Hepatitis hipóxica / Hypoxic hepatitis

Hypoxic hepatitis (HH), or ischemic hepatitis occurs in the context of cardiac, circulatory or respiratory failure and is characterized by a sharp increase in serum aminotransferase levels due to anoxic necrosis of centrilobular liver cells. It is frequently observed in the ICU and has been associated to increased patient morbidity and mortality. Hepatic ischemia in the presence of a shock state is the main hemodynamic mechanism. However, other hemodynamic mechanisms of hypoxia, such as hepatic passive congestion, arterial hypoxemia and tissue dysoxia play an important role. Shock state is observed in only 50 percent of the cases. HH therapy of depends primarily on the nature of the underlying condition. Patients with HH have poor prognosis with more than 50 percent of mortality during the hospital stay.

Hepatitis hipóxica (HH) o hepatitis isquémica se presenta en el contexto de insuficiencia cardíaca, respiratoria o circulatoria y se caracteriza por aumento brusco de transaminasas debido a la necrosis por anoxia de las células centrilobulillares del hígado. La HH es frecuente en UCI y está asociada a un aumento en la morbilidad y mortalidad. La isquemia hepática por un estado de shock es la principal causa. Sin embargo, mecanismos de hipoxia como la congestión pasiva del hígado, hipoxemia arterial y disoxia tisular juegan un importante rol. Se shock observa en sólo 50 por ciento de los casos. El tratamiento depende primariamente de la causa subyacente. Los pacientes con HH tienen un mal pronóstico con más de 50 por ciento de mortalidad intrahospitalaria.

Acute Hepatitis Like Presentation of Budd Chiari Syndrome in a Child.

The patient presented with progressively increasing ascites and pain abdomen but without any bleeding tendency, or encephalopathy. The initial diagnosis of acute hepatitis was proved wrong by contrast enhanced CT scan of abdomen which showed atretic hepatic veins. Atretic hepatic veins causing Budd Chiari Syndroem (BCS) is a rarity in literature.

[Evaluation of hepatitis in children]

The causes of hepatitis or increased liver enzymes which follow liver cells [hepatocytes] are numerous. They vary from a temporary asymptomatic viral disease to a serious chronic liver disease that needs more attention and follow up. In a child with hepatitis, primary lab data including CBC, U/A, ALT, AST and PT are needed. According to the early clinical and paraclinical evaluation, hepatitis can be divided to cytotoxic and cholestatic types. In this paper, we suggest the appropriate approach for diagnosis and treatment of each type of hepatitis. Paying attention to this suggested approach will help physicians to do best in the management of their patients

comparison of treatments offered to patients with nonalcoholic steatohepatitis

To compare various treatment options provided to patients with Nonalcoholic Steatohepatitis [NASH] and assess improvement in liver status via reduction in serum Alanine Aminotransferase [ALT] levels. Study Design: Retrospective cohort study. The Aga Khan University Hospital, Karachi, from April 2000 to April 2007. Methodology: All available records of patients aged between 20-70 years, fatty liver on ultrasound, elevated serum ALT and having at least one follow-up, after a baseline visit were included. The patients had variable number of follow-ups and a maximum of 3 follow-ups were considered. Information was collected on demographic and clinical characteristics of the subjects. The treatment options were categorized as weight reduction alone, with statins, and with other medications. Serum ALT level was the main outcome measured in IU/l. Repeated-measures ANOVA, using a mixed model approach was performed with treatment options as between subject factor, and follow-up as within subject factor and p-value < 0.05 was considered significant. Sixty-nine records of subjects, consisting of 50 males and 19 females were selected. The mean [ +/- SD] age was 40 +/- 12 years. Thirty-one subjects [45%] were advised weight reduction only, and experienced a 72% reduction in serum ALT levels, over the mean follow-up time of 9 +/- 3 months. Twelve subjects [17%] received statins along with weight reducing advice, and experienced a 56% reduction in mean ALT over the mean follow-up of 11 +/- 7 months. Twenty-six subjects [38%] received other medications along with advice for weight reduction and experienced a 73% reduction in serum ALT levels over the mean time of 10 +/- 4 months. The mean ALT declined at follow-up times, irrespective of the prescribed treatment, and that the decline with time was different for males and females. Serum ALT levels among patients with NASH decreased with time, regardless of the provided treatment, and the decrease was different for males and females

Influence of biphenyl dimethyl dicarboxylate [DDB] on social play behavior of young rats

Biphenyl Dimethyl Dicarboxylate [DDB] is a synthetic analogue of schisandrin C, a component of Fructus schisandrae. It is a widely prescribed agent for the improvement of liver function of hepatitis patients and has been recently proved to possess immunomodulatory properties. In our earlier work, DDB was shown to interfere with behavior. The present work was to assess the possible effect of DDB on the play behavior. The study was carried out on young Sprague Dawley Rats. DDB was administered orally for seven consecutive days [100mg/kg/day]. Animals were isolated for about 28hr before the day of the experiment. Each pair was placed in an aquarium glass cage where the play behavior of a pair of animals was recorded by a special Infrared Video Camera allowing super night shots, for 25 min. Three major categories were assessed, namely "play social behavior", "non-play social behavior" and "non-social behavior". DDB was found to affect the play behavior of the partner rat where the "pounce on" and "pinning" were significantly increased. Parallel changes in brain NE were found. In conclusion, DDB was shown to change the play behavior of the partner rat

