4/3/2014. Elizabeth Thompson, PharmD April Understand the importance of the liver and basic physiology.
|
|
- Diane Wheeler
- 6 years ago
- Views:
Transcription
1 Liver Disease Elizabeth Thompson, PharmD April 2014 Objectives Understand the importance of the liver and basic physiology. Review hepatic disorders Recognize liver function scoring systems used to determine treatment plans. Recognized medications related to liver diseases Appreciate the implications of these medications in hepatic disorders What does the liver do? 1
2 Liver Physiology 1 Stomach, small intestine, large intestine, spleen and pancreatic veins drain into the liver. The liver filters the blood and helps in protein synthesis How the liver works 1 Hepatocyte is the main functional unit of the liver How a damaged liver works: o Damaged cells in the liver start producing protein o Permanent scaring of liver tissue o Disrupted blood flow o Backed up blood flow results in portal hypertension Liver Function Tests 2
3 Laboratory Abnormalities Liver enzymes o Aminotransferase: AST and ALT o Enzymes located in the hepatocytes are elevated when injury occurs Bilirubin o Product of the breakdown of hemoglobin Albumin o Marker of hepatic synthetic activity therefore a estimation of hepatocyte activity PT and INR o Clotting factors are synthesized in the liver o PT and INR is prolonged in liver injury Child Pugh Score or Meld Score: What are these measuring? Table for Scoring 3
4 Liver Disorders Cirrhosis Hepatitis Hepatic Disorders Coagulation Disorders Alcoholic Liver Disease Acetaminophen Hepatotoxicity 4
5 Cirrhosis Cirrhosis is the 8 th leading cause of death. Cirrhosis 2,3,5 Cirrhosis Defined o Presence of fibrosis o Usually a result of years of continuous injury to the liver Causes of Cirrhosis o Excessive alcohol abuse o Hepatitis B and C Classification 3 Compensated Cirrhosis Preserved hepatic synthetic function No evidence of complications Decompensated Cirrhosis Reduced hepatic synthetic function Evidence of complications include: o Portal Hypertension Ascites Varices Hepatic Encephalopathy o Jaundice 5
6 No cure Treatment 2,3 Treat the underlying condition o Hepatitis Avoid substances that could injury the liver Liver transplant Treat complications Portal Hypertension 2,3 Due to the excessive fibrosis in the liver blood flow is backed up resulting in portal hypertension Complications: o Build up of fluid upstream from the liver o Stomach, small intestine, large intestine, spleen and pancreatic veins Conditions include: o Ascites o Hepatic Encephalopathy o Varices Ascites 2,3 Most common presentations of cirrhosis. o Over 50% of compensated cirrhosis patients will develop ascites within 10 years Pathophysiology o Ascites is the accumulation of lymph fluid within the peritoneal cavity. Treatment: o Sodium Restriction o Combo of furosemide 40 mg and spironolactone 100 mg Paracentesis o Albumin dose of 6-8 g/l of fluid removed 6
7 Spontaneous Bacterial Peritonitis 4 Infection of the ascitic fluid Antibiotics o Cefotaxime 2 g q8-12 hours, Ceftriaxone 2 g/day or Fluoroquinolones o Duration 5-10 days Albumin o 1.5 g/kg on admission and 1 g/kg on day 3 o Use if poor kidney function and high bilirubin Hepatic Encephalopathy 2,4 Liver dysfunction results in abnormal brain function. Ammonia is a neurotoxin associated with this condition o Ammonia is a by-product of protein metabolism done by the liver to urea, which is then renally eliminated Treatment goal targets ammonia levels: o Limit protein intake o Lactulose o Neomycin o Rifaximin: (cost ~ $1500) Gastroesophageal Varices 4 Varices: o Collateral vessels formed secondary to increased resistance to blood flow within the liver Medical Management o Octreotide/Somastatin o Antibiotic: Norfloxacin or Cipro x 7 days Alternative: Ceftriaxone 1 gram/day 7
8 Prevention of Variceal Bleeds 4 Primary prevention o Small varices + high bleeding risk o Medium/Large varices o Non selective beta blockers Secondary prevention o All patients with history of bleeding o Non selective beta blockers o Endoscopic (band ligation) Hepatitis Viral Hepatitis 4 Hepatitis A Hepatitis B Hepatitis C Hepatitis Defined; o Liver inflammation Acute hepatitis: infection < 6 months Chronic Hepatitis: infection >6 months 8
9 Hepatitis Overview 2,4,6 Type Hepatitis A Hepatitis B Hepatitis C Signsand symptoms Transmission Fecal-oral route Fever, fatigue, jaundice, N/V, abdominal pain, Dark Urine 30% asymptomatic 30% asymptomatic IV, bodily fluids, sexual contact, perinatal Duration Acute Acute and Chronic Chronic Preventative Treatment Vaccine or Immune Globulin Supportive care Vaccine Pegylated interferon or Entecaviror Tenofovir Transfusion, IV drug abuse, transplant No Vaccine Pegylatedinterferon & ribavirin and sofosbuvir +/- simeprevir(boceprevir Or Telaprevir) Hepatitis Summary 2 Hepatitis A: o Get vaccinated if you are at high risk o Supportive Care o Wash your hands! Hepatitis B: o Get vaccinated o Vaccinate your children o Treatment is available Hepatitis C o Treatment is available o 65% of infected people will develop chronic liver disease or liver cancer Coagulation Disorder 9
10 Coagulation Disorder 4 Clotting factors synthesized in the liver are not decreased in liver disease Prolonged PT and INR o Regularly INR=1 o More prone to bleed Thrombocytopenia o Platelet count less than 150,000 o 30-65% of cirrhosis patients o Primary caused by portal hypertension resulting in a backflow or pooling of platelets in the spleen. Alcohol Induced Liver Disease Alcoholic Liver Disease 2,4 Heavy Alcohol Ingestion o Men: 40-80g/day for years o Women: 20-80g/day for years Types of Liver Disease o Fatty Liver Fatty infiltration in the liver Hepatomegaly and mild liver enzyme elevation Potentially reversible if alcohol is stopped o Alcoholic Hepatitis Hepatic inflammation with necrosis o Cirrhosis Fibrosis 10
