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Liver Disease—Alcoholic Hepatitis/Cirrhosis
Published in Charles Theisler, Adjuvant Medical Care, 2023
Cirrhosis can result from any cause of chronic liver inflammation, but is primarily due to alcoholic hepatitis, NASH, or the hepatitis C virus.3 The spectrum of alcoholic liver disease encompasses several conditions so that a single patient may be affected by fatty liver, and/or alcoholic hepatitis, and/or alcoholic cirrhosis. Symptoms of liver toxicity are right upper abdominal pain, jaundice (yellowing of the skin and whites of the eyes), itching, fatigue, loss of appetite, weight loss, and dark or tea-colored urine. Alcoholic hepatitis can lead to scarring, or cirrhosis, of the liver and ultimately liver failure.
The patient with acute gastrointestinal problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Rebecca Maindonald, Adrian Jugdoyal
The patient in liver failure will also have abnormal blood results that detect deterioration in liver function. These have previously been referred to as liver function tests (LFTs), but as LFTs include elevations of hepatobiliary liver enzymes that indicate ongoing injury rather than functional changes, the term ‘abnormal liver blood test’ is now used (Newsome et al. 2017). These are summarised below: Indicators of abnormal function: abnormal clotting (e.g., prolonged PT or increased INR). Clotting factors are synthesised in the liver and there is a reduction in circulating clotting factors with the degree of prolongation of PT being used as a prognosticator. Serial tests need to be analysed with platelets and FFP being administered only if bleeding actively.Assessment of damage: liver enzymes are raised. These exist normally within liver cells, but will leak into the plasma when damaged (e.g., AST, Aspartate transaminase and ALT, Alanine aminotransferase [most specific for liver damage]).Excretory capacity: bilirubin is increased in obstruction (direct/conjugated) or erythrocyte breakdown (indirect/unconjugated). At a level above 50 umol/L, jaundice will be apparent.
Dilated Abdominal Wall Veins
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
Hepatorenal syndrome is said to exist when renal failure develops in a patient with cirrhosis and ascites. The decline in the kidney function is only secondary to liver failure; improvement in liver function is associated with improvement in renal function. The exact mechanism of this syndrome remains unclear. The onset of renal failure is accompanied by acute intrarenal vasoconstriction and reduction in the renal blood flow. Serum renin and aldosterone levels are typically high. The renal tubular functions remain normal; oliguria is common. Severe renal failure may develop over a period of days to weeks. In all cases, other underlying causes of renal failure must be excluded. There is no satisfactory treatment available. Plasma expansion with monitoring of renal output has been noted to be beneficial. Prognosis remains poor; over 90% of patients die, mostly because of progressive liver failure, hepatic encephalopathy or sepsis.
Heparin anticoagulation versus regional citrate anticoagulation for membrane therapeutic plasma exchange in patients with increased bleeding risk
Published in Renal Failure, 2023
Jing Jiao, Yan Yu, Suijiao Wei, Xiujuan Tian, Xiaoxia Yang, Shidong Feng, Yajuan Li, Shiren Sun, Peng Zhang, Ming Bai
Patients with liver failure are known to be associated with an increased risk of bleeding [36]. Yuan et al. [15] reported that the incidence of bleeding episodes in HA-mTPE patients with liver failure was 13.7%, and 1.3% of treatments were interrupted due to bleeding episodes. In our present study, 32 patients with liver failure were treated with 57 mTPE (Appendix). Among the included patients, the incidence of bleeding episodes was 26.9% in HA-mTPE. Although the dose of heparin in our center was lower than that reported by Yuan et al. (the first dose was 2500UI, and the additional dose was 50UI/h), the incidence of bleeding episodes was about twice as high. Due to the small sample size, our results may be biased. Furthermore, the former excluded patients with active bleeding before starting the study, which is also a crucial reason.
Simple and feasible detection of hepatitis a virus using reverse transcription multienzyme isothermal rapid amplification and lateral flow dipsticks without standard PCR laboratory
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2023
Mao-ling Sun, Yang Zhong, Xiao-na Li, Jun Yao, Yu-qing Pan
Hepatitis A virus (HAV), classified as hepatovirus, is a small, unenveloped symmetrical RNA virus. It belongs to the micro ribonucleic acid viruses and is the cause of infectious or epidemic hepatitis [1]. HAV spreads through the fecal-oral route and is commonly contracted by ingesting food or water contaminated with the faeces of infected patients and vegetables fertilised with faeces and uncooked shellfish [2–4]. In developing regions, the source pollution of primary and processed agricultural products is still a serious problem. Although, the infection of HAV is more common in developing countries, an increased number of HAV cases has been reported in developed countries [5]. In developed cities, food may also be contaminated by unkilled HAV virus [6]. A 2019 HAV-mediated outbreak in the United States was linked to imported fresh blackberries [7]. HAV infections cause nausea, vomiting, abdominal pain, jaundice, fever, and diarrhoea [8]. Approximately 10 to 15% of infected patients will have recurring symptoms within six months of the initial infection. In severe cases, acute liver failure may be life-threatening [9]. Moreover, HAV infections during community-based, person-to-person outbreaks cannot be ignored [10].
Efficacy and safety of plasmapheresis without plasma transfusion tandem with chemotherapy to treat multiple myeloma
Published in Hematology, 2022
Yigang Guo, Lulu Zhang, Rongyao Zhang, Meiling Zhou, Xu Chen, Chucheng Wan, Ping Hu, Yuanyuan He, Hua Jiang, Wei Geng, Weixing Zhang, Fariha Kanwal, Muhammad Fayyaz ur Rehman, Zhangzhi Li
Newly diagnosed multiple myeloma (MM) was analyzed in 72 patients from April 2019 to April 2021 in the Taihe Hospital of Shiyan City, China. Seventeen patients with severe heart, lungs, liver failure and other reasons were excluded from 89 patients suffering from MM. Severe heart condition include ACS, middle or severe valvular disease; CHF, BNP UP 1000 ng/L, EF under 50. Severe lung disease was defined as PO2 under 60 mmol/L AND/OR PCO2, 45 mmol/L. Pulmonary edema, pneumonia and/or fever. Liver failure include patients with Cirrhosis /heavy hepatitis. All patients were informed about procedures regarding disease diagnosis, treatment standards for bone marrow cytology, bone marrow biopsy, bone marrow flow analysis, hematuria immunofixation electrophoresis, necessary imaging (MRI/ CT/ X-ray), electrocardiogram, cardiac color Doppler examination evaluation and consent was obtained. The control group patients have a lower risk factors; the experimental group have higher globular proteins, more severe impairment of renal functions, but after four courses of above treatment, an effective evaluation not inferior to the control group was observed. We want to propose plasmapheresis without plasma can benefit MM patients with higher globular proteins and impaired renal function.