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stringlengths 12
494
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listlengths 384
384
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|---|---|
Finally,\tthe\tliver\nacts\tas\ta\tfilter\tand\tflood\tchamber\tby\tremoving\tbacteria\tand\tdebris\tfrom\tblood\tthrough\tthe\tphagocytic\taction\tof\nspecialized\tmacrophages\tcalled\t\nKupffer\tcells\n\tlocated\tin\tthe\tsinusoids\tand\tby\tstoring\tblood\tbacked\tup\tfrom\tthe\tvena\ncava\tas\tin\tright\theart\tfailure.\nAssessment\tof\tliver\tfunction
|
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] |
cava\tas\tin\tright\theart\tfailure.\nAssessment\tof\tliver\tfunction\nBiochemical\tmarkers\tare\tused\tto\tevaluate\tand\tmonitor\tpatients\thaving\tor\tsuspected\tof\thaving\n\tliver\tdisease.\tEnzyme\nassays\tmeasure\tthe\trelease\tof\tliver\tenzymes,\tand\tother\ttests\tmeasure\tliver\tfunction.\tScreening\ttests\tfor
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] |
hepatobiliary\tdisease\tinclude\tserum\tlevels\tof\tbilirubin,\talkaline\tphosphatase\t(Alk\tPhos),\taspartate\tamino\ttransferase\n(AST),\tand\talanine\taminotransferase\t(ALT).\t\nTable\t28.1\n\telaborates\tcommon\tlaboratory\ttests\tfor\tliver\tdisorders\t(see\nalso\t\nAppendix\t12\n).\nTABLE\t28.1\nCommon\n\tLaboratory\tTests\tUsed\tto\tTest\tLiver\tFunction\nLaboratory\tTest\nComment
|
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] |
Laboratory\tTests\tUsed\tto\tTest\tLiver\tFunction\nLaboratory\tTest\nComment\nHepatic\tExcretion\nTotal\tserum\tbilirubin\nWhen\tincreased,\tmay\tindicate\tbilirubin\toverproduction\tor\timpaired\thepatic\tuptake,\tconjugation,\tor\nexcretion\nIndirect\tserum\nbilirubin\nUnconjugated\tbilirubin;\tincreased\twith\texcessive\tbilirubin\tproduction\t(hemolysis),\timmaturity\tof
|
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] |
enzyme\tsystems,\tinherited\tdefects,\tdrug\teffects\nDirect\tserum\tbilirubin\nConjugated\tbilirubin;\n\tincreased\twith\tdepressed\tbilirubin\texcretion,\thepatobiliary\tdisease,\nintrahepatic\tor\tbenign\tpostoperative\tjaundice\tand\tsepsis,\tand\tcongenital\tconjugated
|
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-0.02248646505177021,
-0.003544929903000593,
-0.016421718522906303,
-0.005220107734203339,
-0.007688823621720076,
0.031000550836324692,
-0.029268264770507812,
0.021820077672600746,
0.03777466341853142,
0.03671461343765259,
0.0032047864515334368,
-0.024478506296873093,
0.002539269858971238,
-0.05209111422300339,
0.05431390181183815,
0.055610716342926025,
-4.9123549672458466e-8,
0.06582696735858917,
-0.025400061160326004,
0.026631461456418037,
-0.07784540206193924,
0.015136850997805595,
-0.027880139648914337,
-0.021099701523780823,
0.0716676414012909,
-0.0015399591065943241,
-0.036532916128635406,
-0.05886901915073395,
0.11978107690811157,
-0.1009320542216301,
-0.03046179935336113,
0.11708841472864151,
0.008931372314691544,
-0.07309115678071976,
0.06252613663673401,
-0.0176107045263052,
-0.07004880160093307,
-0.0702313557267189,
0.021092170849442482,
-0.05069686099886894,
0.062084540724754333,
0.007365054916590452,
-0.06586968153715134,
0.047232214361429214,
-0.004290585871785879,
0.002729048253968358,
0.07980906218290329,
0.010688232257962227,
-0.014499434269964695,
-0.031172405928373337,
-0.11002162843942642,
-0.09819994121789932,
0.01837487891316414,
0.008781030774116516,
-0.03870479762554169,
-0.025974474847316742,
0.12449823319911957,
0.011344002559781075,
-0.05749340355396271,
-0.05837298184633255,
0.018963050097227097,