11 Alcoholic Liver Disease 2,4 Signs and Symptoms o Fatigue, anorexia, weight loss, nausea, vomiting, jaundice, right upper quadrant pain MELD Score: Maddrey Discriminant Function (MDF) 4.6 (PT control PT)+ total bilirubin Scores >32 have a poorer prognosis Treatment of ALD 2,4 Alcohol Abstinence When to consider therapy: o MDF >32 or MELD Score >18 o Prednisolone 40 mg/day 4 weeks course followed by a 2 week taper 30% decrease in risk ratio of short term death o Pentoxifylline 400 mg TID If steroids are contraindicated 40% lower hospital mortality Approximately 75% of patients will ultimately need a liver transplant. Acetaminophen Hepatotoxcity 11
12 Tylenol Overdose 2 Acetaminophen overdose o Leading cause of acute liver disease Dose related toxin Mechanism: o Glutathione in the liver normally detoxifies a metabolite of Acetaminophen, N-acetyl-p-benzoquinone imine(napqi) o At large doses there is not enough glutathione to detoxify NAPQI which can cause hepatocellular necrosis o Levels of Acetaminophen can be tested Tylenol Toxicity 2 Presentation o Nausea and vomiting o Right upper quadrant pain o Elevated Liver enzymes o Possible Elevation in bilirubin and INR o If untreated progression to multi-organ failure Treatment o Activated Charcoal Given within 1 hours of ingestion (up to 3-4 hours post ingestion) o N-Acetylcysteine Precursor of glutathione (increase the livers glutathione stores) Dose not reverse damage to liver already suffered to the liver Treat within 8 hours, may be beneficial within 48 hours How does all of this apply to us? 12
13 Review of Disorders and Medications Cirrhosis Hepatitis Coagulation Disorder Ascites and SBP: Furosemide Spironolactone Albumin Antibiotics Encephalopathy: Lactulose Neomycin Rifaximin Varacies: Octreotide- Somastatin Antibiotics Non-selective Beta blockers Hepatitis A: Vaccine Supportive Care Hepatitis B: Vaccine Treatment Hepatitis C: No vaccine Treatment Increased bleeding risk Aspirin and Coumadin??? ALD Alcohol Abstinence Steroids Pentoxifylline Tylenol OD Charcoal N-Acetylcystiene Summary The liver can impact almost every other organ in the body and if it is not functioning correcting it can have devastating affects to our bodies. It is important to avoid toxins, high risk behaviors or excess amounts of alcohol to prevent liver disease. Summary Continued Treatment or management of liver disease is available. Pharmacy personnel are a large part of getting the right medications to the patients in a timely matter. At the end of the day every medication we touch is going to be used by a person and therefore it deserves our best efforts. 13
14 Reference 1. Boron WF, Boulpaep EL: Medical Physiology: a cellular and molecular approach. Saunder Elsevier: Second edition Shargel L, Mutnick AH, Souney PF, Swanson LN: Comprehensive Pharmacy Review for Naplex. Wolters Kluwer: Lippincott Williams& Wilkins. Eighth Edition Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: a pathophysiologic approach. Mcgraw Hill Medical. Seventh Edition Hemstreet, Brian A. Gastrointestinal Disorders. ACCP Updates in Therapeutics 2013: The Pharmacotherapy Preparatory Review and Recertification Course 5. Bruce A. Runyon, M.D Management of Adult Patients with Ascites Due to Cirrhosis: Update AASLD PRACTICE GUIDELINE. HEPATOLOGY, February Recommendations for Testing, Managing, and Treating Hepatitis C. American Associated for the study of liver diease and Infectious Disease Socity of American. March 12 th 2014 Learning Objectives 14
15 Understand the importance of the liver and basic physiology. What is the basic function of the liver: A. Digest food B. Filter the blood C. Provide pancreatic enzymes D. Helps in bone marrow formation Understand the importance of the liver and basic physiology. What is the basic function of the liver: A. Digest food B. Filter the blood C. Provide pancreatic enzymes D. Helps in bone marrow formation Recognized medications related to liver diseases. If a patient has hepatic encephalopathy all of the medication below which except one could be considered for treatment: A. Lactulose B. Neomycin C. Rifaximin D. Albumin 15
16 Recognized medications related to liver diseases. If a patient has hepatic encephalopathy all of the medication below which except one could be considered for treatment: A. Lactulose B. Neomycin C. Rifaximin D. Albumin Appreciate the need for meds in liver disease. You are talking to a friend who just found out they had hepatitis C. They think their life is over. What is a possible conversation you could have with them. A. You can get vaccinated for that. B. There are treatments available. C. That will blow over in a couple of weeks. D. Your life is over, there is no hope. Appreciate the need for meds in liver disease. You are talking to a friend who just found out they had hepatitis C. They think their life is over. What is a possible conversation you could have with them. A. You can get vaccinated for that. B. There are treatments available. C. That will blow over in a couple of weeks. D. Your life is over, there is no hope. 16
CHAPTER 1. Alcoholic Liver Disease
CHAPTER 1 Alcoholic Liver Disease Major Lesions of Alcoholic Liver Disease Alcoholic fatty liver - >90% of binge and chronic drinkers Alcoholic hepatitis precursor of cirrhosis Alcoholic cirrhosis end
More informationEtiology of liver cirrhosis
Liver cirrhosis 1 Liver cirrhosis Liver cirrhosis is the progressive replacement of normal hepatic cells by fibrous scar tissue, This scarring is accompanied by the loss of viable hepatocytes, which are
More informationLIVER CIRRHOSIS. The liver extracts nutrients from the blood and processes them for later use.
