Autonomic neuropathy and chronic liver disease

Autonomic neuropathy has been reported in association with alcoholic cirrhosis but there is no information on its occurrence in non-alcoholic liver disease. We have examined autonomic function in 64 patients with biopsy-proven liver disease (22 with alcoholic liver disease and 42 with non-alcoholic liver disease) together with 29 age-matched controls. Forty-five per cent of patients with alcoholic liver disease and 43 per cent with non-alcoholic liver disease showed evidence of parasympathetic damage; 11 per cent of patients with alcoholic liver disease and 12 per cent with non-alcoholic liver disease had sympathetic damage. Forty-five per cent of patients with alcoholic liver disease and 22 per cent with non-alcoholic liver disease had peripheral neuropathy on clinical examination. Sixty-eight per cent of those with peripheral neuropathy also had autonomic neuropathy. This study confirms that autonomic neuropathy is common in alcoholic patients but the fact that it is found with comparable frequency in non-alcoholic liver disease suggests that the neurological defect may be secondary to the disturbed liver function. The implications of these observations with regard to prognosis of chronic liver disease are discussed.     

Autonomic Neuropathy and Chronic Liver Disease

Autonomic neuropathy has been reported in association with alcoholiccirrhosis but there is no information on its occurrence in non-alcoholicliver disease. We have examined autonomic function in 64 patientswith biopsy-proven liver disease (22 with alcoholic liver diseaseand 42 with non-alcoholic liver disease) together with 29 age-matchedcontrols. Forty-five per cent of patients with alcoholic liverdisease and 43 per cent with non-alcoholic liver disease showedevidence of parasyrapathetic damage; 11 per cent of patientswith alcoholic liver disease and 12 per cent with non-alcoholicliver disease had sympathetic damage. Forty-five per cent ofpatients with alcoholic liver disease and 22 per cent with non-alcoholicliver disease had peripheral neuropathy on clinical examination.Sixty-eight per cent of those with peripheral neuropathy alsohad autonomic neuropathy. This study confirms that autonomicneuropathy is common in alcoholic patients but the fact thatit is found with comparable frequency in non-alcoholic liverdisease suggests that the neurological defect may be secondaryto the disturbed liver function. The implications of these observationswith regard to prognosis of chronic liver disease are discussed.     

Screening test data analysis for liver disease prediction model using growth curve

This study was done based on screening test data accumulated from 1994 to 2001 for studying of risk factor related with liver disease and prediction model of liver disease. In the existing study related with liver, the main current is studying on liver cancer, not on liver disease, previous step into liver cancer. As a result of estimating prediction model through the risk factors of liver disease and the growth curve on the basis of data, it is shown that most of the risk factors about liver disease are also those about known well as liver cancer. In addition, to investigate liver disease prevalence from the viewpoint of the future, this study presumed risk factor through the various growth curve analysis and examined logistic regression, decision tree and neural network from those estimators. In the case of neural network using growth curve estimator of Xi(5)=alphai+betaiT+epsiloniT, accuracy of liver disease was 72.55% and sensitivity was 78.62%. On the other hand, in the case of liver disease prediction model using recent screening test data estimator, accuracy was 72.09% and sensitivity was 71.72%. Those are lower than liver disease prediction model of growth curve analysis. In the various liver disease prediction models assumed by growth curve and many distinction models, when growth curve estimator was used, sensitivity value was improved.     

Quantification of liver fat with magnetic resonance imaging

Intracellular fat accumulation is common feature of liver disease. Intracellular fat (steatosis) is the histologic hallmark of nonalcoholic fatty liver disease but also may occur with alcohol abuse, viral hepatitis, HIV and genetic lipodystrophies, and chemotherapy. This article reviews emerging MR imaging techniques that attempt to quantify liver fat. The content provides an overview of fatty liver disease and diseases where fat is an important disease feature. Also discussed is the current use and limitation of nontargeted biopsy in diffuse liver disease and why quantitative noninvasive biomarkers of liver fat would be beneficial.     

Nonalcoholic Fatty liver disease.

Nonalcoholic fatty liver disease is a condition gaining increasing recognition as a cause of cirrhosis and end-stage liver disease. The condition appears identical to alcoholic liver disease histologically, yet occurs in patients with negligible alcohol intake. Nonalcoholic fatty liver disease covers a spectrum of diseases ranging from simple fatty deposition in the liver to fat and inflammation and finally to fibrosis and cirrhosis. Conditions most frequently found in association with nonalcoholic fatty liver disease include obesity, Type 2 diabetes, and hyperlipidemia. Although the exact etiology of nonalcoholic fatty liver disease is not clear, insulin resistance is thought to play an important factor. Patients typically present with asymptomatic serum aminotransferase elevations of 2-3 times normal. Symptoms may include fatigue and abdominal pain. The clinical course is difficult to predict due to a lack of research in the natural history of the disease. It is known a percentage of patients progress to end-stage liver disease and may require liver transplantation. No medical treatment has been found to be totally effective. Patients who are overweight or obese should be encouraged in gradual weight reduction that has been associated with improvement in liver test abnormalities.     