0.046105653047561646,
-0.0256583821028471,
-0.00017810464487411082,
0.08172488212585449,
-0.02277209237217903,
-0.07283395528793335,
0.023886872455477715,
0.020646005868911743,
0.006051098927855492,
-0.04507263004779816,
-0.07015872746706009,
0.040049321949481964,
0.08528796583414078,
-0.022118596360087395,
0.02330487035214901,
-0.047432079911231995,
0.003730130847543478,
0.09075497090816498,
0.2064865231513977,
-0.02018565870821476
] |
hyperbilirubinemia\nCholestasis\nSerum\talkaline\nphosphatase\nEnzyme\twidely\tdistributed\tin\tliver,\tbone,\tplacenta,\tintestine,\tkidney,\tleukocytes;\tmainly\tbound\tto\ncanalicular\tmembranes\tin\tliver;\tincreased\tlevels\tsuggest\tcholestasis\tbut\tcan\tbe\tincreased\n\twith\nbone\tdisorders,\tpregnancy,\tnormal\tgrowth,\tand\tsome\tmalignancies\nγ-Glutamyl\ntranspeptidase\n(GGT)
|
[
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-0.09474492073059082,
-0.02299155481159687,
-0.033325083553791046,
-0.08958299458026886,
-0.004105383064597845,
0.05750216171145439,
0.06678306311368942,
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0.05444721505045891,
0.07527941465377808,
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0.02300649881362915,
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0.029565181583166122,
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0.021553946658968925,
0.029701950028538704,
0.023057185113430023,
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0.07010693848133087,
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0.01738576963543892,
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0.0310469139367342,
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0.07031641155481339,
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0.02974020317196846,
0.016206834465265274,
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0.0028413699474185705,
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0.0016501942882314324,
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0.08451157063245773,
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0.016161050647497177,
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0.012278303503990173,
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0.03191085159778595,
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0.07615266740322113,
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0.07327708601951599,
0.023106563836336136,
0.08901694416999817,
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0.0042277174070477486,
-0.021032486110925674,
0.08362148702144623,
-0.07829024642705917,
-0.001020909403450787,
0.00349340308457613,
-0.011383483186364174,
-0.015717893838882446,
-0.011875473894178867,
-0.003974666353315115,
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0.007588210981339216,
-0.07456109672784805,
0.038571637123823166,
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-0.04435811936855316,
0.0628538429737091,
0.01333926897495985,
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0.033114947378635406,
-0.04148462042212486,
-0.005478442180901766,
-0.006261676084250212,
-0.030106911435723305,
0.00645036157220602,
0.01984827034175396,
0.10111556947231293,
-0.019082317128777504,
0.012861276976764202,
-0.012610656209290028,
0.03152469918131828,
0.05580492317676544,
0.1133110523223877,
0.0864497721195221,
-0.02238268032670021,
0.008071704767644405,
0.053908735513687134,
0.011644648388028145,
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0.013103727251291275,
0.002683516824617982,
3.740759509574442e-33,
0.0382813923060894,
0.03487824648618698,