LIVER CIRRHOSIS William Sanchez, M.D. & Jayant A. Talwalkar, M.D., M.P.H. Advanced Liver Disease Study Group Miles and Shirley Fiterman Center for Digestive Diseases Mayo College of Medicine Rochester,
More informationLiver Disease. By: Michael Martins
Liver Disease By: Michael Martins Recently I have been getting a flurry of patients that have some serious liver complications. This week s literature review will be the dental management of the patients
More informationManagement of Cirrhosis Related Complications
Management of Cirrhosis Related Complications Ke-Qin Hu, MD, FAASLD Professor of Clinical Medicine Director of Hepatology University of California, Irvine Disclosure I have no disclosure related to this
More informationChronic Hepatic Disease
Chronic Hepatic Disease 10 th Leading Cause of Death Liver Functions Energy Metabolism Protein Synthesis Solubilization, Transport, and Storage Protects and Clears drugs, damaged cells Causes of Liver
More informationInt. J. Pharm. Sci. Rev. Res., 46(1), September - October 2017; Article No. 07, Pages: 37-41
Research Article Assessment of Clinical Profile and Prescription Pattern of Drugs in Alcoholic Liver Disease and Hepatitis in a Tertiary Care Hospital Christeena James*, Dr.ShirishInamdar, Dr.Bharathi
More informationThe Yellow Patient. Dr Chiradeep Raychaudhuri, Consultant Hepatologist, Hull University Teaching Hospitals NHS Trust
The Yellow Patient Dr Chiradeep Raychaudhuri, Consultant Hepatologist, Hull University Teaching Hospitals NHS Trust there s a yellow patient in bed 40. It s one of yours. Liver Cirrhosis Why.When.What.etc.
More informationWEEK. MPharm Programme. Liver Biochemistry. Slide 1 of 49 MPHM14 Liver Biochemistry
MPharm Programme Liver Biochemistry Slide 1 of 49 MPHM Liver Biochemistry Learning Outcomes Assess and evaluate the signs and symptoms of illness Assess and critically appraise a patients medication regimen,
More informationManagement of Chronic Liver Failure/Cirrhosis Complications in Hospitals. By: Dr. Kevin Dolehide
Management of Chronic Liver Failure/Cirrhosis Complications in Hospitals By: Dr. Kevin Dolehide Overview DX Cirrhosis and Prognosis Compensated Decompensated Complications Of Cirrhosis Management Of Complications
More informationVIRAL HEPATITIS. Definitions. Acute Liver Disease (Hepatitis A &E, Alcoholic hepatitis, DILI and ALF) Acute Viral Hepatitis Symptoms
Acute Liver Disease (Hepatitis A &E, Alcoholic hepatitis, DILI and ALF) Definitions AST and ALT Markers of hepatocellular injury Ryan M. Ford, MD Assistant Professor of Medicine Director of Viral Hepatitis
More informationCOMPLICATIONS OF CIRRHOSIS: ASCITES & HEPATIC ENCEPHALOPATHY
COMPLICATIONS OF CIRRHOSIS: ASCITES & HEPATIC ENCEPHALOPATHY DR. ESTER YAGUDAYEVA CLINICAL PHARMACIST HOSPICE PHARMACY SOLUTIONS OBJECTIVES Understand the prognosis of End Stage Liver Disease (ESLD) Identify
More informationLiver failure &portal hypertension
Liver failure &portal hypertension Objectives: by the end of this lecture each student should be able to : Diagnose liver failure (acute or chronic) List the causes of acute liver failure Diagnose and
More informationTreating patients with end-stage liver disease: Are we ready? Dr. Mino R. Mitri, M.D., C.M., M.Ed., FRCPC
Treating patients with end-stage liver disease: Are we ready? Dr. Mino R. Mitri, M.D., C.M., M.Ed., FRCPC mino.mitri@ubc.ca No Conflict of Interest 157 patients 157 patients 6 transplanted Criteria Liver
More informationDISEASE LEVEL MEDICAL EVIDENCE PROTOCOL
DISEASE LEVEL MEDICAL EVIDENCE PROTOCOL 1. This Protocol sets out the medical evidence that must be delivered to the Administrator for proof of Disease Level. It is subject to such further and other Protocols
More informationHepatocytes produce. Proteins Clotting factors Hormones. Bile Flow
R.J.Bailey MD Hepatocytes produce Proteins Clotting factors Hormones Bile Flow Trouble.. for the liver! Trouble for the Liver Liver Gall Bladder Common Alcohol Hep C Fatty Liver Cancer Drugs Viruses Uncommon