Nonalcoholic Fatty Liver Disease in Children: Beyond Metabolic Syndrome

Nonalcoholic fatty liver disease (NAFLD) has been identified as the number one cause of liver disease in children and adolescents in the United States. This increasing rate of liver disease is directly related to obesity. Often the initial presentation of NAFLD is a child or adolescent with increased risk of cardiovascular and/or metabolic risk factors. According to the United Network of Organ Sharing, NAFLD is rapidly becoming the leading cause of chronic liver disease and liver transplants in older children. It is important for pediatric primary care providers to recognize the risk factors for NAFLD and provide a coordinated, multidisciplinary approach for interventions to prevent and limit liver disease in children and adolescents.     

Sonography of diffuse liver disease.

Sonography is often the first imaging procedure performed in the evaluation of individuals with suspected liver disease. Evaluation for biliary dilatation is always performed, because bile duct obstruction can cause abnormal liver test results, raising the suspicion of liver disease. Ultrasound is a useful but imperfect tool in evaluating diffuse liver disease. We discuss the uses and limitations of sonography in evaluating parenchymal liver disease. Sonography can show hepatomegaly, fatty infiltration of the liver, and cirrhosis, all with good but imperfect sensitivity and specificity. Sonography is of limited usefulness in acute hepatitis. Increased parenchymal echogenicity is a reliable criterion for diagnosing fatty liver. Cirrhosis can be diagnosed in the correct clinical setting when the following are present: a nodular liver surface, decreased right lobe-caudate lobe ratio, and indirect evidence of portal hypertension (collateral vessels and splenomegaly). Ultrasound plays an important role in the imaging of conditions and procedures common in patients with diffuse liver disease.     

Preventive strategies in chronic liver disease: part I. Alcohol, vaccines, toxic medications and supplements, diet and exercise.

Chronic liver disease is the 10th leading cause of death in the United States. Hepatitis C virus infection is the most frequent cause of chronic liver disease and the most common indication for liver transplantation. Preventive care can significantly reduce the progression of liver disease. Alcohol and hepatitis C virus are synergistic in hastening the development of cirrhosis; therefore, patients with hepatitis C infection should abstain from alcohol use. Because superinfection with hepatitis A or B virus can lead to liver failure, vaccination is recommended. Potentially hepatotoxic medications should be used with caution in patients with chronic liver disease. In general, nonsteroidal anti-inflammatory drugs should be avoided; acetaminophen in a dosage below 2 g per day is the safest choice. Many herbal remedies are potentially hepatotoxic, and only milk thistle can be used safely in patients who have chronic liver disease. Weight reduction and exercise can improve liver function in patients with fatty liver.     

Hypercoagulation and thrombophilia in liver disease.

A complex balance exists between endogenous procoagulants and the anticoagulant system in liver disease patients. Hypercoagulable events occur in cirrhosis patients despite the well-known bleeding diathesis of liver disease. These events may be clinically evident, such as in portal vein thrombosis or pulmonary embolism, but these conditions may also be a silent contributor to certain disease states, such as portopulmonary hypertension or parenchymal extinction with liver atrophy as well as thrombosis of extracorporeal circuits in dialysis or liver assist devices. Moreover, liver disease-related hypercoagulability may contribute to vascular disease in the increasingly common condition of non-alcoholic fatty liver disease. Despite the incidence of these problems, there are few widely accessible and practical laboratory tests to evaluate the risk of a hypercoagulable event in cirrhosis patients. Furthermore, there is little research on the use of commonly accepted anticoagulants in patients with liver disease. This article is a result of an international symposium on coagulation disorders in liver disease and addresses several areas of specific interest in hypercoagulation in liver disease. Critical areas lacking clinical information are highlighted and future areas of research interest are defined with an aim to foster clinical research in this field.     

Nonalcoholic Fatty Liver Disease: Implications for Clinical Practice and Health Promotion

Nonalcoholic fatty liver disease (NAFLD), a condition caused by fatty infiltration of the liver, in the absence of large alcohol consumption, that can result in liver failure. It is the leading cause of elevated liver enzymes in adults and of liver disease in children, and it is increasing in the United States commensurately with obesity. Initially an asymptomatic disease, diagnosis is based on risk factor assessment, laboratory findings, and imaging studies. Prevention and early intervention require lifestyle changes. Prognosis is typically good, especially early in the disease course.     

