Chronic liver disease

The 23-valent pneumococcal polysaccharide vaccine is recommended for use in all adults 65 years of age or older and adults less than 65 years who have medical comorbidities that increase the risk for serious complications from S. pneumoniae infection, such as chronic pulmonary disorders, cardiovascular disease, diabetes mellitus, chronic liver disease, chronic renal failure, functional or anatomic asplenia, and immunosuppressive disorders. Alaskan natives and certain Native American populations are also at increased risk. Children over the age of 2 years may be vaccinated with the 23-valent pneumococcal polysaccharide vaccine if they are at increased risk for invasive S. pneumoniae infections, such as children with sickle cell anemia or those receiving cochlear implants. 

GZ (23) is known to decrease elevated plasma levels of AST and ALT in various liver diseases. Thus it has been widely used for the treatment of chronic liver diseases (chronic viral hepatitis) in Japan for several years [82]. However, the mechanism of its transaminase-lowering action is not fully understood. Some studies suggested that the decrease of transaminase levels by GZ in patients with chronic viral hepatitis is mediated in part by inhibition of immune-mediated cytotoxicity against hepatocytes [83]. GZ (23) was shown to inhibit the cytotoxicity of CTL against antigen-presenting cells and also to suppress TNF-a induced cytotoxicity in the TNF-a sensitive cell line in vitro. A clinical study reported the use of GZ to bring about an improvement of hepatitis after liver transplantation performed for cirrhosis secondary to hepatitis B complicated by a small hepatocellular carcinoma [84],... 

Most patients with Wilson disease, whatever their clinical presentation, have some degree of liver disease. Chronic liver disease (if undiagnosed and untreated) may precede manifestation of neurological symptoms for more than 10 years. Patients can present with liver disease at any age. The most common age of hepatic manifestation is between 8 and 18 years, but cirrhosis may already be present in children below the age of 5. On the other hand, Wilson disease is diagnosed also in patients presenting with advanced chronic liver disease in their 50s or 60s, without neurological symptoms and without Kayser-Fleischer rings. 

Symptoms of deficiency. Oral, ocular, cutaneous, and genital lesions. Primary deficiency is associated with inadequate consumption of milk and other animal products. Secondary deficiencies are most common in chronic diarrheas, liver disease, chronic alcoholism, and postoperative situations. 

GI Concomitant liver disease (chronic HCV-infectioni alcoholic liver disease hemosiderosis of the liver) +... 

Hepatocellular carcinoma (HCC) develops in patients with chronic liver diseases associated with hepatitis B and hepatitis C vims infections with high incidences. Here, an acyclic retinoid has been shown to suppress the posttherapeutic recurrence after interferon-y or glycerrhicin treatment in cirrhotic patients who underwent curative treatment of preceding tumors. The retinoid induced the disappearance of serum lectin-reactive a-fetoprotein (AFP-L3), a tumor marker indicating the presence of unrecognizable tumors in the remnant liver, suggesting a deletion of such minute (pre)malignant clones (clonal deletion). As a molecular mechanism of the clonal deletion, a novel mechanism of... 

These dru are contraindicated in patients with known hypersensitivity. Hydroxychloroquine is contraindicated in patients with porphyria (a group of serious inherited disorders affecting the bone marrow or the liver), psoriasis (chronic skin disorder), and retinal disease (may cause irreversible retinal damage). MTX is contraindicated during pregnancy because it is a Pregnancy Category X dmg and may cause birth defects... 

Liaw YF, Sung JJ, Chow WC, Farrell G, Lee CZ, Yuen H, Tanwandee T, Tao QM, Shue K, Keene ON, Dixon JS, Gray DF, Sabbat J (2004) Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med 351(15) 1521-1531 Lindahl K, Stable L, Bruchfeld A, Schvarcz R (2005) High-dose ribavirin in combination with standard dose peginterferon for treatment of patients with chronic hepatitis C. Hepatology 41(2) 275-279... 

There is very little evidence relating to the role of ROMs in cholestatic liver disease. Serum selenium and glutathione peroxidase activity are decreased in humans with intrahepatic cholestasis of pregnancy (Kauppila et al., 1987). Low levels of vitamin E have been reported in patients with primary biliary cirrhosis, and in children with Alagille s syndrome or biliary atresia (Knight et al., 1986 Jeffrey etal., 1987 Lemonnier etal., 1987 Babin etal., 1988 Kaplan et al., 1988 Sokol etal., 1989). Serum levels of Mn-SOD are increased in patients with all stages of primary biliary cirrhosis compared with patients with other forms of chronic liver disease, although whether this causes or results from the disease process is unclear (Ono etal., 1991). 

Jeffrey, G.P., Muller, D.P.R., Burroughs, A.K., Matthews, S., Kemp, C., Epstein, O., Metcalfe, T.A., Southam, E., Tazir-Melbourcy, M., Thomas, P.K. and McIntyre, N. (1987). Vitamin E deficiency and its clinical significance in adults with primary biliary cirrhosis and other forms of chronic liver disease. J. Hepatol. 4, 307-317. 