More informationDISCLOSURES. This activity is jointly provided by Northwest Portland Area Indian Health Board and Cardea
DISCLOSURES This activity is jointly provided by Northwest Portland Area Indian Health Board and Cardea Cardea Services is approved as a provider of continuing nursing education by Montana Nurses Association,
More informationGastrointestinal System: Accessory Organ Disorders
Gastrointestinal System: Accessory Organ Disorders Mary DeLetter, PhD, RN Associate Professor Dept. of Baccalaureate and Graduate Nursing Eastern Kentucky University Disorders of Accessory Organs Portal
More informationManagement of Alcoholic Liver Disease. Hafez Fakheri Professor of medicine, Sari, Iran
Management of Alcoholic Liver Disease Hafez Fakheri Professor of medicine, Sari, Iran Alcoholic Hepatitis Scores DF = (4.6 x [ PT- control PT]) + (bili ) MELD = 10 * ((0.957 * ln(cr)) + (0.378 * ln(bil))
More informationEnd-Stage Liver Disease (ESLD): A Guide for HIV Physicians
Slide 1 of 32 End-Stage Liver Disease (ESLD): A Guide for HIV Physicians Marion G. Peters, MD John V. Carbone, MD, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California
More informationCrackCast Episode 28 Jaundice
CrackCast Episode 28 Jaundice Episode overview: 1) Describe heme metabolism 2) List common pre-hepatic/hepatic/post-hepatic causes of jaundice Wisecracks: 1) What are clinical signs of liver disease? 2)
More informationComplications of Cirrhosis
Complications of Cirrhosis Causes of Cirrhosis Alcohol Chronic Viral Hepatitis (B/C) Haemochromatosis Autoimmune Hepatitis NAFLD/NASH Primary Biliary Cirrhosis Primary Sclerosing Cholangitis 1-AT deficiency
More informationESLD a Guide for HIV Physicians. Marion Peters University of California San Francisco June 2015
ESLD a Guide for HIV Physicians Marion Peters University of California San Francisco June 2015 Disclosures Honararia from Johnson and Johnson Roche Merck Gilead Spouse employee of Hoffman La Roche Natural
More informationFaculty Disclosure. Objectives. Cirrhosis Management for the Family Physician 18/11/2014
Cirrhosis Management for the Family Physician Mang Ma, MD, FRCP Professor University of Alberta Faculty: Mang Ma Faculty Disclosure Relationships with commercial interests: Advisory Board: Merck, Gilead
More informationStick or twist management options in hepatitis C
Stick or twist management options in hepatitis C Dr. Chris Durojaiye & Dr. Matthijs Backx SpR Microbiology and Infectious Diseases University Hospital of Wales, Cardiff Patient history 63 year old female
More informationCHAPTER 7. End Stage Liver Disease in the ICU: Walking a Tightrope. Lynn A. Kelso, MSN, APRN, FCCM, FAANP University of Kentucky College of Nursing
CHAPTER 7 End Stage Liver Disease in the ICU: Walking a Tightrope Lynn A. Kelso, MSN, APRN, FCCM, FAANP University of Kentucky College of Nursing Besey Oren, Assistant Professor Istanbul University Health
More informationCIRRHOSIS Definition
Cirrhosis Update Robert S. Brown, Jr., MD, MPH Vice Chair, Transitions of Care Interim Chief, Division of Gastroenterology & Hepatology Weill Cornell Medical College CIRRHOSIS Definition Irreversible fibrous
More informationSteps in Assessing Fibrosis 4/30/2015. Overview of Liver Disease Associated With HCV
Overview of Liver Disease Associated With HCV Marion G. Peters, MD John V. Carbone, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California San Francisco San Francisco,
More informationEsophageal Varices Beta-Blockers or Band Ligation. Cesar Yaghi MD Hotel-Dieu de France University Hospital Universite Saint Joseph
Esophageal Varices Beta-Blockers or Band Ligation Cesar Yaghi MD Hotel-Dieu de France University Hospital Universite Saint Joseph Esophageal Varices Beta-Blockers or Band Ligation? Risk of esophageal variceal
More informationClinical Presentation of Viral Hepatitis 1-The symptoms of acute viral hepatitis caused by HAV, HBV, HCV, HDV, and HEV are similar (3).
