Liver disorders management

Insulin is an endogenous hormone produced by fi-cells of islets of Langerhans of the pancreas, which consist of two chains of amino acids. It is required to be administered by a parenteral routes as it is destroyed when given orally. Insulin is used for the control of IDDM and in the emergency management of diabetic ketoacidosis.30 Insulin promotes the intracellular uptake of potassium and is used in hyperkalemia. Baker et al.31 have used insulin and glucagon in the treatment of liver disorders. Recent evidence indicates that the effects of insulin with glucose and potassium in ischemic heart disease have proved beneficial.32 It also is used in acute myocardial infarction.32... 

Kanamycin, neomycin, and paromomycin are used orally in the management of hepatic coma. In this disorder, liver failure results in an elevation of blood ammonia levels. By reducing tire number of ammoniaforming bacteria in the intestines, blood ammonia levels may be lowered, thereby temporarily reducing some of the symptoms associated with this disorder. 

It has been suggested that milk thistle may be beneficial in the management of hypercholesterolemia and gallstones. A small trial in humans showed a reduction in bile saturation index and biliary cholesterol concentration. The latter may reflect a reduction in liver cholesterol synthesis. To date, however, there is insufficient evidence to warrant the use of milk thistle for either of these disorders. 

The treatment for these disorders is limited. Antipruritic agents and UDCA are indicated for itching. Good dietary management lowers the risk of malnutrition. Bi-phosphonates and calcium can have a positive effect on bone density. As yet, there is no medical treatment available for the often annoying chronic fatigue syndrome. Liver transplantation may ultimately be indicated. 

Ben-Ari Z, Amlot P, Lachmanan SR et al (1999) Posttransplantation lymphoproliferative disorder in liver recipients characteristics, management, and outcome. Liver Transpl Surg 5(3) 184-191... 

---