Minimal hepatitis

Liu Q, Duan ZP, Ha DK, Bengmark S, Kurto-vic J, Riordan SM Symbiotic modulation of gut flora Effect on minimal hepatic encephalopathy in patients with cirrhosis. Hepatololy 2004 39 1441-1449. 

Lockwood, A. H., Yap, E. W. H. and Wong, W. H. Cerebral ammonia metabolism in patients with severe liver disease and minimal hepatic encephalopathy. /. Cereb. Blood Flow Metab. 11 337-341,1991. 

Terazosin undergoes minimal hepatic first-pass metabolism nearly all of the circulating dose is in the form of parent drug. 

Metoclopramide undergoes minimal hepatic metabolism, except for simple conjugation. Its safe use has been described in patients with advanced liver disease whose renal function was normal. 

The antipseudomonal penicillins undergo renal elimination (Table 45.1). Piperacillin and ticarcillin have minimal hepatic metabolism. In contrast, mezlocillin has significant hepatic metabolism and requires dose adjustment in patients with hepatic insufficiency. 

Mechanism of Action An antihyperlipidemicthat interferes with cholesterol biosynthesis by inhibiting the conversion of the enzyme hydroxymethylglutaryl-CoA (HMG-CoA) to mevalonate, a precursor to cholesterol. Therapeutic Effect Decreases LDL cholesterol, VLDL, and plasma triglyceride levels, increases HDL concentration. Pharmacokinetics Protein binding 88%. Minimal hepatic metabolism. Primarily eliminated in the feces. Half-life 19 hr (increased in patients with severe renal dysfunction). 

Distribution of penicillin antibiotics is limited to extracellular fluids, but inflammation may enhance their distribution into tissues. Penicillins are actively transported in kidney, brain, and liver. Most penicillins undergo minimal hepatic metabolism and are cleared from the plasma primarily by renal excretion. Secretion of penicillins by the renal tubules results in high urine concentrations and rapid elimination from the body (50). 

Romero-Gomez, M., Grande, L., Camacho, I., Benitez, S., Irles, J.A., Castro, M. Altered response to oral glutamine challenge as prognostic factor for overt episodes in patients with minimal hepatic encephalopathy. J. Hepatol. 2002 37 781-787... 

Wein, C., Koch, H., Popp, B., Oehler, G., Schauder, R Minimal hepatic encephalopathy impairs fitness to drive. Hepatology 2004 39 739-745... 

The course of minimal hepatitis (O. Klinge, 1976) is generally found in anicteric or subicteric patients and only shows minor histological... 

The buccal and sublingual routes of administration permit rapid delivery to the systematic circulation. Absorption from the buccal and sublingual vasculature and lymphatics bypasses hepatic circulation and, thereby, reduces first-pass metabolism. The driving force of absorption is the high thermodynamic activity of the compounds. Organic nitrates and testosterone have been administered by these routes to produce rapid plasma concentrations and to minimize hepatic metabolism. 

Levocetirizine is the R-enantiomer of cetirizine dihydrochloride and, like cetirizine, undergoes minimal hepatic metabolism (1). Levocetirizine has twice the affinity for Hi receptors as cetirizine (1). It is efficacious and well tolerated in patients with seasonal allergic rhinitis (2). 

HUMAN HEALTH RISKS Acute Risks abdominal pain nausea vomiting rashes jaundice dermatitis skin and eye irritation Chronic Risks damage to kidneys and liver minimal hepatic changes digestive disturbances cancers of the buccal cavity or pharynx. 

CHRONIC HEALTH RISKS liver damage minimal hepatic changes liver abnormalities, digestive disturbances increased rate of spontaneous abortion cancer of the pharynx. 

In the case of chronic liver disease, episodic HE and persistent HE were defined and the term minimal hepatic encephalopathy (MHE) was coined to replace the hitherto inappropriate term subclinical encephalopathy . It is expected that this new system of classification will help to dispel the confusion frequently present in current textbook definitions and to facilitate multi-centre clinical trials in HE. 

Cagnin A, Taylor-Robinson SD, Forton DM, Banati RB. In vivo qirantification of cerebral peripheral benzodiazepine binding site in minimal hepatic encephalopathy A [ C]R-PKl 1195 positron emission tomography study. J. Hepatol., 34, 58, 2001... 

Romero-Gomez, M., Cordoba, J., Jover, R., Del Olmo, J.A., Ramirez, M., Rey, R., de Madariti, E., MontoUu, C., Nunez, D., Ravia, M., Company, L., Rodrigo, J.M., Felipo, V. 2007. Value of the critical flicker frequency in patients with minimal hepatic encephalopathy. Hepatology 45(4) 879-885... 

Schomerus, H., Hamster, W. 2001. Quality of life in cirrhotics with minimal hepatic encephalopathy. Metab Brain 16 (1/2) 37-42... 

He, D.Y. Karbowski, C.M., Werner, J. Everds, N. et al. Common handling procedures conducted in preclinical safety studies result in minimal hepatic gene expression changes in Sprague-dawley rats. PLoS One 2014 9 e88750. 

Mercury toxicity is related to the induction of oxidative stress, as revealed by the decrease in antioxidant enzymes as glutathione S-transferase (Reddy et al. 1981). Examining interactions of purified Mn-superoxide dismutase (1 fM) with HgCl2 indicated that mercury ions suppressed Mn-superoxide dismutase activity by reduction of the native form (Shimojo et al. 2002). Due to the minimal hepatic accumulation of inorganic mercury after the subcutaneous application of HgCl2 (0.25-3 mg/kg) to mice the hepatic Mn-superoxide dismutase might be unaffected while the renal enzyme due to a 34-75 times higher accumulation of mercury in the kidney was decreased in a dose-dependent manner. 

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