5 th Year Therapeutics 2015 Viral Hepatitis Introduction 1-There are five types of viral hepatitis: hepatitis A (HAV), B (HBV), C (HCV), D (HDV), and E (HEV). These types may present as either acute or
More informationMedicines for Chronic Liver Disease
UW MEDICINE PATIENT EDUCATION Medicines for Chronic Liver Disease Treating common conditions This handout gives basic information about how the liver works and what happens during liver failure. It describes
More informationCirrhosis Patient Teaching Information
Cirrhosis Patient Teaching Information CIRRHOSIS What is Cirrhosis: Cirrhosis is the end stages of a liver disease. Over time, from years to decades, fibrosis (or scar tissue) progresses through stages
More informationCirrhosis and Portal Hypertension Gastroenterology Teaching Project American Gastroenterological Association
CIRRHOSIS AND PORTAL HYPERTENSION Cirrhosis and Portal Hypertension Gastroenterology Teaching Project American Gastroenterological Association WHAT IS CIRRHOSIS? What is Cirrhosis? DEFINITION OF CIRRHOSIS
More informationChronic Hepatitis C. Risk Factors
Chronic Hepatitis C The hepatitis C virus is one of the most important causes of chronic liver disease in the United States. Almost 4 million Americans or 1.8 percent of the U.S. population have an antibody
More informationPathophysiology I Liver and Biliary Disease
Pathophysiology I Liver and Biliary Disease The Liver The liver is located in the right upper portion of the abdominal cavity just beneath the right side of the rib cage. The liver has many functions that
More informationALCOHOLIC LIVER DISEASE (ALD) Nayan Patel, DO Transplant Hepatology/GI Banner Advanced Liver Disease and Transplant Center
ALCOHOLIC LIVER DISEASE (ALD) Nayan Patel, DO Transplant Hepatology/GI Banner Advanced Liver Disease and Transplant Center Objectives Spectrum of alcoholic liver disease Focus on Alcoholic Hepatitis (AH)
More informationLiver Failure. The most severe clinical consequence of liver disease is liver failure:
Liver diseases I The major primary diseases of the liver are: - Viral hepatitis, - Nonalcoholic fatty liver disease (NAFLD), - Alcoholic liver disease, - Hepatocellular carcinoma (HCC) Hepatic damage also
More informationMANAGEMENT OF LIVER CIRRHOSIS: PRACTICE ESSENTIALS AND PATIENT SELF-MANAGEMENT
MANAGEMENT OF LIVER CIRRHOSIS: PRACTICE ESSENTIALS AND PATIENT SELF-MANAGEMENT Sherona Bau, ACNP The Pfleger Liver Institute 200 UCLA Medical Plaza, Suite 214 Los Angeles, CA 90095 September 30, 2017 I
More informationHepatitis Panel/Acute Hepatitis Panel
190.33 - Hepatitis Panel/Acute Hepatitis Panel This panel consists of the following tests: Hepatitis A antibody (HAAb), IgM antibody; Hepatitis B core antibody (HBcAb), IgM antibody; Hepatitis B surface
More informationHepatitis B Virus. Taylor Page PharmD Candidate 2019 February 1, 2019
Hepatitis B Virus Taylor Page PharmD Candidate 2019 February 1, 2019 Epidemiology 3218 cases of acute HBV reported in 2016 847,000 non-institutionalized persons living with chronic HBV in 2011-2012 Viral
More informationHepatitis C Virus (HCV)
Clinical Practice Guidelines Hepatitis C Virus (HCV) OBJECTIVE The purpose is to guide the appropriate diagnosis and management of Hepatitis C Virus (HCV). GUIDELINE These are only guidelines, and are
More informationManagement of Acute Decompensation of Cirrhosis JOHN O GRADY KING S COLLEGE HOSPITAL
Management of Acute Decompensation of Cirrhosis JOHN O GRADY KING S COLLEGE HOSPITAL Terminology Acute decompensation of cirrhosis - stable patient with sudden deterioration Acute-on-chronic liver failure
More informationACG & AASLD Joint Clinical Guideline: Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis
ACG & AASLD Joint Clinical Guideline: Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis Guadalupe Garcia-Tsao, M.D., 1 Arun J. Sanyal, M.D., 2 Norman D. Grace,
More informationDiseases of liver. Dr. Mohamed. A. Mahdi 4/2/2019. Mob:
Diseases of liver Dr. Mohamed. A. Mahdi Mob: 0123002800 4/2/2019 Cirrhosis Cirrhosis is a complication of many liver disease. Permanent scarring of the liver. A late-stage liver disease. The inflammation
More informationModule 1 Introduction of hepatitis
Module 1 Introduction of hepatitis 1 Training Objectives At the end of the module, trainees will be able to ; Demonstrate improved knowledge of the global epidemiology of the viral hepatitis Understand
More informationOptimal management of ascites
Optimal management of ascites P. Angeli, Dept. of Medicine, Unit of Internal Medicine and epatology (), University of Padova (Italy) pangeli@unipd.it 10th Paris epatology Conference National Conference
More informationDefinition: fibrosis and nodular regeneration resulting from hepatocellular injury
Cirrhosis Understanding the liver: Patterns of LFT Abnormalities - Hepatocellular/Transaminitis: o Ratio of AST: ALT >2:1 ETOH (keep in mind AST is also produced by red cells, heart muscle) o If Aminotransferases
