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Liver Disease—Alcoholic Hepatitis/Cirrhosis
Published in Charles Theisler, Adjuvant Medical Care, 2023
A liver disease is any disturbance of liver function that causes illness. Liver disease can present as a spectrum of clinical conditions that ranges from asymptomatic disease to end-stage liver disease.1 The two most common chronic liver diseases are viral hepatitis (see Hepatitis) and cirrhosis. In cirrhosis, liver cells are replaced with fibrotic tissue. The term cirrhosis is derived from the Greek “kirrhos” meaning orange-colored, and refers to the yellow-orange hue of the liver seen by the pathologist or surgeon.2 Cirrhosis is the twelfth most common cause of death in the U.S. and the fourth most frequent cause in the 45-54 year age group.
Pregnancy After Liver and Other Transplantation
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
End-stage liver disease (ESLD): Any hepatic disease that jeopardizes the survival or that seriously modifies the quality of life of the patient, and for which the transplant is the only therapy, since no other therapy exists to provide a chance of recovery.
Infectious Diseases
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
HCV RNA is the investigation of choice to diagnose acute HCV infection. Anti-HCV antibodies are detectable 3–4 months post-infection. Management includes educating the patient about the condition and the need to avoid alcohol during the acute illness in addition to lifestyle advice and informing injection/sexual contacts. Patients are given measures to prevent the spread of other blood-borne viruses and are offered hepatitis A+B vaccination. Medication depends of the viral genotype (at least six different ones are known). Treatment aims to reduce HCV RNA to undetectable levels 6 months following the end of treatment. Usually a combination of protease inhibitors (e.g. daclatasvir) with or without ribavirin are used. Liver transplantation is the treatment of choice for patients with end-stage liver disease. Regular alpha-fetoprotein measurement can be used to screen those with active hepatitis C to early identify transformation to HCC.
Histological and biochemical studies on effect of Sofosbuvir (Sovaldi) on adult male albino rat kidney
Published in Ultrastructural Pathology, 2021
Amany F. Mohamed, Amany M. Abo-Ouf, Mona A.A. Arafa
Hepatitis C is a global health problem that affects almost every region across the world. It is the leading cause of end-stage liver disease and primary liver cancer. There is an intense interest in developing therapeutic regimens that are capable of inhibiting HCV replication and eradicating infection.1 Sofosbuvir (Sovaldi) is an antiviral candidate against multiple hepatitis C virus genotypes.2 It is the backbone of many anti‐HCV drug regimens.3 It is a nucleotide analogue that is a potent inhibitor of NS5B polymerase in HCV. NS5B is a non-structural protein that is essential for viral RNA replication and has been a valuable target for many directly acting antiviral agents.4 The Food and Drug Administration approve it for the treatment of chronic HCV infection.2 Effective and powerful antiviral drugs are well-known causes of the additional increase in the incidence of antiviral drug nephrotoxicity.5 Sofosbuvir is principally renal excreted. It is converted into inactive metabolites that undergo renal excretion.3 Many clinicians had concerns to use sofosbuvir-based regimens in chronic kidney disease patients because clinical data are limited and heterogeneous.6
Old and novel prognostic biomarkers in primary biliary cholangitis
Published in Expert Opinion on Orphan Drugs, 2021
G Mulinacci, A Palermo, Pietro Invernizzi, Marco Carbone
Primary biliary cholangitis (PBC) is a chronic liver pathology characterized by intrahepatic biliary obstruction and chronic cholestasis potentially leading to end-stage liver disease and its associated complications [1,2]. It is clinically characterized by chronic cholestasis, serologic reactivity to antimitochondrial antibodies (AMA) or specific antinuclear antibody (ANA), gp210 and sp100, and histologic evidence of chronic non-suppurative, granulomatous cholangitis. The disease is generally slowly progressive, but many patients eventually develop end-stage liver disease with attendant need for liver transplantation (LT). Epidemiologic studies report heterogeneous incidence rates of 0.33 to 5.8 per 100.000 inhabitants per year, and prevalence rates of 1.9 to 40.2 per 100.000 inhabitants. Such figures, in particular the prevalence, have shown some increasing in the last decades. Improvement of diagnostic tools, increasing disease awareness, and digitalized patient registration with easing of case-findings, along with an improved survival likely contributed to the rising prevalence rates.
Emerging synthetic drugs for the treatment of liver cirrhosis
Published in Expert Opinion on Emerging Drugs, 2021
Jonathan Andrew Fallowfield, Maria Jimenez-Ramos, Andrew Robertson
Although 90% of cirrhosis is due to preventable causes, three-quarters of people are diagnosed at a late stage when the impact of lifestyle changes (e.g., weight loss, alcohol abstinence) or etiological treatment (e.g., antiviral therapy) is attenuated. Liver transplantation is the most effective therapeutic option for end-stage liver disease but is a scarce resource. There are currently no Food and Drug Administration (FDA) or European Medicines Agency (EMA) approved antifibrotic or pro-regenerative drug therapies for cirrhosis. However, there is intense activity in drug development, especially for liver fibrosis and cirrhosis related to NASH. In this article, we review the current drug development landscape in cirrhosis, with a specific focus on emerging synthetic drugs that are being evaluated in phase 2 or phase 3 trials.