冠状动脉粥样硬化性心脏病从肝论治的理论探讨

目的探讨中医肝脏功能对心脏生理病理的影响,为冠心病从肝论治提供理论指导. 方法从维持气血正常运行,调节情志活动,和促进消化吸收等方面探讨肝脏对心脏的调节作用,及在病理条件下肝失疏泄,而致冠心病发生的病理机制. 结果肝脏是调节心脏功能的重要因素,肝失疏泄是冠心病发生始动条件.结论研究冠心病中医机理应重视肝脏的功能,从肝论治是冠心病中医治疗的重要途径.     

Chronic liver disease and arteriosclerosis

The liver is the main metabolic organ of the body and is strongly associated with lifestyle-related diseases in which abnormal metabolism of glucose and lipid are the main manifestations. Recently, the prevalence of nonalcoholic fatty liver disease(NAFLD), including nonalcoholic steatohepatitis (NASH), has been increasing due to a higher rates of obesity. It has been reported that the presence of NAFLD/NASH and associated liver dysfunction are predictors for cardiovascular disease. In addition, attention has been paid to the link between chronic hepatitis C and lifestyle-related diseases such as obesity and insulin resistance. Atherosclerosis is an important risk factor for cardiovascular disease and is associated with lifestyle-related diseases. Thus, chronic liver disease seems to be strongly associated with atherosclerosis. Cardiovascular disease induced by atherosclerosis should be attended to along with liver cirrhosis and hepatocellular carcinoma, and medications for lifestyle-related diseases are needed in patients with chronic liver disease.     

Nutrition as Therapy in Liver Disease

PurposeThe importance of nutrition is often underrecognized in the routine clinical care of patients with chronic liver disease. Nutrition therapy plays a significant role in the management of alcohol-related liver disease and nonalcoholic fatty liver disease. In patients with cirrhosis from any etiology, malnutrition and sarcopenia are directly related to mortality, and nutritional interventions play an important role in the management of these patients. This review explores the role of nutritional intervention as adjuvant therapy across all chronic liver disease.MethodsA narrative, qualitative systematic review was performed via searches of PubMed for nutritional aspects in the care of chronic liver disease.FindingsNutritional therapy plays a critical role in the management of chronic liver disease. In nonalcoholic fatty liver disease, specific macronutrient management can lead to weight loss and improved outcomes in these patients. In patients with alcohol-related liver disease, chronic cholestatic liver disease, and decompensated cirrhosis, caloric and protein intake plays a vital role improving outcomes in these patients. Micronutrient deficencies are also common in these patients and require supplementation to prevent other complications of malnutrition. Assessment and management of nutrition should accompany the typical care plan of patients with chronic liver disease.ImplicationsThis review of nutritional therapy in chronic liver disease highlights the current evidence-based and societal recommendations of macronutrient and micronutrient management across the spectrum of all chronic liver disease.     

gamma-Glutamyl transpeptidase activity in liver disease: serum elevation is independent of hepatic GGTP activity

gamma-Glutamyl transpeptidase activity was measured in liver and serum from 110 patients undergoing diagnostic liver biopsy, including patients with alcoholic liver disease, fatty liver not due to alcohol, primary biliary cirrhosis, persistent hepatic disease, chronic active hepatitis and normal livers. Serum gamma-glutamyl transpeptidase was markedly elevated in patients with alcoholic liver disease and primary biliary cirrhosis while mean hepatic gamma-glutamyl transpeptidase activity was significantly increased only in the alcoholic liver disease group. There was considerable overlap of individual enzyme values among the different disease groups. There was no inhibitors or activators of liver gamma-glutamyl transpeptidase in any of these disorders. The increased liver activity was not related to the degree of hepatic fibrosis or cirrhosis. There was no correlation between hepatic and serum gamma-glutamyl transpeptidase activity. Hepatic and serum gamma activities were equally increased in individuals with alcoholic liver disease whether or not they were drinking at the time of the study. The data suggest that increased hepatic gamma-glutamyl transpeptidase activity is neither specific for alcoholic liver disease nor essential for serum GGTP to be elevated.     