More informationManagement of Ascites and Hepatorenal Syndrome. Florence Wong University of Toronto. June 4, /16/ Gore & Associates: Consultancy
Management of Ascites and Hepatorenal Syndrome Florence Wong University of Toronto June 4, 2016 6/16/2016 1 Disclosures Gore & Associates: Consultancy Sequana Medical: Research Funding Mallinckrodt Pharmaceutical:
More informationHepatitis Panel/Acute Hepatitis Panel
190.33 - Hepatitis Panel/Acute Hepatitis Panel This panel consists of the following tests: Hepatitis A antibody (HAAb), IgM antibody; Hepatitis B core antibody (HBcAb), IgM antibody; Hepatitis B surface
More informationEDUCATION PRACTICE. Management of Refractory Ascites. Clinical Scenario. The Problem
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2005;3:1187 1191 EDUCATION PRACTICE Management of Refractory Ascites ANDRÉS CÁRDENAS and PERE GINÈS Liver Unit, Institute of Digestive Diseases, Hospital Clínic,
More informationThe Continuum of Care for Advanced Liver Disease: Partnering with the Liver Specialist. K V Speeg, MD, PhD UT Health San Antonio
The Continuum of Care for Advanced Liver Disease: Partnering with the Liver Specialist K V Speeg, MD, PhD UT Health San Antonio Objectives Review staging of liver disease Review consequences of end-stage
More informationRenal Care and Liver Disease: Disease Trajectory and Hospice Eligibility
Renal Care and Liver Disease: Disease Trajectory and Hospice Eligibility Terri L. Maxwell PhD, APRN VP, Strategic Initiatives Weatherbee Resources/HEN Course Materials & Disclosure Course materials including
More informationCauses of Liver Disease in US
Learning Objectives Updates in Outpatient Cirrhosis Management Jennifer Guy, MD MAS Director, Liver Cancer Program California Pacific Medical Center guyj@sutterhealth.org Review cirrhosis epidemiology,
More informationIntron A Hepatitis C. Intron A (interferon alfa-2b) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.01.05 Subject: Intron A Hepatitis C Page: 1 of 5 Last Review Date: November 30, 2018 Intron A Hepatitis
More informationEnd Stage Liver Disease & Disease Specific Indications for Liver Transplant. Susan Kang, RN, MSN, ANP-BC
End Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP-BC Introduction (https://www.srtr.org) What does the liver do? STORAGE METABOLIC DETOXIFICATION SYNTHETIC
More informationEnd Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP BC
End Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP BC Introduction (https://www.srtr.org) 1 What does the liver do? STORAGE METABOLIC DETOXIFICATION SYNTHETIC
More informationPrognosis of untreated Primary Sclerosing Cholangitis (PSC) Erik Christensen Copenhagen, Denmark
Prognosis of untreated Primary Sclerosing Cholangitis (PSC) Erik Christensen Copenhagen, Denmark Study of Prognosis of PSC Difficulties: Disease is rare The duration of the course of disease may be very
More informationConflict of interest disclosures. Complications of end stage liver disease. None. The many complications of Cirrhosis. Portal Hypertension.
Complications of end stage liver disease Conflict of interest disclosures None Amir Qamar, MD Instructor of Medicine Brigham and Women s s Hospital Harvard Medical School Boston, MA 02115 The many complications
More informationAlpha-1 Antitrypsin Deficiency: Liver Disease
Alpha-1 Antitrypsin Deficiency: Liver Disease Who is at risk to develop Alpha-1 liver disease? Alpha-1 liver disease may affect children and adults who have abnormal Alpha-1 antitrypsin genes. Keys to
More informationInfective Liver Disease
The Role oeofdrugs in Non Infective Liver Disease Peter Tenni Senior Lecturer in Therapeutics, School of Pharmacy University of Tasmania Senior Research Fellow Unit for Medication Outcomes Research and
More informationCase Report: Acute-on-Chronic Liver Failure: Making the Diagnosis between Infection and Acute Alcoholic Hepatitis
Diagnostic Problems in Hepatology 181 Case Report: Acute-on-Chronic Liver Failure: Making the Diagnosis between Infection and Acute Alcoholic Hepatitis Carmen Sendra, MD 1 Javier Ampuero, MD, PhD 1,2 Álvaro
More informationEvaluation Process for Liver Transplant Candidates
Evaluation Process for Liver Transplant Candidates 2 Objectives Identify components of the liver transplant referral to evaluation Describe the role of the liver transplant coordinator Describe selection
More informationMrs Janet Catt. Pre-Conference Nurse s Course. Royal Free London NHS Foundation Trust. Janet Catt MSc RN Lead Nurse Specialist Practic 12/12/2014
Pre-Conference Nurse s Course in partnership with Mrs Janet Catt Royal Free London NHS Foundation Trust Janet Catt MSc RN Lead Nurse Specialist Practic 1 Liver blood tests monitoring cirrhosis HIV/HCV
More informationHepatitis. Dr. Mohamed. A. Mahdi 5/2/2019. Mob:
Hepatitis Dr. Mohamed. A. Mahdi Mob: 0123002800 5/2/2019 Hepatitis Hepatitis means the inflammation of the liver. May cause by viruses or bacteria, parasites, radiation, drugs, chemical and toxins (alcohol).