Pharmacological and phytochemical investigations on moringa oleifera lam

Sahajna [Moringa oleifera Lam.] is a plant drug used in Unani System of Medicine since long. It is useful in the treatment of various diseases like paralysis, epilepsy, rheumatism, gout, pain, hepatitis, asthma, bronchitis, headache, and inflammatory conditions etc. The present paper is aimed to discuss the pharmacology and phytochemistry of the plant

L-Carnitine ameliorates immunological-induced hepatitis in rats

Immunological mediated hepatitis can be initiated by bacterial product; Lipopolysaccharide [LPS]. The later is increased during severe infection, bacterial overgrowth or translocation. LPS stimulates Kupffer cells. Activation of the kupffer cells contributes to the onset of liver injuries by producing and releasing cytotoxic agents, inflammatory cytokines and reactive oxygen species. In the present study, L-carnitine, a natural antioxidant and immunoprotective agent, is used to protect against LPS-induced hepatitis. Liver content of glutathione [GSH], malondialdehyde [MDA], nitric oxide [NO] and the DNA adduct S-hydroxydeoxyguanosine [8-HDG] are estimated. Serum activity of liver enzymes ALT, AST, and Gamma-GT, in addition to IL2 level are also estimated. Moreover, liver histopathological changes are determined. Results revealed that LPS [5mg/kg once i.p] significantly increased 8-HDG, MDA, NO and depleted GSH in the liver of the treated rats. It also, increased serum 1L2 and activity of all the estimated liver enzyme markers indicating massive hepatic cellular damage as also shown as a necrotic damage in liver histological sections. LCR administered [500 mg/kg] 3h before LPS protected against LPS-induced lethality by 100%. LCR also prevented the increase in liver content of 8-HDG, MDA and NO. It rescued the depleted GSH and prevented the necrotic damage in the liver tissue as shown by normalization of ALT, AST and Gamma-GT as well as IL2 and a remarkable improvement in liver histology. These data suggest that LCR could be used as an adjuvant therapy in severely infected and septic patients to counteract LPS-induced liver hepatitis

Impact of blood salvage during liver transplantation on reduction in transfusion requirements / Impacto do uso do cell saver na redução de transfusão sanguínea durante o transplante de fígado

PURPOSE: The aim of this study was to analyse the changes in transfusion requirements, in patients submitted to orthotopic liver transpantation from cadaveric donors, with the use of intraoperative red blood cell salvage (Cell Saver). METHODS: Data from 41 transplants were analysed. Intraoperative blood loss was calculated from the cell salvage, suction and the swabs. The autologous and heterologous transfusions were recorded The red blood salvage was performed using the Cell Saver 5 System (Haemonetics).. For analysis the patients were divided in two groups: one that used the Cell Saver and another that didn't. RESULTS: The median age of the patients was 50 years and the main indication for liver transplantation was cirrhosis (35 cases - 85.3 percent). The median blood loss was 8362 + 3994 ml (with the Cell Saver) and 10824 + 7002 ml (without the Cell Saver) and the median transfusion of heterologous packed red blood cells was 9,6 + 8 units (with the Cell Saver) compared to 22,3 + 21 units (without the Cell Saver). CONCLUSIONS: The Cells Saver has the potential to reduce the need for heterologous blood transfusion reducing the risks of transmissible diseases.

OBJETIVO: O objetivo desse estudo foi analisar as mundanças na quantidade de transfusão necessária com uso do Intraoperative red blood cell salvage (Cell saver), em pacientes submetidos a transplante ortotópico de fígado, doador cadáver. MÉTODOS: Foram avaliados dados de 41 pacientes submetidos a transplante de fígado. O sangramento foi calculado de acordo com débito do aspirador, compressas e captação do Cell saver. A reposição necessária foi avaliada de acordo com a quantidade de transfusão heteróloga e autóloga. Para análise dos dados os pacientes foram dividos em dois grupos: com e sem uso de Cell saver. RESULTADOS: A mediana de idade foi 50 anos e principal indicação de transplante foi cirrose hepática com 35 casos (85,3 por cento). A mediana de sangramento durante o procedimento cirúrgico 8362 + 3994 ml (com cell saver) e 10824 + 7002 ml (sem cell saver) e a mediana de transfusão de concentrado de hemácias heterólogo, durante o período de internação hospitalar 9,6 + 8 unidades (com cell saver) compar 22,3 + 21 unidades (sem cell saver). CONCLUSÃO: Uso de Cell Saver tem um potential para reduzir a quantidade de transfusão heteróloga, dimuindo o risco de transmissão de doenças.

