Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During the last 20 years there has been much interest in nutritional treatment for patients with advanced cirrhosis. Most studies have measured the potential benefit of nutritional supplements of dietary proteins, generic protein hydrolysates, or specific branched-chain amino acid (BCAA)-enriched formulas in regard to nutritional parameters and hepatic encephalopathy. The issue is not definitively settled; data are conflicting and meta-analyses have failed to produce unequivocal results. A consensus review, recently produced under the auspices of the European Society for Parenteral and Enteral Nutrition, concluded that: (1) patients with cirrhosis tend to be hypermetabolic, and a higher-than-normal supply of dietary proteins is needed to achieve nitrogen balance; (2) most patients tolerate a normal or even increased dietary protein intake, without risk of hepatic encephalopathy; (3) a modified eating pattern, based on several meals and a late evening snack, is useful; (4) in severely malnourished patients, amino acid supplements may be considered to provide the necessary amount of proteins to meet protein requirements; (5) in a few patients intolerant to the required protein intake, BCAA supplements may be considered to provide the necessary nitrogen intake without detrimental effects on the mental state, perhaps even improving it. Future studies are needed to quantify the advantage of nutritional support with amino acids or BCAA supplements on overall well-being, complications, and ultimately survival with a long-lasting disease where self-perceived health-related quality of life is a major outcome.
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PMID:Nutritional treatment with branched-chain amino acids in advanced liver cirrhosis. 1077 7

Coagulopathy in patients with liver disease results from impairments in the clotting and fibrinolytic systems, as well as from reduced number and function of platelets. Parenteral vitamin K replacement corrects coagulopathy related to biliary obstruction, bacterial overgrowth, or malnutrition. Vitamin K is less effective for coagulopathy caused by severe parenchymal liver injury. Transfusion of fresh frozen plasma is the hallmark of treatment of significant coagulopathy in patients with liver disease and active bleeding. Transfusion of fresh frozen plasma also reverses moderate to severe coagulopathy of cirrhosis prior to invasive procedures. Cryoprecipitate is useful for severe coagulopathy with hypofibrinogenemia, especially when avoidance of volume overload is desired. Exchange plasmapheresis is useful in selected patients with coagulopathy due to liver disease, in whom fresh frozen plasma fails to correct coagulopathy or in patients who have coexistent severe fluid overload. Platelet transfusions, pooled or single donor, are useful in thrombocytopenic patients prior to performing invasive procedures or in the presence of significant bleeding, especially when the platelet count is below 50,000/mL. The use of recombinant factor VIIa and thrombopoietin therapy for correction of coagulopathy and thrombocytopenia, respectively, in patients with cirrhosis, is currently under investigation. Therapy with prothrombin complex concentrates, 1-deamino-8-d-arginine vasopressin and antithrombin III concentrates for the management of coagulopathy caused by liver disease can be hazardous and the use of these products is considered investigational at the present time.
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PMID:Coagulopathy of Liver Disease. 1109 2

Parenteral nutrition represents standard therapy for children with short bowel syndrome and other causes of intestinal failure. Most infants with short bowel syndrome eventually wean from parenteral nutrition, and most of those who do not wean tolerate parenteral nutrition for protracted periods. However, a subset of children with intestinal failure remaining dependent on parenteral nutrition will develop life-threatening complications arising from therapy. Intestinal transplantation (Tx) can now be recommended for this select group. Life-threatening complications warranting consideration of intestinal Tx include parenteral nutrition-associated liver disease, recurrent sepsis, and threatened loss of central venous access. Because a critical shortage of donor organs exists, waiting times for intestinal Tx are prolonged. Therefore, it is essential that children with life-threatening complications of intestinal failure and parenteral nutrition therapy be identified comparatively early, i.e. in time to receive suitable donor organs before they become critically ill. Children with liver dysfunction should be considered for isolated intestinal Tx before irreversible, advanced bridging fibrosis or cirrhosis supervenes, for which a combined liver and intestinal transplant is necessary. Irreversible liver disease is suggested by hyperbilirubinemia persisting beyond 3-4 months of age combined with features of portal hypertension such as splenomegaly, thrombocytopenia, or prominent superficial abdominal veins; esophageal varices, ascites, and impaired synthetic function are not always present. Death resulting from complications of liver failure is especially common during the wait for a combined liver and intestinal transplant, and survival following combined liver and intestinal Tx is probably lower than following an isolated intestinal transplant. The incidence of morbidity and mortality following intestinal Tx is greater than that following liver or kidney Tx, but long-term survival following intestinal Tx is now at least 50-60%. It is probable that outcomes shall improve in the future with continued refinements in operative technique and post-operative management, including immunosuppression.
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PMID:Indications for pediatric intestinal transplantation: a position paper of the American Society of Transplantation. 1132 44