Role of hemostatic factors in hepatic injury and disease: animal models de‐liver

Chronic liver damage is associated with unique changes in the hemostatic system. Patients with liver disease often show a precariously rebalanced hemostatic system, which is easily tipped towards bleeding or thrombotic complications by otherwise benign stimuli. In addition, some clinical studies have shown that hemostatic system components contribute to the progression of liver disease. There is a strong basic science foundation for clinical studies with this particular focus. Chronic and acute liver disease can be modeled in rodents and large animals with a variety of approaches, which span chronic exposure to toxic xenobiotics, diet‐induced obesity, and surgical intervention. These experimental approaches have now provided strong evidence that, in addition to perturbations in hemostasis caused by liver disease, elements of the hemostatic system have powerful effects on the progression of experimental liver toxicity and disease. In this review, we cover the basis of the animal models that are most often utilized to assess the impact of the hemostatic system on liver disease, and highlight the role that coagulation proteases and their targets play in experimental liver toxicity and disease, emphasizing key similarities and differences between models. The need to characterize hemostatic changes in existing animal models and to develop novel animal models recapitulating the coagulopathy of chronic liver disease is highlighted. Finally, we emphasize the continued need to translate knowledge derived from highly applicable animal models to improve our understanding of the reciprocal interaction between liver disease and the hemostatic system in patients.     

A visceral form of Rendu-Osler-Weber syndrome

A case of a visceral pattern (with primary liver injury) of the Rendu-Osler-Weber disease is described with emphasis on the diagnostic difficulties due to the absence of external symptoms of disease and hemorrhage. Stress is laid on the importance of making liver biopsy in the diagnosis of this pattern of teleangioectatic disease. It is assumed that microcirculatory disorders in the liver provoked by the development of teleangioectasia are essential factors in the formation of liver cirrhosis in visceral pattern of the Rendu-Osler-Weber disease.     

Sex Differences in Alcohol Consumption and Alcohol-Associated Liver Disease

Alcohol-associated liver disease is becoming increasingly prevalent throughout the United States. Previously alcohol-associated liver disease was known to affect men more often than women; however, this gap between the sexes is narrowing. Studies show that women develop liver disease with lesser alcohol exposure and suffer worse disease as compared with men. This review article explores the increasing prevalence of alcohol-associated liver disease in women, reasons for changing patterns in alcohol consumption and liver disease development including obesity and bariatric surgery, proposed mechanisms of sex-specific differences in alcohol metabolism that may account for this discrepancy between men and women, and sex differences in treatment enrollment and response. Studies were identified by performing a literature search of PubMed and Google Scholar and through review of the references in retrieved articles. Search terms included alcohol-associated liver disease, alcoholic hepatitis, alcoholic cirrhosis, sex, gender, female, epidemiology, bariatric surgery, obesity, treatment. Due to the paucity of literature on some of the relevant subject matter and inclusion of landmark studies, no date range was selected. Studies were included if their methods were sufficiently robust and they made a comparison between the sexes that is clinically relevant. Understanding of the changing epidemiology and mechanisms of liver disease development unique to women are paramount in creating appropriate and effective interventions for women who represent a rapidly growing subset of patients with alcohol-associated liver disease.     

Management of Hemostatic Disorders in Patients With Advanced Liver Disease Admitted to an Intensive Care Unit

Patients with liver diseases frequently acquire complex changes in their hemostatic system. Traditionally, bleeding complications in patients with liver disease were ascribed to these hemostatic changes, and liver diseases were considered as an acquired bleeding disorder. Nowadays, it is increasingly acknowledged that patients with liver diseases are in “hemostatic rebalance” due to a commensurate decline in pro- and anticoagulant drivers. Indeed, both thrombosis and bleeding may complicate liver disease. Such complications may be particularly worrisome in critically ill patients with liver disease. This review will outline knowns and unknowns in prediction, prevention, and treatment of bleeding and thrombosis in patients with liver disease admitted to an intensive care unit.     

Role of hepatitis B virus infection in alcoholic patients

Summary The aim of this study was to determine the incidence of HBV markers in patients with alcoholic liver disease and to compare the results with those of patients with non-alcoholic liver disease and control subjects. We tried to determine whether the association between alcohol intake and HBV infection increases the risk of developing severe liver disease. The results showed an increased incidence of HBsAg in alcoholic patients when compared with controls as well as an increased incidence of severe chronic liver disease in HBV-positive groups when compared with HBV-negative groups. We conclude that HBV infection is an important additional risk factor for the development of severe liver disease in alcoholic patients.     

从肝论治原发性痛经的经验探析

原发性痛经发病率高,易复发,治疗棘手。导师厉健将现代社会环境对女性情志的影响与肝的生理特性、"肝藏血、主疏泄"的生理功能相结合,认为该病发生与肝有密切关系,其主要病机为肝郁气结,气病及血,气血瘀滞,冲任闭阻,不通则痛。故从肝论治疗原发性痛经,临床疗效显著。