Acitretin
Sarah H. Wakelin, Howard I. Maibach, Clive B. Archer in Handbook of Systemic Drug Treatment in Dermatology, 2015
Extra caution should be taken when acitretin is prescribed in the following: Liver dysfunction.Severe renal dysfunction (elimination reduced).Hyperlipidaemia.Alcohol dependency.History of pancreatitis.Diabetes (glucose tolerance may be impaired).Obesity.Arteriosclerosis.Contact lens use.Serious disorders of the retina.
Drug-Resistant Tuberculosis
Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies in Clinical Tuberculosis, 2020
Patients with significant chronic liver disease should not receive pyrazinamide. Ethionamide, prothionamide, and PAS can also be hepatotoxic while the fluoroquinolones are rarely implicated in hepatitis. Essentially, all second-line drugs may be used in chronic stable liver disease, but close monitoring of liver enzymes is mandatory and significant deterioration in liver function should trigger immediate withdrawal of the offending drug. The source of other causes of liver dysfunction, including viral hepatitis and alcohol consumption, should be addressed and treated to prevent further complications during treatment. A combination of four non-hepatotoxic drugs should ideally be used when formulating a regimen in patients with chronic liver dysfunction, including a fluoroquinolone, to ensure the efficacy of the regimen.207
HPB Surgery
Tjun Tang, Elizabeth O'Riordan, Stewart Walsh in Cracking the Intercollegiate General Surgery FRCS Viva, 2020
A 65-year-old male, with history of non-alcoholic steatohepatitis (NASH), presents with weight loss, loss of appetite and vague discomfort over the right upper quadrant. On examination, he is mildly jaundiced and has hepatomegaly. How would you investigate this patient?This patient is at risk for liver dysfunction and also development of hepatocellular carcinoma (HCC). A thorough history looking at other possible causes of liver disease needs to be elucidated and this includes alcohol intake, and also of hepatitis B and/or C exposure including at-risk behaviour.The important blood investigations here would be the liver function panel to determine his current status and also alphafoetoprotein (AFP) for possible HCC. As a good number of patients with HCC have normal AFP levels, I would also request for imaging to look for tumour in the liver and the ultrasound (US) is a simple, quick and cost-effective initial modality for this purpose. Any suspicious findings on US would lead me to proceed on to either a triphasic CT or an MRI of the liver depending on availability and cost considerations.
Update on diagnosis and treatment of immune thrombocytopenia
Published in Expert Review of Clinical Pharmacology, 2021
Rajeev Sandal, Kundan Mishra, Aditya Jandial, Kamal Kant Sahu, Ahmad Daniyal Siddiqui
Eltrombopag is a non-peptide oral drug approved for chronic ITP and is generally started at dose of 50 mg once daily (maximum 75 mg/day). The patients with Asian ethnicity can be started at a lower dose (25 mg once daily) [89,90]. It should be taken 2 hours before or 4 hours after meals and drugs which contain polyanions (calcium supplements, antacids), for its maximum absorption [91].Platelet count starts increasing after 1–2 weeks of therapy. In previous studies, 40%-80% of ITP patients were able to achieve the target platelet count. After discontinuation, 10–30% ITP patients continued to remain in remission [76,90–93]. Short-term side effects include thrombocytosis, gastrointestinal discomfort, headache, and liver dysfunction. Liver function tests should be monitored regularly in patients on eltrombopag. Long-term and rare side effects include thrombosis, hepatic, and bone marrow fibrosis [91,94]. Some studies have shown worsening of renal failure when it is used in patients with systemic lupus erythromatous [95]. Other studies did not show any major safety concern with the drug [94,96].
Toll-Like Receptors -2, -3, -4 and -7 Expression Patterns in the Liver of a CLP-Induced Sepsis Mouse Model
Published in Journal of Investigative Surgery, 2020
Chrysostomos V. Aravanis, Alkistis Kapelouzou, Stylianos Vagios, Diamantis I. Tsilimigras, Michalis Katsimpoulas, Demetrios Moris, Theano D. Demesticha, Dimitrios Schizas, Alkiviadis Kostakis, Anastasios Machairas, Theodore Liakakos
In our experiment, the septic groups were generated following application of the CLP procedure, which has been thought to help in the understanding of sepsis complex mechanisms. CLP is thought to represent a well-established animal model which largely mimics human response.6,21 With the progression of sepsis, the mice undergoing the CLP procedure showed a gradual deterioration of their liver function with reference to the constant elevation of bilirubin and transaminase levels. Hepatic dysfunction in sepsis could be a result of either systematic bacteremia or even just portal endotoxemia- when failed gut-barrier is the cause or outcome of sepsis and allows bacterial translocation from the intestine into the portal circulation.7 This could explain the gradual equalization of the TLRs expression in the liver and intestine tissues in our findings. The pathophysiology, however, of liver dysfunction is still poorly understood and according to the current knowledge it could be the result either of hemodynamic alterations or cellular and immunological changes.
Identifying areas of improvement in nursing knowledge regarding hepatic encephalopathy management
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Aalam Sohal, Victoria Green, Sunny Sandhu, Marina Roytman
Hepatic encephalopathy (HE) is defined as a reversible brain dysfunction caused by liver insufficiency and/or portosystemic shunting [1]. Hepatic encephalopathy occurs as a complication of advanced liver disease or acute liver failure (ALF). In developed countries, the causes of advanced liver disease include excessive alcohol intake, non-alcoholic fatty liver disease (NAFLD), chronic viral hepatitis and autoimmune diseases [2]. Drug-induced liver injury due to acetaminophen overdose accounts for the majority of the cases of ALF in the developed world. Other causes of ALF include acute viral hepatitis, ischemic liver injury from septic shock or circulatory failure [3] With the world-wide rise in obesity and metabolic syndrome, non-alcoholic steatohepatitis (NASH) cirrhosis is expected to increase and as a result increase in the incidence of hepatic encephalopathy.
Related Knowledge Centers
- Fasciola Hepatica
- Hepatitis
- Hepatotoxicity
- Liver Fluke
- Viral Hepatitis
- Chronic Liver Disease
- Liver
- Micrograph
- Metabolic Dysfunction–Associated Steatotic Liver Disease
- Fasciolosis