Digoxin-like immunore active substances (found in patients with chronic heart failure, end stage renal disease, liver disease, or third trimester of pregnancy) may cross-react with certain digoxin immunoassays and may result in a false elevation of levels... 

Cirrhosis is the result of long-term insult to the liver, so damage is typically not evident clinically until the fourth decade of life. Chronic liver disease and cirrhosis combined were the 12th leading cause of death in the United States in 2002. In patients between the ages of 25 and 64, damage from excessive alcohol use accounted for over one-half of the deaths.2 Alcoholic liver disease and viral hepatitis are the most common causes of cirrhosis in the United States and worldwide. 

FIGURE 19-4. Treatment algorithm for active gastrointestinal bleeding resulting from portal hypertension. (From Schianotd, Bodenheimer HC. Complications of Chronic Liver Disease. In Friedman SL, McQuaid KR, Grendell JH (eds.)... 

O Prevention and treatment of viral hepatitis may prevent progression to chronic hepatitis, cirrhosis, and end-stage liver disease. 

Chronic hepatitis (disease lasting longer than 6 months) is usually associated with hepatitis B, C, and D. Chronic viral hepatitis may lead to the development of cirrhosis, which may induce end-stage liver disease (ESLD). Complications of ESLD include ascites, edema, jaundice, hepatic encephalopathy, infections, and bleeding esophageal varices. Therefore, prevention and treatment of viral hepatitis may prevent ESLD. 

Patients with viral hepatitis B, C, and D may develop chronic disease leading to ESLD. Treatment is only available for chronic liver disease associated with HBV, HCV, and HDV.20,21... 

Lok ASF, McMahon BJ. Practice Guidelines Committee, American Association for the Study of Liver Diseases (AASLD). Chronic hepatitis B Update of recommendations. Hepatology 2004 39 857-861. 

Generally, a CA 15-3 cutoff of 25 U/ml is used to detect stage I breast cancer. In higher stages, the sensitivity is reported to be much better, which makes it a good test of tumor burden. CA 15-3 is reported to be elevated in other disease conditions such as liver disease (particularly chronic hepatitis, cirrhosis, and carcinoma), some inflammatory conditions (sarcoidosis, tuberculosis, systemic erythematosus), and other carcinoma (lung and ovary). For this reason, positive CA 15-3 results should be interpreted with caution (20,21). 

Although as many as 20% of patients with chronic hepatitis C may be coinfected with HGV/GB V-C, coinfection does not appear to influence the severity of liver disease or response to interferon-a therapy (Martinot et al., 1997). 

Martinot, M, etal, (1997). Influence of hepatitis G virus infection on the severity of liver disease and response to interferon-a in patients with chronic hepatitis C. Ann. Intern. Med. 126,874-881. 

Cirrhosis A liver disease commonly associated with chronic alcohol misuse and characterised by the replacement of once-healthy hepatocytes with abnormal connective tissue. 

Education, simple rules of personal hygiene and safe food preparation can prevent many diarrheal diseases. Hand washing with soap is an effective step in preventing spread of illness. Human feces must always be considered potentially hazardous. Immunocompromised persons, alcoholics, persons with chronic liver disease and pregnant women may require additional attention, and health care providers can play an important role in providing information about food safety. These populations should avoid undercooked meat, raw shellfish, raw dairy products, French-style cheeses and unheated deli meats [114]. 

Branch RA, Morgan MH, James J, Read AE Intravenous administration of diazepam in patients with chronic liver disease. Gut 1976 17 975-983. 

Smith, I.R., G.M. Kirby, H.W. Ferguson, and M.A. Hayes. 1993. Benzo[a]pyrene metabolism and excretion in white suckers with chronic liver diseases. Environ. Toxicol. Chem. 12 897-901. 

Acetaminophen is recommended by the ACR as first-line drug therapy for pain management of OA. The dose is 325 to 650 mg every 4 to 6 hours on a scheduled basis (maximum dose 4 g/day maximum 2 g/day if chronic alcohol intake or underlying liver disease). Comparable relief of mild to moderate OA pain has been demonstrated for acetaminophen (2.6 to 4 g/ day) compared with aspirin (650 mg four times daily), ibuprofen (1,200 or 2,400 mg daily), and naproxen (750 mg daily). However, some patients respond better to NSAIDs. 

Acetaminophen is usually well tolerated, but potentially fatal hepatotoxicity with overdose is well documented. It should be used with caution in patients with liver disease and those who chronically abuse alcohol. Chronic alcohol users (three or more drinks daily) should be warned about an increased risk of liver damage or GI bleeding with acetaminophen. Other individuals do not appear to be at increased risk for GI bleeding. Renal toxicity occurs less frequently than with NSAIDs. 

MTX is contraindicated in pregnant and nursing women, chronic liver disease, immunodeficiency, pleural or peritoneal effusions, leukopenia, thrombocytopenia, preexisting blood disorders, and creatinine clearance <40 mL/min. 

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