More informationAcute Liver Failure. Neil Shah, MD UNC School of Medicine High-Impact Hepatology Saturday, Dec 8 th, 2018
Acute Liver Failure Neil Shah, MD UNC School of Medicine High-Impact Hepatology Saturday, Dec 8 th, 2018 Disclosures None Outline Overview of ALF Management of ALF Diagnosis of ALF Treatments and Support
More informationUnderstanding this condition will help you provide optimal care for patients and their families.
Cirrhosis A complex cascade of care ILLUSTRATION BY STEVE OH/PHOTOTAKE Understanding this condition will help you provide optimal care for patients and their families. By Ann Crawford, PhD, RN, CNS, CEN,
More informationProgram Disclosure. This program is supported by an educational grant from Salix Pharmaceuticals.
Program Disclosure This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the sponsorship
More informationACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries
ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries Ashwani K. Singal, MD, MS, FACG 1, Ramon Bataller, MD, PhD, FACG 2, Joseph Ahn, MD, MS, FACG (GRADE Methodologist) 3, Patrick S. Kamath,
More informationDisorders of the Liver, Gallbladder and Pancreas
Disorders of the Liver, Gallbladder and Pancreas Objectives: Disorders of the liver Disorders of the gall bladder Disorders of the pancreas Part 1: Disorders of the Liver 1 Jaundice: is a manifestation
More informationAlcoholic Hepatitis: Routine Screening for Early Recognition and Management. Juan Guerrero, MD
Alcoholic Hepatitis: Routine Screening for Early Recognition and Management Juan Guerrero, MD Global Problem 1% of GNP of medium/high income countries Additional societal costs Disproportionately affects
More informationEvaluating HIV Patient for Liver Transplantation. Marion G. Peters, MD Professor of Medicine University of California San Francisco USA
Evaluating HIV Patient for Liver Transplantation Marion G. Peters, MD Professor of Medicine University of California San Francisco USA Slide 2 ESLD and HIV Liver disease has become a major cause of death
More informationAlcoholism and Alcohol Liver Disease from a Transplant Hepatology Perspective
Alcoholism and Alcohol Liver Disease from a Transplant Hepatology Perspective Clark Kulig, MD Director, Porter Center for Liver Care Denver, CO February 2015 Does quantity of alcohol correlate with liver
More informationApproved regimens for cirrhotic patients
5th Workshop on HCV THERAPY ADVANCES New antivirals in clinical practice Approved regimens for cirrhotic patients Amsterdam, 4-5 december 2015 Disease burden in Spain 400000 350000 300000 F0 Peak cirrhosis
More informationGI bleeding in chronic liver disease
GI bleeding in chronic liver disease Stuart McPherson Consultant Hepatologist Liver Unit, Freeman Hospital, Newcastle upon Tyne and Institute of Cellular Medicine, Newcastle University. Case 54 year old
More informationPORTAL HYPERTENSION An Introduction to the Culprit of Many Liver Failure Complications
PORTAL HYPERTENSION An Introduction to the Culprit of Many Liver Failure Complications Edy G. Trujillo, RN, MSN, ACNP-BC Liver Transplant RRUCLA Medical Center July 31, 2018 What Do We All Look Forward
More informationManagement of acute alcoholic hepatitis
Management of acute alcoholic hepatitis Yesim ALAHDAB Marmara University Hospital, Istanbul/TURKEY 5 th European Young Hepatologists Workshop August, 27-29, 2015 Moulin de Vernègues, France 1.4L ALCOHOL
More informationProvider/Patient Education Guide (P/PEG) #1: What should I do about my hepatitis C?
