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)

Extensive intrahepatic portal-hepatic venous anastomosis is very rare. This report describes a 47-year-old man with cirrhosis who presented with mental confusion and flapping tremor, and in whom percutaneous transhepatic portography and superior mesenteric angiography demonstrated shunting between the portal vein branches and the right hepatic vein. Measurements of pressure, ammonia, and immunoreactive insulin in blood of the portal and right hepatic veins clearly indicated that a large amount of portal vein blood was being shunted into the right hepatic vein. These findings suggest that hepatic encephalopathy in this patient is accounted for at least in part by an intrahepatic portal-hepatic venous shunting.
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PMID:Hepatic encephalopathy associated with extensive portal-hepatic venous shunts: a case report. 403 31

The Number Connection Test (NCT) by Harold O. Conn was tested for its usefulness for diagnosis and treatment control of portasystemic encephalopathy in out-patients. For this purpose in 30 patients with liver cirrhosis the time in the NCT was determined and the serum ammonia level (NH3) was measured before the treatment with lactulose and neomycin was started. Moreover, 12 clinical symptoms and 10 laboratory parameters were tested for correlation with the NCT-time. We found a positive correlation between the NCT-time and NH3 serum level. For the prediction of the NCT-time the multiple linear regression yielded the combination of NH3 with the proof of ascites and palmar erythema as the best subset of predictor variables. By means of the NCT the effectiveness of the treatment with lactulose and neomycin was demonstrated. We recommend the NCT for the clinical routine in particular for the early diagnosis and for treatment control of portasystemic encephalopathy in patients with liver cirrhosis.
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PMID:[Ambulatory diagnosis and therapy control of portasystemic encephalopathy in patients with liver cirrhosis]. 409 54

The oral administration of short (C(6)) and medium (C(8) and (C(10)) chain triglycerides produced no clinical or electroencephalographic changes in patients with cirrhosis of the liver. Arterial ammonia levels were also monitored in these patients and showed no significant change after medium chain triglycerides. It was concluded that medium chain triglycerides, known to be of potential value in the treatment of malabsorption in patients with cirrhosis, are not clinically contraindicated, even in patients with evidence of hepatic encephalopathy.
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PMID:Medium chain triglycerides and hepatic encephalopathy. 484 Dec 75

Plasma levels of tyrosine were assayed in the fasting state and after oral administration of either tyrosine (tyrosine tolerance test) or phenylalanine (phenlyalanine conversion test) in normal subjects and in patients with hepatitis, biliary obstruction, or cirrhosis. Fasting tyrosine levels tended to be slightly increased in patients with hepatitis and biliary obstruction and markedly increased in patients with cirrhosis. Tyrosine tolerance tests in patients with cirrhosis were characterized by larger than normal increments in tyrosine levels and by delayed returns toward fasting levels. The results of phenylalanine conversion tests were abnormal in approximately one-half of patients with either hepatitis or biliary obstruction and four-fifths of patients with cirrhosis. Abnormalities were characterized by elevated fasting plasma tyrosine levels, or small and delayed increments in tyrosine levels, or both. Abnormal phenylalanine conversion test results in patients with cirrhosis did not correlate closely with any clinical feature of cirrhosis or with the results of any standard liver function test; there was positive correlation only with abnormal ammonia tolerance, a test of portalsystemic shunting. Tests of tyrosine metabolism do not appear to be useful for routine clinical assessment of liver function. Tyrosine tolerance tests and phenylalanine conversion tests done for purposes of diagnosis of other diseases may yield misleading results in patients with liver disease.
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PMID:Tyrosine metabolism in patients with liver disease. 607 4

Propranolol (20 mg 4 times a day) was given to patients with liver cirrhosis or fatty infiltration of the liver. In six patients with cirrhosis and a stable arterial plasma ammonia concentration before treatment, blood ammonia was increased significantly on day 3 of propranolol treatment. Arterial plasma ammonia concentration was still high on day 6 of propranolol. Individual percentage change in arterial ammonia ranged from 8% to 66%. After propranolol had been discontinued ammonia concentration returned to pretreatment concentrations in 3 to 6 days. In 3 patients with fatty livers and normal pretreatment ammonia concentrations no change was detected in arterial plasma ammonia while they were on propranolol.
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PMID:Propranolol increases arterial ammonia in liver cirrhosis. 612 60

Serum levels of GABA (gamma-aminobutyric acid)-like activity were measured by a radioreceptor assay in 22 healthy subjects and 170 patients with liver diseases. Levels were within normal limits (mean +/- SEM in healthy controls 0.52 +/- 0.04 mumol/l; range 0.2-0.8 mumol/l GABA equivalents) in most patients with uncomplicated acute viral hepatitis, compensated chronic hepatitis, and primary biliary cirrhosis (PBC). In 96% of patients with compensated (non-PBC) cirrhosis levels were slightly high (1.5 +/- 0.06 mumol/l). In 4 patients with decompensated cirrhosis but without hepatic encephalopathy (range 3.0-6.4 mumol/l) and in most of 26 patients with overt hepatic encephalopathy due to acute or chronic hepatocellular failure (range 2.3-18.0 mumol/l) levels were very high. Levels did not correlate closely with the clinical stage of hepatic encephalopathy or with arterial plasma ammonia concentrations. particularly high levels were detected in patients with cirrhosis 12-16 h after gastrointestinal haemorrhages. These findings are compatible with the hypothesis that the GABA neurotransmitter system is involved in the pathogenesis of hepatic encephalopathy in man.
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PMID:Serum levels of gamma-aminobutyric-acid-like activity in acute and chronic hepatocellular disease. 613 47

