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Patients with liver disease often require drug therapy. Since the liver is the main site of drug detoxification and elimination in the body, patients must be carefully assessed for the need for therapy. If a drug is needed for a patient with liver disease, the choice of drug, its dose, and duration of therapy must be carefully considered in order to avoid adverse effects. Ideally, in patients with...
With an ever increasing range of investigative tools available for suspected liver or biliary tract disease, it is even more important that they are used rationally in the knowledge of their individual value. Conventional liver function tests are non-specific although the distinction between hepatitic and cholestatic patterns can be useful. Serum albumin and prothrombin time are the only routine liver...
Hepatitis C virus infection is an important worldwide public health problem. Considerable progress has been made in our understanding of hepatitis C infection. Treatments have also improved, so that at least half of patients with chronic hepatitis C can be cured. Notwithstanding, current treatments have limitations, and new therapeutic approaches, gained from a better understanding of the biology...
Infections with hepatitis A virus (HAV) or hepatitis E virus (HEV) cause acute, self-limited hepatitis with no progression to chronic liver disease. Hepatitis A and E are enterically transmitted diseases which share several common features such as faecal–oral route of transmission, no chronic carrier state for these two infections, the infection is asymptomatic in a proportion of cases, resulting...
Histopathological assessments play an important role in diagnosis and management of patients with liver disease. For some conditions, histopathology is still regarded as the diagnostic gold standard. In other circumstances, evaluation of morphological changes may provide additional information that is useful for clinical management, for example, grading of inflammatory activity and staging of fibrosis...
Alcoholic liver disease (ALD) is a significant burden on the healthcare systems in the developed world and deaths from ALD continue to rise in the UK. The first stage of ALD – fatty liver – is present in most heavy drinkers and is due to a combination of reduced fat oxidation and export from the liver and increased fatty acid synthesis. Alcoholic hepatitis, characterized by liver inflammation and...
Chronic liver disease is increasingly common in the UK, and now causes in excess of 5000 deaths per year. The natural history of liver injury is of increasing fibrosis in response to hepatocellular injury, which is usually asymptomatic until decompensation occurs. Up until this point, it is usually identified only by the presence of elevated liver enzyme levels. Thorough investigation of abnormal...
The liver is frequently involved in infections that are prevalent in different regions of the tropics. Chronic liver disease, sometimes of multiple aetiologies, is an important cause of early morbidity and mortality. This article describes some hepatic and biliary problems that are seen in the tropics, or which may be imported from the tropics.
Drugs that damage the liver account for 9.5% of all suspected adverse drug reactions (ADRs), are the main cause of fatal ADRs and are the most common reason for withdrawal of drugs from the market. Pre-market surveillance detects common ADRs, but those seen in clinical practice are rare (1 in 10,000–100,000). Their recognition depends on individual reports and post market surveillance. In the UK,...
Chronic hepatitis B affects 400 million people worldwide and up to 30% will die either of decompensated cirrhosis or hepatocellular carcinoma. During the HBe antigen positive and negative viraemic phases, when viral levels are > 105 IU/ml, the patient may develop progressive hepatitis and fibrosis. In these phases, when patients have chronic hepatitis with some degree of hepatic fibrosis, a trial...
This update focuses on new problems and advances in infectious diseases over the last two years. Several important emerging infections, the problem of drug resistance and increasing virulence in common pathogens, and the continuing challenge of tuberculosis, as both a global and local problem, will be discussed. Advances include new diagnostic strategies for tuberculosis, novel antimicrobial agents,...
Jaundice is the result of accumulation of bilirubin in plasma, sometimes from its overproduction but more usually through failure of the liver to either remove it from plasma or excrete it into the intestine via the bile ducts. Bilirubin is a breakdown product of haemoglobin from senescent erythrocytes and circulates tightly bound to albumin before being extracted by hepatocytes and conjugated with...
Rik of variceal bleeding can be estimated by the size of varices, presence of endoscopic red signs and degree of liver dysfunction. All cirrhotic patients with large varices and severe liver disease should receive primary prophylaxis with non-selective β-blockers. Banding ligation is equivalent and is used if there are contraindications or intolerance to these drugs. Acute variceal bleeding should...
Wilson’s disease is an autosomal recessive disorder of hepatic copper disposition caused by mutations in the gene ATP7B, located on chromosome 13. This gene encodes a P-type ATPase, known as the Wilson ATPase, which functions within hepatocytes to move copper across intracellular membranes. The copper-transporting action directly supports production of the ferroxidase ceruloplasmin, in which copper...
Primary biliary cirrhosis (PBC) is a chronic progressive disease of the intrahepatic bile ducts that primarily affects middle-aged women. The characteristic features include pruritus and lethargy. Although there is a widespread disturbance of the immune system, with association with other autoimmune diseases such as thyroid disease, sicca syndrome and Raynaud’s syndrome, elevation of immunoglobulins...
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