-0.01291520707309246,
0.0742960125207901,
0.03548154607415199,
0.07029902935028076,
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0.0701993778347969,
0.03086218237876892,
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0.01772833801805973,
0.004982969723641872,
-0.03813423588871956,
0.15971001982688904,
0.018723569810390472,
-0.03866207227110863,
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0.005756343249231577,
0.02432835102081299,
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0.008875945582985878,
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0.04401107504963875,
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0.026471242308616638,
0.06360957026481628,
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0.07171183079481125,
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0.004516701214015484,
0.00100975320674479,
0.004125152248889208,
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0.043311137706041336,
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0.020991526544094086,
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0.10586126148700714,
0.055420491844415665,
0.04406828433275223,
-0.027503006160259247,
0.017988841980695724,
0.01264349464327097,
0.02832738310098648,
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-0.09623104333877563,
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0.024412550032138824,
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-0.04408960044384003,
0.05215450003743172,
0.03354848176240921,
0.052442241460084915,
0.061476025730371475,
0.004104808904230595,
0.02411281131207943,
-0.02808896079659462,
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-0.02676844783127308,
-0.024508800357580185,
0.031433820724487305,
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-0.018857058137655258,
-0.07181656360626221,
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-0.04140188917517662,
-0.012767207808792591,
0.005144480150192976,
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-0.0687752217054367,
-0.08423137664794922,
-4.247168353380437e-33,
-0.021326951682567596,
-0.07072577625513077,
0.03155560418963432,
-0.01927553303539753,
-0.009894014336168766,
0.07602690160274506,
0.0504748709499836,
0.017174407839775085,
0.02703820914030075,
0.02027677185833454,
0.12386573851108551,
0.007597004994750023,
-0.08776093274354935,
-0.14931781589984894,
-0.090692438185215,
0.039911847561597824,
-0.029952839016914368,
0.08837879449129105,
-0.0026746445801109076,
-0.028318896889686584,
-0.1116718053817749,
0.08030729740858078,
-0.0734867975115776,
0.07224489748477936,
0.035700924694538116,
0.050473641604185104,
-0.011980179697275162,
-0.0240572951734066,
0.033471278846263885,
0.0679754838347435,
-0.019225794821977615,
-0.009094580076634884,
-0.01905202679336071,
0.02556542120873928,
0.04584681987762451,
0.015453916043043137,
0.0257129967212677,
-0.07668071240186691,
-0.001824062317609787,
0.007489531300961971,
-0.02540792152285576,
-0.04551132768392563,
0.10276187211275101,
0.0043723019771277905,
0.06893932074308395,
0.029575452208518982,
-0.04016517847776413,
-0.03048579767346382,
-0.05097920447587967,
0.03218117728829384,
0.02239297702908516,
-0.010015526786446571,
-0.04530884698033333,
0.08118902891874313,
0.019638022407889366,
0.028587084263563156,
0.05296140909194946,
-0.05189087986946106,
0.013631772249937057,
-0.05177709460258484,
-0.012971014715731144,
-0.0710487961769104,
0.04509371519088745,
-0.015932297334074974,
0.03357580304145813,
-0.01490816380828619,
-0.028247058391571045,
-0.03831158205866814,