Hepatitis C virus is an RNA virus belonging to the Flaviviridae family. The diagnosis of hepatitis C virus infection was based on the detection of serum antibody to hepatitis C virus (anti-HCV) using immunoassay or recombinant immunoblot assay, or the direct detection of serum hepatitis C virus RNA using polymerase chain reaction. The anti-HCV positive rate in the general population or healthy blood donors is 0.5% to 4% worldwide. Parenteral transmission was the major route of hepatitis C virus infection. High-risk groups for hepatitis C virus infection included recipients of blood transfusion of which the blood donors were not screened for anti-HCV, intravenous drug abusers, hemophiliacs, and patients who have received hemodialysis. More than 80% of patients with hepatitis C virus infection progressed into chronicity, 20% to 30% of patients with chronic hepatitis C progressed to cirrhosis after 10 to 20 years of follow-up, and some developed hepatocellular carcinoma. Hepatitis C virus was the most common cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma in Western countries and in Japan, where hepatitis B virus is not endemic. Interferon therapy at a dosage of 3 MU and subcutaneous injection 3 times per week for 6 months normalized serum transaminase in 50% of patients with chronic hepatitis C at the end of treatment. However, the relapse rate was high and only 20% to 25% of patients sustained response 1 year after discontinuing therapy. Prolonged interferon therapy up to 12 to 18 months has been suggested to improve interferon efficacy by decreasing the relapse rate and thus increasing the sustained response rate. New interferon preparation such as consensus interferon and long-acting pegylated-interferon has recently shown better treatment response than the traditional interferon regimen. The combined regimen of interferon and ribavirin was shown to have better efficacy than interferon alone in treating patients with chronic hepatitis C.
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PMID:Hepatitis C virus infection: an overview. 1182 1

Patients with cirrhosis develop metabolic derangements of protein, carbohydrate, and lipid metabolism. Malnutrition is commonplace and is associated with morbidity and mortality. Specific nutrient deficiencies may occur and enteral or parenteral nutritional support may improve outcome in appropriately selected patients. Parenteral nutrition itself has been associated with hepatic dysfunction, although the preponderance of evidence suggests that hepatic dysfunction is more a function of the underlying disorder and malabsorption. Intravenously infused organic nutrients may be metabolized differently than the same nutrient consumed enterally. The pathophysiology of total parenteral nutrition-associated liver disease is discussed as well as potential management options.
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PMID:Total parenteral nutrition: challenges and practice in the cirrhotic patient. 1690 40

Parenteral nutrition is a life-saving treatment for patients who have acute and chronic intestinal failure. Severe cholestasis induced by total parental nutrition (TPN-IC) is characterized by bile duct regeneration, portal inflammation, and fibrosis. Its progression could be very rapid, and in some patients liver cirrhosis may develop in few months. This article describes the definition, incidence, hepatic changes, histopathologic findings, risk factors, pathogenesis, and clinical implications of TPN-IC. The goal is to improve hospital and home management, quality of life, and prognosis of patients requiring parenteral nutrition.
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PMID:Cholestasis induced by total parenteral nutrition. 1824 99

Hepatitis C virus (HCV) infection is widely prevalent world-wide particularly in high-risk individuals including patients on hemodialysis (HD). Parenteral route seems to be the main route of transmission of this infection though other routes also exist. The high prevalence of HCV infection in patients on HD who have never received blood transfusions points to the dialysis machine as one of the likely sources of transmission of infection. The reported prevalence of anti-HCV in patients on HD in Saudi Arabia is about 68%. The natural history of HCV shows a tendency to progress to chronic liver disease including chronic active hepatitis, cirrhosis and hepatocellular carcinoma. The prevalence of anti-HCV in the general population varies from 0.5 to 3% and thus vigorous screening should be applied to all potential blood donors. A policy of public health education should be designed and implemented on the general public and health workers to reduce the non-parenteral spread of HCV. Separate HD machines should be considered for patients who are anti-HCV positive. Such preventive measures are vital because treatment of HCV with interferon has met with mixed success so far.
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PMID:Hepatitis C virus infection: an update. 1858 47

