Liver disease risk factors

Bone marrow toxicity that leads to leukopenia, anemia, and thrombocytopenia has been shown to be induced by methotrexate. A serious long-term adverse effect is hepatotoxicity. Consequently, methotrexate should typically be avoided in patients with liver disease. Risk factors for hepatotoxicity include a history of excessive alcohol consumption, hepatitis, persistent elevated liver function tests, and family history of inheritable liver disease. ... 

Biomarkers can also be used to identify factors that increase the likelihood that an individual will develop disease. This is an important area of research in molecular epidemiology as it becomes more evident that not all risk factors will contribute to disease equally across the human population. Therefore, in order to determine whether an environmental agent is related to disease, those factors that are also required for disease development need to be taken into account. Otherwise, many disease risk factors may go undetected. Examples of susceptibility factors that can be ascertained using biomarkers are some viral infections, which may predispose to specific diseases (for example, HIV infection and Kaposi sarcoma) or HBV infection and liver cancer. Biomarkers can also be used to measure dietary factors that can contribute to disease. The most common susceptibility factor studied using a molecular epidemiological approach are hereditary factors, which are discussed in the following section. 

Content of medical surveillance, (i) Medical and work history. The comprehensive medical and work history shall emphasize neurological symptoms, skin conditions, history of hematologic or liver disease, signs or symptoms suggestive of heart disease (angina, coronary artery disease), risk factors for cardiac disease, MC exposures, and work practices and personal protective equipment used during such exposures. 

Cholesterol is biosynthesized in the liver trans ported throughout the body to be used in a va riety of ways and returned to the liver where it serves as the biosynthetic precursor to other steroids But cholesterol is a lipid and isn t soluble in water How can it move through the blood if it doesn t dis solve in if The answer is that it doesn t dissolve but IS instead carried through the blood and tissues as part of a lipoprotein (lipid + protein = lipoprotein) The proteins that carry cholesterol from the liver are called low density lipoproteins or LDLs those that return it to the liver are the high-density lipoproteins or HDLs If too much cholesterol is being transported by LDL or too little by HDL the extra cholesterol builds up on the walls of the arteries caus mg atherosclerosis A thorough physical examination nowadays measures not only total cholesterol con centration but also the distribution between LDL and HDL cholesterol An elevated level of LDL cholesterol IS a risk factor for heart disease LDL cholesterol is bad cholesterol HDLs on the other hand remove excess cholesterol and are protective HDL cholesterol IS good cholesterol... 

Low-density lipoprotein (LDL) (Section 26.11) A protein which carries cholesterol from the liver through the blood to the tissues. Elevated LDL levels are a risk factor for heart disease LDL is often called bad cholesterol. ... 

Non-alcoholic fatty liver disease begins with asymptomatic fatty liver but may progress to cirrhosis. This is a disease of exclusion elimination of any possible viral, genetic, or environmental causes must be made prior to making this diagnosis. Non-alcoholic fatty liver disease is related to numerous metabolic abnormalities. Risk factors include diabetes mellitus, dyslipidemia, obesity, and other conditions associated with increased hepatic fat.26... 

What are this patient s risk factors for liver disease ... 

Document any risk factors for allergic reactions such as chronic urticaria, liver or kidney disease, human immunodeficiency virus, or any other immune deficiencies. 

Describe the etiology and risk factors for liver complications and metabolic bone disease in patients receiving PN. 

A complete history and physical examination should assess (1) presence or absence of cardiovascular risk factors or definite cardiovascular disease in the individual (2) family history of premature cardiovascular disease or lipid disorders (3) presence or absence of secondary causes of hyperlipidemia, including concurrent medications and (4) presence or absence of xanthomas, abdominal pain, or history of pancreatitis, renal or liver disease, peripheral vascular disease, abdominal aortic aneurysm, or cerebral vascular disease (carotid bruits, stroke, or transient ischemic attack). 