0.03552748262882233,
0.02258051000535488,
-0.0019291150383651257,
-0.02846890687942505,
-0.08579234778881073,
-0.1091042086482048,
0.06030159071087837,
-0.009213943034410477,
-0.03468244895339012,
-0.0117128174751997,
0.0010437935125082731,
-0.028007060289382935,
-0.02898166887462139,
-0.01256937999278307,
0.039255719631910324,
0.0023078296799212694,
0.07105898857116699,
-0.03042261116206646,
-0.001125845592468977,
0.028005894273519516,
0.009138988330960274,
0.029074467718601227,
0.005759097170084715,
-0.007727895397692919,
-0.0825023502111435,
0.08301813900470734,
0.09767971932888031,
-4.604386560913554e-8,
0.1300131380558014,
-0.003856263356283307,
-0.014233846217393875,
-0.0887073501944542,
0.027992095798254013,
-0.053923312574625015,
0.03072228655219078,
0.049931012094020844,
0.048375897109508514,
-0.005044159945100546,
-0.06358808279037476,
0.09291603416204453,
-0.0840224176645279,
-0.03545019030570984,
0.030712002888321877,
0.08014503121376038,
-0.02661401778459549,
0.07866554707288742,
-0.0010549327125772834,
-0.07451975345611572,
-0.04130897298455238,
0.053664494305849075,
-0.038748472929000854,
0.021129721775650978,
-0.008140157908201218,
-0.016856599599123,
0.03903763368725777,
-0.002644218737259507,
0.0655241310596466,
-0.01070704311132431,
0.11200804263353348,
-0.018662510439753532,
0.03163319453597069,
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0.053292226046323776,
0.0024244196247309446,
-0.03862740099430084,
-0.026843367144465446,
0.08612637966871262,
-0.0445256344974041,
-0.046425964683294296,
-0.015918854624032974,
0.03787798434495926,
0.09251651912927628,
-0.08747734129428864,
0.016947941854596138,
0.08094175159931183,
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-0.05422423407435417,
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0.03531551733613014,
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0.05523265525698662,
0.05676962062716484,
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0.04403666779398918,
-0.016588039696216583,
0.0018265052931383252,
0.088546983897686,
0.11932899057865143,
-0.022496214136481285
] |
γ-Glutamyl\ntranspeptidase\n(GGT)\nEnzyme\tfound\tin\thigh\tconcentrations\tin\tepithelial\tcells\tlining\tbile\tductules\tin\tthe\tliver;\talso\tpresent\nin\tkidney,\tpancreas,\theart,\tbrain;\tincreased\twith\tliver\tdisease,\tbut\talso\tafter\tmyocardial\ninfarction,\tin\tneuromuscular\tdisease,\tpancreatic\tdisease,\tpulmonary\tdisease,\tdiabetes\tmellitus,\nand
|
[
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0.014609803445637226,
0.006030977237969637,
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0.058999933302402496,
0.08843961358070374,
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0.030499987304210663,
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0.07712607830762863,
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0.027280298992991447,
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2.8634928510015688e-33,
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] |
and\n\tduring\talcohol\tingestion\nHepatic\tSerum\tEnzymes\nAlanine\naminotransferase\n(ALT,\tformerly\tSGPT,\nserum\tglutamic\npyruvic\ntransaminase)\nLocated\tin\tcytosol\tof\thepatocyte;\tfound\tin\tseveral\tother\tbody\ttissues\tbut\thighest\tin\tliver;\tincreased\nwith\tliver\tcell\tdamage\nAspartate\naminotransferase\n(AST,\tformerly\nSGOT,\tserum\nglutamic\toxaloacetic\ntransaminase)
|
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0.09588657319545746,
0.06872282922267914,
0.10585980862379074,
-0.027652349323034286
] |
