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Chronic Liver Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Julia M. Boster, Kelly A. Klaczkiewicz, Shikha S. Sundaram
Autoimmune hepatitis (AIH) is a progressive, immune-mediated inflammatory condition of the liver. There is a wide spectrum of presentation for AIH, including asymptomatic transaminase elevation; elevated transaminases associated with malaise, fever, rash, arthritis, abdominal pain, and gradual onset of jaundice; acute liver failure; or end-stage liver disease with complications of cirrhosis such as ascites and gastrointestinal bleeding. AIH should be suspected in patients with elevated transaminases, elevated IgG, and positive autoantibodies, especially if there is a personal or family history of autoimmunity. The diagnosis of AIH is confirmed by liver biopsy. AIH is treated with long-term immunosuppressive medications. Liver transplantation may be required in medication-refractory or clinically advanced disease.
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.
Immunomodulating Agents in Gastrointestinal Disease
Published in Thomas F. Kresina, Immune Modulating Agents, 2020
Samir A. Shah, Athos Bousvaros, A. Christopher Stevens
Azathioprine (AZA) and 6-mercaptopurine (6MP) are purine derivatives that are incorporated into DNA and inhibit DNA synthesis. Azathioprine is metabolized in vivo to 6-mercaptopurine by a nonenzymatic nucleophilic attack by sulfhydral-containing compounds (e.g., glutathione) and its biological effects are identical to those of 6MP. Thus, both the mechanisms of action and the toxicities of these drugs are identical. Both drugs are useful in the treatment of liver transplantation rejection, as well as in the therapy of inflammatory bowel disease and chronic active autoimmune hepatitis.
Health care costs related to hepatitis B in Finland are mostly due to chronic infections: a register-based study
Published in Infectious Diseases, 2022
Tanja Nieminen, Heini Salo, Markku Nurhonen, Tuija Leino
However, our study also has some limitations. We could not separate compensated and decompensated cirrhosis nor inactive and active chronic hepatitis B in our evaluations as has been done elsewhere [20–22]. We excluded the liver transplantation costs from this study due to small number of performed hepatitis B-related liver transplantations in Finland. We restricted the analyses of antiviral medication to chronic disease and did not account for acute hepatitis B as the vast majority of newly infected adults recover spontaneously [23,24]. Furthermore, we restricted the evaluation of costs related to chronic hepatitis B, liver cirrhosis, and liver cancer to 15, 7, and 2 years, respectively, since register data were not available from each individual from the detection of the disease until death. We based these periods of time on the register data and the typical progression of diseases. For instance, 65% of the hepatitis B-related liver cancer cases died from cancer within 2 years of the cancer detection. Instead, chronic hepatitis B is a persistent disease [5]. In addition, we estimated the average health care resource use by hepatitis B-related outcome of those individuals with valid IDs and full follow-up time excluding those individuals with overlapping health care resource use due to other hepatitis B-related outcome or liver transplantation (Supporting Information, Figure S1). Nevertheless, the estimates on the total annual health care costs were based on the average number of cases in 2004–2012.
Importance of daptomycin dosage on the clinical outcome in liver transplant recipients with vancomycin-resistant enterococci infection
Published in Journal of Chemotherapy, 2022
Ing-Kit Lee, Yi-Ping Sng, Wei-Feng Li, Chao-Long Chen, Chih-Chi Wang, Chih-Che Lin, I-Ling Chen
Altogether, 428 patients who underwent liver transplantation were identified during the study period. Among them, 22 (5.1%) patients (median age: 60.5 years [range: 1–67 years]) who developed VRE colonization/infection were included in the analysis. All patients with VRE colonization/infection had undergone transplant for the first time. Twenty patients underwent living-donor liver transplantation and two underwent transplantation from deceased donors. The three leading causes of liver disease were hepatocellular carcinoma, hepatitis B infection and hepatitis C infection. Among the 22 patients with VRE colonization/infection, 2 (9%) patients acquired VRE in the pre-transplant period, 16 (72.7%) in the early post-liver transplant period and 4 (18.1%) in the late post-liver transplant period. VRE colonization was observed in three patients in the early post-liver transplant period and in two patients in the late post-liver transplant period. Two patients acquired VRE infection while they were on the waiting list for a liver transplant. However, none of them developed VRE infection after transplantation. One patient had two episodes of VRE infection within a 3-month span during the late post-liver transplant period. Four out of 22 patients died, including three deaths in the early post-liver transplant period and one death in the late post-liver transplant period, resulting in a mortality rate of 18.2% (Table 1).
The Qualitative Value of Social Support for Liver Transplantation
Published in The American Journal of Bioethics, 2019
The true extreme demands of liver transplantation happen to the minority of patients who have complicated postoperative courses, spend weeks to months in the intensive care unit, and have to build themselves back up from nothing through rehabilitation; learning to walk, talk, and eat again. These are the patients who need the strong emotional component of social support. They need their family and friends to be with them, encourage them, push them and support them through the intense recovery process. They also need adequate preoperative physical functioning and reserve, which is why frailty in liver transplantation has become such an important predictive tool (Lai et al. 2019). Frail patients who have severe complications do not have the physical reserve to rebound. Likewise, unsupported patients who have severe complications do not have the emotional support reserve to rebound.