Significant elevation of glutamic acid and glutamine concentrations in CSF was observed in hepatic encephalopathic patients with fulminant hepatitis and liver cirrhosis. However, the ratios of CSF glutamic acid to CSF glutamine levels and of CSF to serum glutamic acid and glutamine levels were significantly higher only in cirrhotic patients with hepatic encephalopathy. CSF glutamine levels were positively correlated with blood ammonia and CSF tyrosine levels in cirrhotic patients. The results indicate that CSF glutamic acid and glutamine levels are important tools in diagnosing hepatic encephalopathy in severe liver disease.
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PMID:Glutamic acid and glutamine levels in serum and cerebrospinal fluid in hepatic encephalopathy. 615 Jul 6

Hospitalized patients with hepatic insufficiency often suffer from severe catabolic states and are in urgent need of nutritional support during their acute illness. Protein intolerence, however, remains a significant problem with respect to the provision of adequate nutrition, either enterally or parenterally. The following report is an anecdotal series of 63 consecutive patients in a large urban hospital treated prospectively with nutritional support using a prototype high branched-chain amino acid solution (FO80) given by technique of total parenteral nutrition by the subclavian or internal jugular route with hypertonic dextrose. Sixty-three patients, of which 42 had chronic liver disease (cirrhosis) with acute decompensation and 17 with acute hepatic injury as well as four with hepatorenal syndrome, are the subject of this report. All required intravenous nutritional support and were either intolerant to commercially available parenteral nutrition solutions or were in hepatic encephalopathy at the time they were initially seen. The cirrhotic patients had been hospitalized for a mean of 14.5 +/- 1.9 days before therapy, had a mean bilirubin of 13 mg/100 ml, and had been in coma for 4.8 +/- 0.7 days despite standard therapy. Patients with acute hepatitis had been in the hospital for 16.2 +/- 4.1 days before therapy, had a mean bilirubin of 25 mg/100 ml, and had been in coma 5.2 +/- 1.6 days before therapy. Routine tests of liver function, blood chemistries, amino acids, EEGs, and complex neurological testing including Reitan trailmaking tests were used in the evaluation of these patients. Up to 120 grams of synthetic amino acid solution with hypertonic dextrose was tolerated in these patients with improvement noted in encephalopathy of at least one grade in 87% of the patients with cirrhosis and 75% of the patients with hepatitis. Nitrogen balance was achieved when 75 to 80 grams of synthetic amino acids were administered. Survival was 45% in the cirrhotic group and 47% in the acute hepatitis group. Encephalopathy appeared to correlate with individual amino acids differentially in the various groups and with the ratio between the aromatic and the branched-chain amino acids. Ammonia did not correlate with either the degree of encephalopathy or improvement therefrom. In 24 Patients therapy for hepatic encephalopathy was limited to infusion of the branched-chain enriched amino acid solution only, with wake-up in 66% of this group. The results strongly suggest that in protein intolerant patients requiring nutritional support, infusion with branchedchain enriched amino acid solutions is well tolerated with either no worsening of or improvement in hepatic encephalopathy coincident with the achievement of nitrogen equilibrium and adequate nutritional support.
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PMID:Infusion of branched-chain enriched amino acid solution in patients with hepatic encephalopathy. 628 73

Effects of enteric coated polymyxin B capsules on hyperammonemia and endotoxemia in liver cirrhosis were investigated. Six million units of polymyxin B were orally administered daily to 21 patients with liver cirrhosis and 3 patients with hepatoma cum liver cirrhosis, whose plasma ammonia was higher than normal limit and/or whose plasma endotoxin was positive, for 5-32 days, and serum polymyxin B concentration (in 5 cases), changes of plasma ammonia level (in 19 cases) and plasma endotoxin (in all cases) were observed. Serum polymyxin B concentration was below the detectable limit (0.5 unit/ml) in all cases observed. In the patients with liver cirrhosis, plasma endotoxin and ammonia levels decreased rapidly after polymyxin B treatment, and the decreases in endotoxin levels were kept throughout the treatment. Twelve patients with liver cirrhosis (10 among them were treated with lactulose) were served as controls. All patients who were treated with lactulose alone showed rapid decrease in plasma ammonia, but the decrease in endotoxin in these patients was slower than that in those treated with polymyxin B. From these results, oral administration of polymyxin B is concluded to be useful in the treatment of hyperammonemia and endotoxemia in liver cirrhosis, as a poorly absorbed antibiotic and as an antiendotoxin agent.
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PMID:Enteric coated polymyxin B in the treatment of hyperammonemia and endotoxemia in liver cirrhosis. 629 48

Repeated plasmaphereses were done in 7 patients with acute hepatic failure (5 of them with coma stage IV and two with stage III). Acute liver insufficiency was induced by fulminant viral hepatitis in 4 cases, by drugs in one case, and was caused by a dystrophic exacerbation of liver cirrhosis in two further cases. Four of the 7 treated patients have survived. Beginning improvement of hepatic function was evidenced by an increase of factor VII and prothrombin in plasma. Significant lowering of bilirubin could be observed in all cases. While ammonia values decreased continuously in the four successfully treated patients while on plasmapheresis, the opposite behaviour was observed in the decreased patients. The influence of plasmapheresis on the pathologically altered aminoacid pattern in hepatic coma was investigated in two patients: Before treatment clearly to excessively increased values of methionine and aromatic aminoacids (phenylalanine and tyrosine) were seen. Branched-chain aminoacids leucine, isoleucine and valine were normal to moderately decreased. After termination of plasmapheresis methionine and aromatic aminoacids were significantly lower, branched-chain aminoacids were slightly below the initial values. Improvement of consciousness correlated with increase of the quotient (val+leu+ile)/(phe+tyr).
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PMID:[Treatment of acute liver failure by plasmapheresis]. 640 57


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