(AST,\tformerly\nSGOT,\tserum\nglutamic\toxaloacetic\ntransaminase)\nLocated\tin\tcytosol\tand\tmitochondria\tof\thepatocyte;\n\talso\tin\tcardiac\tand\tskeletal\tmuscle,\theart,\nbrain,\tpancreas,\tkidney;\tincreased\twith\tliver\tcell\tdamage\nSerum\tlactic\ndehydrogenase\nLocated\tin\tliver,\tred\tblood\tcells,\tcardiac\tmuscle,\tkidney;\tincreased\twith\tliver\tdisease\tbut\tlacks
|
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0.1288026124238968,
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] |
sensitivity\tand\tspecificity\tbecause\tit\tis\tfound\tin\tmost\tother\tbody\ttissues\nSerum\tProteins\nProthrombin\ttime\t(PT)\nMost\tblood\tcoagulation\tfactors\tare\tsynthesized\tin\tthe\n\tliver;\tvitamin\tK\tdeficiency\tand\tdecreased\nsynthesis\tof\tclotting\tfactors\tincrease\tprothrombin\ttime\tand\trisk\tof\tbleeding\nInternational\nNormalized\tRatio\n(INR)
|
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International\nNormalized\tRatio\n(INR)\nA\tstandardized\tway\tto\treport\tPT\tlevels\tso\tthat\tlevels\tfrom\tdifferent\tlaboratories\tcan\tbe\tcompared\nSerum\talbumin\nMain\texport\tprotein\tsynthesized\tin\tthe\tliver\tand\tmost\timportant\tfactor\tin\tmaintaining\tplasma\noncotic\tpressure;\thypoalbuminemia\n\tcan\tresult\tfrom\texpanded\tplasma\tvolume\tor\treduced
|
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can\tresult\tfrom\texpanded\tplasma\tvolume\tor\treduced\nsynthesis\tas\twell\tas\tincreased\tlosses\tas\toccurs\twith\tprotein-losing\tenteropathy,\tnephrotic\nsyndrome,\tburns,\tgastrointestinal\tbleeding,\texfoliative\tdermatitis\nSerum\tglobulin\nAlpha\n1\n\tand\talpha\n2\n-globulins\tare\tsynthesized\tin\tthe\tliver;\tlevels\tincrease\twith\tchronic\tliver\tdisease;
|
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limited\tdiagnostic\tuse\tin\thepatobiliary\tdisease,\talthough\tthe\tpattern\n\tmay\tsuggest\tunderlying\ncause\tof\tliver\tdisease\t(e.g.,\televated\timmunoglobulin\t[Ig]G\tsuggests\tautoimmune\thepatitis,\nelevated\tIgM\tsuggests\tprimary\tbiliary\tcirrhosis,\televated\tIgA\tsuggests\talcoholic\tliver\tdisease)\nMarkers\tof\tSpecific\tLiver\tDiseases\nSerum\tferritin
|
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] |
Markers\tof\tSpecific\tLiver\tDiseases\nSerum\tferritin\nMajor\tiron\tstorage\tprotein;\tincreased\tlevel\tsensitive\tindicator\tof\tgenetic\themochromatosis\nCeruloplasmin\nMajor\tcopper-binding\tprotein\n\tsynthesized\tby\tliver;\tdecreased\tin\tWilson’s\tdisease\nAlpha-fetoprotein\nMajor\tcirculating\tplasma\tprotein;\tincreased\twith\thepatocellular\tcarcinoma\nAlpha\n1\n-antitrypsin
|
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] |
Alpha\n1\n-antitrypsin\nMain\tfunction\tis\tto\tinhibit\tserum\ttrypsin\tactivity;\tdecreased\tlevels\tindicate\talpha\n1\n-antitrypsin\ndeficiency,\twhich\tcan\tcause\tliver\tand\tlung\tdamage\nMarkers\tfor\tViral\nHepatitis\nAnti-HAV\tIgM\n(antibody\tto\nhepatitis\tA\tvirus)\nMarker\n\tfor\thepatitis\tA;\tindicates\tcurrent\tor\trecent\tinfection\tor\tconvalescence\nHBsAg\t(hepatitis\tB
|
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] |
HBsAg\t(hepatitis\tB\nsurface\tantigen)\nMarker\tfor\thepatitis\tB;\tpositive\tin\tmost\tcases\tof\tacute\tor\tchronic\tinfection\nAnti-HBc\t(antibody\tto\nhepatitis\tB\tcore\nantigen)\nAntibody\tto\thepatitis\tB\tcore\tantigen;\tmarker\tfor\thepatitis\tB;\tdenotes\trecent\tor\tpast\thepatitis\ninfection\nAnti-HBs\t(antibody\tto\nhepatitis\tB\tsurface\nantigen)
|
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0.12169945240020752,
0.1314588040113449,