Parenteral and community-acquired routes of contamination sanguins of hepatitis B virus (HBV) explain its frequency (9 to 20%) in dialysis patients and kidney recipients. In dialysis, HBV infection has few impact on morbidity and mortality; by contrast, in kidney recipients HBV: 1. reduces the allograft survival; 2. the patients survival in association with a frequent and rapid evolution to cirrhosis and hepatocellular carcinoma or rare cholestatic fibrosis. Finally, cirrhosis contra-indicates renal transplantation alone given its poor short-term prognosis and a combined liver-kidney transplantation has to be discussed. Thus, it is necessary to evaluate the liver severity of the liver disease. The treatement of HBV in allograft recipients and dialysis is based on nucleos(t)idic analogues like in the general population with the same advantages and questions. The variations of the immune status either in an HBV-infected patients at the induction or at the reduction of chemotherapies (solid tumors or hemopathies) or allograft transplantation may result in two, potentially severe, events in miror: a reactivation or a spontaneous discontinuation of viral replication (seronconversion). These risks evidence that any HBs Ag carrier exposed to immune suppression has to be diagnosed, evaluated for viral replication and underlying liver disease and has to be treated by a so-called pre-emptive treatment based on analogues.
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PMID:[Chronic hepatitis B: unusual situations: dialysis, renal transplantation and pre-emptive therapy in immune compromised patients]. 1866 8

Parenteral nutrition associated liver disease (PNALD) is an important problem in patients who require longterm parenteral nutrition as well as in preterm infants. Prevalence varies according to different series. Clinical presentation is different in adults and infants. Although since its first descriptions several hypothesis have been elucidated, the aetiology is not quite clear. It is possible that different factors could be involved. PNALD risk factors can be classified in three groups: 1) those derived from the lack of enteral nutrition stimulus; 2) parenteral nutrition components acting as toxic or the lack of specific nutrients and 3) those due to the underlying disease. If PNALD appears in short-term PN and it presents only as a mild elevation of liver enzymes, there is no need to treat. On the contrary, when direct bilirubin is > 2 mg/dL and lasts longer, there is a need to consider different causes and to minimize risk factors. We review the different approaches to manage PNALD, including optimizing enteral nutrition, modify parenteral solutions, use of specific nutrients -taurine, choline, etc.- or the use of drugs (mainly ursodeoxicolic acid). If liver disease progresses to cirrhosis a liver transplant must be considered.
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PMID:[Parenteral nutrition-associated liver disease]. 1871 8

To evaluate if hypomagnesemia, at the time of admission in the Intensive care Unit (ICU), is associated with a higher mortality in critically ill patients with type 2 diabetes. Fourteen consecutive critically ill patients with type 2 diabetes admitted in the ICU of a teaching General Hospital serving an inner city population were enrolled in a follow-up study. Parenteral or enteral nutritional support, surgical procedures, malignancy, traumatism or physical injury, pulmonary and/or cardiovascular diseases, chronic renal failure, hepatic cirrhosis, cerebrovascular disease, and disorders of the thyroid gland, were exclusion criteria. Hypomagnesemia was defined by serum magnesium levels < 0.66 mmol/L (1.6 mg/dL). At the time of admission in the ICU, 10 (71.4%) individuals had hypomagnesemia. Mortality rates in the hypomagnesemic and normomagnesemic individuals were 80 and 25%, respectively. Serum magnesium levels were significantly lower in the subjects who died (0.51 [0.41, 0.62] mmol/L) compared with those who survived (0.85 [0.65, 1.11], mmol/L), p = 0.01. The logistic regression model adjusted by APACHE II score and hsCRP levels showed that hypomagnesemia is independently associated with mortality (OR 1.9, CI95% 1.2-14.7). Hypomagnesemia at the time of admission in the ICU seems to be associated with high mortality in critically ill patients with type 2 diabetes.
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PMID:Hypomagnesemia and mortality in patients with type 2 diabetes. 1900 19


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