Therapy with INH results in a transient elevation in serum transaminases in 12% to 15% of patients and usually occurs within the first 8 to 12 weeks of therapy. Risk factors for hepatotoxicity include patient age, preexisting liver disease, and pregnancy or postpartum state. INH also may result in neurotoxicity, most frequently presenting as peripheral neuropathy or, in overdose, seizures, and coma. Patients with pyridoxine deficiency, such as alcoholics, children, and the malnourished, are at increased risk, as are patients who are slow acetylators of INH and those predisposed to neuropathy, such as those with diabetes. 

A high plasma concentration of LDL (usually measured as LDL-cholesterol) is a risk factor for the development of atheroma whereas a high concentration of HDL is an anti-risk factor for cardiovascular disease (CVD). Fundamental discoveries relating to cholesterol metabolism and the importance of the LDL receptor made by Nobel laureates Joseph Goldstein and Michael Brown led to an understanding of the role of LDL in atherosclerosis. The impact of HDL in reducing CVD risk is often explained by the removal of excess cholesterol from tissues and its return to the liver, a process known as reverse cholesterol transport. However, evidence from research by Gillian Cockerill and others shows that HDL has a fundamental anti-inflammatory role to play in cardioprotection. 

An elevated level of plasma cholesterol, particularly that carried in LDLs, is an independent risk factor for developing cardiovascular disease. Cholesterol comes from dietary sources and is made in the body, largely in the liver. 

Seleninm in this form is present in three enzymes glutathione peroxidase, iodothyronine deiodinase and thio-redoxin rednctase. Deficiency of selenium therefore decreases the activity of these three enzymes and resnlts, at least in experimental animals, in liver necrosis and mns-cnlar dystrophy. In hnmans, it is known to be a canse of a particnlar form of cardiomyopathy known as Keshan disease which affects children and women. This cardiomyopathy was first described in China in 1979. It is also considered that a deficiency of selenium is a risk factor for cancer. 

Lactic acidosis/severe hepatomegaly with steatosis Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogs alone or in combination with other antiretrovirals. Exercise particular caution when administering nucleoside analogs to any patient with known risk factors for liver disease. 

A minor asymptomatic increase in liver aminotransferase is seen in 10 to 20% of patients, whereas fatal hepatitis is seen in fewer than 1% of isoniazid recipients. Risk factors for hepatitis include underlying liver disease, advanced age, pregnancy, and combination therapy with acetaminophen. Early recognition and prompt discontinuation of the drug is recommended to prevent further damage to the liver. 

Hagglund H, Remberger M, Klaesson S, LonnqvisL B, Ljungman P, Ringden O. Norethisterone treatment, a major risk-factor for veno-occlusive disease in the liver after allogeneic bone marrow transplantation. Blood 1998 92(12) 4568-72. 

Hsueh, Y.-M., Cheng, G.-S., Wu, M.-M. et al. (1995) Multiple risk factors associated with arsenic-induced skin cancer effects of chronic liver disease and malnutritional status. British Journal of Cancer, 71(1), 109-14. 

Other potential adverse responses include malignancy (e.g., lymphoma), liver disease, heart failure, lupuslike disease, irritation around the injection site, and demyelinating disorders that mimic multiple sclerosis.34,70 88 The incidence of these adverse effects, however, seems to be fairly low. For the most part, these drugs provide an acceptable risk-to-benefit ratio for most people with rheumatoid arthritis. Patients should, however, be screened carefully for any risk factors before beginning drug therapy, and should likewise be monitored periodically for any potential adverse reactions to these drugs. 

Liver disease is the most common medical complication of alcohol abuse it is estimated that 15-30% of chronic heavy drinkers eventually develop severe liver disease. Clinically significant alcoholic liver disease may be insidious in onset and progress without evidence of overt nutritional abnormalities. Alcoholic fatty liver, a reversible condition, may progress to alcoholic hepatitis and finally to cirrhosis and liver failure. In the USA, chronic alcohol abuse is the leading cause of liver cirrhosis and of the need for liver transplantation. The risk of developing liver disease is related both to the average amount of daily consumption and to the duration of alcohol abuse. Women appear to be more susceptible to alcohol hepatotoxicity than men. Another factor that increases the risk of severe liver disease is concurrent infection with hepatitis B or C virus. 

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