0.05695430189371109
] |
infection\nAnti-HBs\t(antibody\tto\nhepatitis\tB\tsurface\nantigen)\nAntibody\tto\tHBsAg;\tmarker\tfor\thepatitis\tB;\tdenotes\tprior\thepatitis\tB\tinfection\tor\thepatitis\tB\nvaccine;\tprotective\nHBeAg\t(hepatitis\tBe\nantigen)\nMarker\tfor\thepatitis\tB;\ttransiently\tpositive\tduring\tactive\tvirus\treplication;\treflects\tconcentration\nand\tinfectivity\tof\tvirus
|
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] |
and\tinfectivity\tof\tvirus\nAnti-HBe\t(antibody\tto\nhepatitis\tBe\nantigen)\nMarker\tfor\thepatitis\tB;\tpositive\tin\tall\tacute\tand\tchronic\tcases;\tpositive\tin\tcarriers;\n\tnot\tprotective\nHBV-DNA\t(hepatitis\tB\ndeoxyribonucleic\nacid)\nMeasures\thepatitis\tB\tviral\tload\nAnti-HCV\t(antibody\tto\nhepatitis\tC\tvirus)
|
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0.03963295742869377
] |
Anti-HCV\t(antibody\tto\nhepatitis\tC\tvirus)\nMarker\tfor\thepatitis\tC;\tpositive\t5-6\tweeks\tafter\tonset\tof\thepatitis\tC\tvirus;\tnot\tprotective;\treflects\ninfectious\tstate\tand\tis\tdetectable\tduring\tand\tafter\ttreatment\nHCV-RNA\t(hepatitis\tC\nvirus\tribonucleic\nacid)\nMeasures\thepatitis\tC\tviral\tload\nAnti-HDV\nMarker
|
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] |
acid)\nMeasures\thepatitis\tC\tviral\tload\nAnti-HDV\nMarker\n\tfor\thepatitis\tD;\tindicates\tinfection;\tnot\tprotective\nMiscellaneous\nAmmonia\nLiver\tconverts\tammonia\tto\turea;\tmay\tincrease\twith\thepatic\tfailure\tand\tportal-systemic\tshunts\nData\tfrom\tWedemeyer\tH,\tPawlotsky\tJM:\tAcute\tviral\thepatitis.\tIn\tGoldman\tL\tet\tal,\teditors:\t\nGoldman’s\tCecil\tmedicine
|
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Goldman’s\tCecil\tmedicine\n,\ted\t24,\tPhiladelphia,\t2012,\tElsevier\tSaunders.\nPawlotsky\tJM,\tMchuthinson\tJ:\tChronic\tviral\tand\tautoimmune\n\thepatitis.\tIn\tGoldman\tL\tet\tal,\teditors:\t\nGoldman’s\tCecil\tmedicine,\n\ted\t24,\tPhiladelphia,\t2012,\tElsevier\tSaunders.\nWoreta\tTA,\tAlqahtani\tSA:\tEvaluation\tof\tabnormal\tliver\ttests,\t\nMed\tClin\tNorth\tAm
|
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Med\tClin\tNorth\tAm\n\t98:1,\t2014.\tMartin\tP,\tFriedman\tLS:\tAssessment\tof\tliver\tfunction\tand\tdiagnostic\tstudies.\tIn\nFriedman\tLS,\tKeeffe\tB,\teditors:\t\nHandbook\tof\tliver\tdisease\n,\ted\t3,\tPhiladelphia,\t2012,\tElsevier\tSaunders;\t2012.\tKhalili\n\tH\tet\tal:\tAssessment\tof\tliver\tfunction\tin\tclinical\tpractice.\nIn\tGines\tP\tet\tal,\teditors:
|
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] |
In\tGines\tP\tet\tal,\teditors:\t\nClinical\tgastroenterology:\tchronic\tliver\tfailure\n,\tNew\tYork,\t2011,\tSpringer.
|
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Physical\texamination\tas\twell\tas\tdiagnostic\tprocedures\t(e.g.,\tendoscopy)\tor\tabdominal\timaging\ttests\t(e.g.,\nabdominal\tultrasound,\tmagnetic\tresonance\timaging,\tor\tcomputed\ttomography\tscan)\tcan\tbe\tused\tto\tdiagnose\tor\nevaluate\tpatients\n\tfor\tliver\tdisease.\tA\tliver\tbiopsy\tis\tconsidered\tthe\tgold\tstandard\tto\tassess\tthe\tseverity\tof\thepatic
|
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] |
inflammation\tand\tfibrosis\t(scar\ttissue).\nDiseases\tof\tthe\tliver\nDiseases\tof\tthe\tliver\tcan\tbe\tacute\tor\tchronic,\tinherited\tor\tacquired.\tThe\tfollowing\tsection\tprovides\ta\tbrief\toverview\nof\tviral\thepatitis,\tnonalcoholic\tfatty\tliver\tdisease\t(NAFLD),\talcoholic\tliver\tdisease,\tcholestatic\tliver\tdiseases,\ninherited\tdisorders,\tand\tother\tliver\tdiseases.
