kg 1000 mg 56-75 kg 1500 mg 76-90 kg 2000 mg Children 15-30 mg/kg Hepatotoxicity, gastrointestinal symptoms (nausea, vomiting), non-gouty polyarthralgia, asymptomatic hyperuricemia, acute gouty arthritis, transient morbilliform rash, dermatitis Serum uric acid can serve as a surrogate marker for compliance FFTs in patients with underlying liver disease... 

The metabolic encephalopathies comprise a series of neurological disorders not caused by primary structural abnormalities rather, they result from systemic illness, such as diabetes, liver disease and renal failure. Metabolic encephalopathies usually develop acutely or subacutely and are reversible if the systemic disorder is treated. If left... 

Type A HE is induced by acute liver failure, Type B results from portal-systemic bypass without intrinsic liver disease, and Type C occurs with cirrhosis. HE may be classified as episodic, persistent, or minimal. 

Treatment for HCV infection is necessary because a high percentage of acutely infected patients develop chronic infections. Treatment is indicated in patients previously untreated who have chronic HCV, circulating HCV RNA, increased alanine transaminases levels, evidence on biopsy of moderate to severe hepatic grade and stage, and compensated liver disease. 

Anhaptoglobinemia or subnormal Hp values, often found in acute and chronic liver disease, and in mononucleosis, may also be caused by an increased consumption and not by decreased synthesis. In both disorders there exists a tendency for the development of splenomegaly, i.e., a tendency to retarded splenic blood flow with slightly shortened survival time of the red cells as a consequence. If we do not presume a half-life of Hp in normals below one day, the main part of the Hp catabolism must be secondary to Hb release. Hence, subnormal Hp values will probably appear in conditions with no clinically observable increased hemolysis or slightly decreased Hp synthesis. The latter may be a con-... 

Vulnerability of the liver to injury necessitates routine evaluation of hepatic function in patients and asymptomatic individuals to avert or control adverse clinical conditions. Thus, a plethora of methods has been developed for the diagnosis of liver diseases and dysfunctions. One such method uses physical palpation to determine alterations or changes in the orientation of the liver, which provides valuable information about the organ status but the quality of information is subjective and imprecise [3]. Another common method for the diagnosis of more serious hepatic injuries involves liver biopsies coupled with biochemical tests to determine the extent of liver injury and prognosis [4-7]. However, in acute and some chronic hepatic disorders, dynamic and continuous hepatic function monitoring would be advantageous. 

Active thrombophlebitis or thromboembolic disorders undiagnosed abnormal genital bleeding known or suspected pregnancy acute liver disease benign or malignant... 

Naltrexone is contraindicated in acute hepatitis or liver failure. Carefully consider its use in patients with active liver disease in light of its hepatotoxic effects. 

Hypersensitivity to benzodiazepines psychoses acute narrow-angle glaucoma patients with clinical or biochemical evidence of significant liver disease intra-arterial use (lorazepam injection) children younger than 6 months of age, lactation (diazepam) coadministration with ketoconazole and itraconazole caused by inhibition of cytochrome P450 3A. 

Alcohol has a range of effects for some, desirable acute effects unwanted effects on the developing fetus and with long-term consumption, effects on the liver and other organs. In the US, over 2 million people experience alcohol related liver disease. Effects on the liver are dose related the more you consume the greater the effects. Early on there is an accumulation of fat in the liver as a result of the metabolism of alcohol. Some heavy drinkers develop an inflammation (alcoholic hepatitis) of the liver. Metabolites of alcohol, produced by the liver, are toxic to the liver cells. 

The main acute effect is inebriation, which in turn spawns violence, spousal and child abuse, crime, motor vehicle accidents, workplace and home accidents, drowning, suicide, and accidental death. The chronic effects include alcoholism, liver disease, various forms of cancer, brain disorders, cardiovascular disease and other organ system effects, absence from or loss of work, family dysfunction, and malnutrition. 

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