physico-chemical study of the leaf and root of Moringa oleifera Lam

Moringa oleifera Lam. has got high reputation in Unani and Ayurvedic Systems of Medicine for its remarkable medicinal properties. The leaves and roots are recognised as valuable drugs and frequently used by many Unani physicians. The pharmacognostical and phytochemical details of root and leaf of Moringa oleifera Lam. are presented in the paper for quality control

Non alcoholic steatohepatitis: a concise review for clinicians

Non-alcoholic Steatohepatitis [NASH] is a common liver disease characterized by hepatomegaly, elevated serum aminotransferase levels, and a histological picture similar to alcoholic hepatitis in the absence of alcohol consumption sufficient to cause such changes. Most patients with NASH are obese women, and many have diabetes mellitus, hypercholesterolemia, or hypertriglyceridemia, but it also occurs in younger lean, otherwise healthy individuals. Most of the patients are asymptomatic, although some report fatigue, malaise or right upper quadrant discomfort. The most common sign of NASH is hepatomegaly. Laboratory abnormalities include a two to four fold elevation of serum aminotransferase levels; other liver function tests are usually normal. The pathogenesis of NASH is multifactorial. NASH should be considered in the differential diagnosis of patients with persistently elevated liver enzyme levels, particularly obese patients with diabetes and hyperlipidemia. The course of this disease is highly variable, but it may proceed to cirrhosis. Treatment of NASH is unproven, but weight reduction and altered life style are recommended

Hepatología inducida por retoconazol

La complicación más grave, aunque infrecuente de la terapia con ketoconazol es la hepatitis. Presentamos una paciente de 47 años con hepatitis inducida por un tratamiento con ketoconazol. Se revisa su caso y una compilación de bibliografía sobre el tema.

Enfermedad hepatica alcoholica / Alcoholic liver disease

Se hace una revisión bibliográfica de los diferentes factores involucrados en la etiopatogenia de la enfermedad hepática alcoholoca. En la medida en que se conozcan con detenimiento los factores etiológicos, de riesgo, y otros, se podra evitar la expresión final de esta enfer edad, la cirrosis hepática, que afecta a un alto porcentaje de la población general. La evolución tórpica de esta entidad hace que a los 48 meses de seguimiento de un paciente con cirrosis hepática, cerca del 50 por ciento fallecido. El principal agente etiológico es el alcohol, seguido por los agentes virales, la coexistencia de ambos factores incrementa ostensiblemente la morbilidad. En ocasiones la supresión de la ingesta alcohólica, en fases iniciales, puede disminuir las complicaciones y en consecuencia prolongar la sobrevida

Hepatitis medicamentosa aguda en el Hospital Nacional del Sur - IPSS: de agosto de 1993 a julio de 1996

CONCLUSIONES: 1.-Las drogas que con más frecuencia producen hepatitis son los tuberculostáticos (Isoniazida-Rifampicina), Halotano, Ketoconazol. 2.-Las manifestaciones clínicas similares a las que se presentan en cualquier cuadro de hepatitis aguda, siendo poco frecuentes las manifestaciones de hipersensibilidad. Por lo tanto es importante para el diagnóstico reconocer el antecedente de la ingesta de alguna droga hepatóxica. 3.-Las alteraciones bioquímicas son muy variadas y dependen del tipo y grado de lesión hepática que produzca la droga. 4.-Las alteraciones histopatológicas más frecuentes son las de tipo mixto (hepatocelular y colestático), encontrándose que para cada tipo de droga la manifestación histopatológica puede ser muy variada. Si bien, el estudio histopatológico no es un criterio diagnóstico imprescindible para los cuadros agudos, es muy útil como factor pronóstico y para el diagnóstico de enfermedades hepáticas asociadas, por lo que se recomienda su uso. 5.-La patología asociada más frecuente fue el alcoholismo crónico, la hepatopatía crónica de fondo y el consumo de múltiples drogas, todo estos considerados como factores de riesgo. En un caso se confirmó la presencia de desnutrición como otro factor riesgo.

Hepatite bacteriana na síndrome do choque tóxico / Bacterial hepatitis in toxic shock syndrome

Os autores descrevem caso de síndrome de choque tóxico complicando diarréia por Staphylococcus aureus em paciente diabética de 60 anos, que foi admitida apresentando também febre, vômitos e dor abdominal. Evoluiu com hepatite bacteriana, rash cutâneo e mialgia intensa. A hemocultura confirmou a presença do Staphylococcus aureus. Foi iniciada terapêutica específica após o diagnóstico, com melhora progressiva dos sintomas. Acompanhada ambulatorialmente, nao houve recorrências, estando a paciente totalmente curada. Considerando a aparente raridade do diagnóstico da síndrome em nosso meio, os autores chamam a atençao para essa possibilidade e para que os médicos fíquem atentos aos informes clínicos compatíveis, visando o diagnóstico e a terapêutica corretos.