Provider/Patient Education Guide (P/PEG) #1: What should I do about my hepatitis C? Do I need vaccines? (Protection against Hepatitis A and Hepatitis B) All patients who are not already immune to hepatitis
More informationObjectives. Objectives. Introduction. Hepatitis A. Hepatitis B. At the end of the presentation, pharmacy technician participants will be able to:
Objectives A Revolution in Medicine: Advances in the Treatment of Hepatitis C Infection Spencer H. Durham, Pharm.D., BCPS (AQ ID) Assistant Clinical Professor of Pharmacy Practice Auburn University Harrison
More informationHepatitis C Update on New Treatments
Hepatitis C Update on New Treatments Kevork M. Peltekian, MD, FRCPC 44th Annual Dalhousie Spring Refresher Course - Therapeutics April 5 - April 7, 2018 Halifax Convention Centre Disclosures Conflicts
More informationManagement of the Cirrhotic Patient in the ICU
Management of the Cirrhotic Patient in the ICU Peter E. Morris, MD Professor & Chief, Pulmonary, Critical Care and Sleep Medicine University of Kentucky Conflict of Interest Funding US National Institutes
More informationInterpreting Liver Function Tests
PSH Clinical Guidelines Statement 2017 Interpreting Liver Function Tests Dr. Asad A Chaudhry Consultant Hepatologist, Chaudhry Hospital, Gujranwala, Pakistan. Liver function tests (LFTs) generally refer
More informationEVALUATION OF ABNORMAL LIVER TESTS
EVALUATION OF ABNORMAL LIVER TESTS MIA MANABAT DO PGY6 MOA 119 TH ANNUAL SPRING SCIENTIFIC CONVENTION MAY 19, 2018 EVALUATION OF ABNORMAL LIVER TESTS Review of liver enzymes vs liver function tests Clinical
More informationPaul Martin, MD, FACG. University of Miami. 30,000 deaths from cirrhosis per annum, alcohol implicated in 48%
Paul Martin, MD, FACG University of Miami 30,000 deaths from cirrhosis per annum, alcohol implicated in 48% Second commonest indication for liver transplant NIAA 2007 Page 1 of 26 Risk Factors Medical
More informationAscites Management. Atif Zaman, MD MPH Oregon Health & Science University Professor of Medicine Division of Gastroenterology and Hepatology
Ascites Management Atif Zaman, MD MPH Oregon Health & Science University Professor of Medicine Division of Gastroenterology and Hepatology Disclosure 1. The speaker Atif Zaman, MD MPH have no relevant
More informationPatterns of abnormal LFTs and their differential diagnosis
Patterns of abnormal LFTs and their differential diagnosis Professor Matthew Cramp South West Liver Unit and Peninsula Schools of Medicine and Dentistry, Plymouth Outline liver function / liver function
More informationConflicts of Interest in the last 12 months
STEATOHEPATITIS Richard K. Sterling, MD, MSc, FACP, FACG VCU Hepatology Professor of Medicine Chief, Section of Hepatology Virginia Commonwealth University Richmond, VA Conflicts of Interest in the last
More informationCommonly Asked Questions About Chronic Hepatitis C
Commonly Asked Questions About Chronic Hepatitis C From the American College of Gastroenterology 1. How common is the hepatitis C virus? The hepatitis C virus is the most common cause of chronic viral
More informationThe Liver for the Nonhepatologist
The Liver for the Nonhepatologist Michael R. Charlton, MBBS, FRCP Professor of Medicine University of Chicago Chicago, Illinois Overview Initial assessment of liver disease How do you diagnose cirrhosis?
More informationDecompensated chronic liver disease
Decompensated chronic liver disease Definition of decompensated chronic liver disease Patients with chronic liver disease can present with acute decompensation due to various causes. The decompensation
More informationPatterns of abnormal LFTs and their differential diagnosis
Patterns of abnormal LFTs and their differential diagnosis Professor Matthew Cramp South West Liver Unit and Peninsula Schools of Medicine and Dentistry, Plymouth Outline liver function tests / tests of
More informationViral Hepatitis. Background
Viral Hepatitis Background Hepatitis or inflammation of the liver can be caused by infectious and noninfectious problems. Infectious etiologies include viruses, bacteria, fungi and parasites. Noninfectious
More informationApproach to the Patient with Liver Disease
Approach to the Patient with Liver Disease Diagnosis of liver disease Careful history taking Physical examination Laboratory tests Radiologic examination and imaging studies Liver biopsy Liver diseases
More informationLIVER DISORDERS (PRACTICAL MANAGEMENT) Dr Pok Kern (PK) TAN Gastroenterologist Calvary hospital, ACT 1 st April 2017
LIVER DISORDERS (PRACTICAL MANAGEMENT) Dr Pok Kern (PK) TAN Gastroenterologist Calvary hospital, ACT 1 st April 2017 TOPICS TO COVER Acute liver failure Chronic liver failure Portal hypertension : Ascites
More informationThe Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (10), Page 5391-5395 Study of Vitamin D Level in Cirrhotic HCV Patients before and after Transplantation Amira Ahmed Salem, Wael Ahmed Yousry,
More informationManagement of autoimmune hepatitis. Pierre-Emmanuel RAUTOU Inserm U970, Paris Service d hépatologie, Hôpital Beaujon, Clichy, France
Management of autoimmune hepatitis Pierre-Emmanuel RAUTOU Inserm U970, PARCC@HEGP, Paris Service d hépatologie, Hôpital Beaujon, Clichy, France 41 year-old woman, coming to emergency department for fatigue
More informationAlcohol-Related Liver Disease
Alcohol-Related Liver Disease Nonalcoholic Fatty Liver Disease (NAFLD) 1 Why is the liver important? Your liver is a vital organ that performs many essential functions. It filters out harmful substances
More informationAlcoholic Hepatitis: Management Options
Alcoholic Hepatitis: Management Options Paul J. Thuluvath, MD. FRCP Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore Professor of Surgery & Medicine, Georgetown University,
More informationPrimary Care Approach to Diagnosis and Management of Chronic Hepatitis C Brian Viviano, D.O.
Primary Care Approach to Diagnosis and Management of Chronic Hepatitis C Brian Viviano, D.O. Objectives Epidemiology of chronic hepatitis C CDC guidelines on screening or hepatitis C Diagnosing hepatitis
More information