|
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] |
inherited\tdisorders,\tand\tother\tliver\tdiseases.\nViral\thepatitis\nViral\t\nhepatitis\n\tis\ta\twidespread\tinflammation\tof\tthe\tliver\tand\tis\tcaused\tby\tvarious\thepatitis\tviruses,\tincluding\tA,\tB,\tC,\nD,\tand\tE\t(\nFig.\t28.1\n\tand\t\nTable\t28.2\n).\tHepatitis\tA\tand\tE\tare\tthe\tinfectious\tforms,\tmainly\tspread\tby\tfecal-oral\troute.
|
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] |
Hepatitis\tB,\tC,\tand\tD\texist\tin\tthe\tserum\tand\tare\tspread\tby\tblood\tand\tbody\tfluids\t(\nPawlotsky,\t2016\n).\tInfectious\tagents\nsuch\tas\tEpstein-Barr\tvirus,\tcytomegalovirus,\tand\therpes\tsimplex\tvirus\talso\tcan\tcause\tan\tacute\thepatitis.\nFIG.\t28.1\nA,\n\tNormal\tliver.\t\nB,\n\tLiver\twith\tdamage\tfrom\tchronic\tactive\thepatitis.\t\nC,
|
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] |
B,\n\tLiver\twith\tdamage\tfrom\tchronic\tactive\thepatitis.\t\nC,\n\tLiver\twith\tdamage\tfrom\tsclerosing\tcholangitis.\t\nD,\nLiver\twith\tdamage\tfrom\tprimary\tbiliary\tcirrhosis.\t\nE,\n\tLiver\twith\tdamage\tfrom\tpolycystic\tliver\tdisease\t\n(background)\n\tand\tnormal\tliver\n(foreground)\n.\n\t\nSource:
|
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(background)\n\tand\tnormal\tliver\n(foreground)\n.\n\t\nSource:\n\t(Courtesy\tBaylor\tSimmons\tTransplant\tInstitute,\tBaylor\tUniversity\tMedical\tCenter,\tDallas,\tTX.)
|
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0.09139208495616913,
0.04615289345383644,
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0.024024488404393196,
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0.0819191187620163,
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0.035631030797958374,
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0.057998619973659515,
0.020733477547764778,
0.03647270426154137,
0.016713999211788177,
0.04775559529662132,
0.048377495259046555,
0.04765428230166435,
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0.11369085311889648,
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0.12428101152181625,
0.046642858535051346,
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0.056500308215618134,
0.045726142823696136,
-0.006955995224416256,
0.03410496562719345,
0.0028726947493851185,
-0.004183279350399971,
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0.037871409207582474,
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0.05643511936068535,
0.021201761439442635,
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0.028522679582238197,
0.10612766444683075,
0.030991321429610252,
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0.021203763782978058,
0.04718600586056709,
0.07156098634004593,
0.034018922597169876,
0.029117722064256668
] |
TABLE\t28.2\nTypes\tof\tViral\tHepatitis\nVirus\nTransmission\nComments\nHepatitis\tA\nFecal-oral\troute;\tis\tcontracted\tthrough\ncontaminated\tdrinking\twater,\tfood,\nand\tsewage.\nAnorexia\tis\tthe\tmost\tfrequent\tsymptom,\tand\tit\tcan\tbe\tsevere.\tOther\ncommon\tsymptoms\tinclude\tnausea,\tvomiting,\tright\tupper\nquadrant\tabdominal\tpain,\tdark\turine,\tand\tjaundice\t(icterus).
|
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0.09091664850711823,
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0.005623259581625462,
0.06552388519048691,
0.0686817318201065,
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0.11204386502504349,
0.07299406826496124,
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0.055243682116270065,
0.02116529643535614,
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0.08782824128866196,
0.09791527688503265,
0.01751003786921501,
0.04464346915483475,
0.014681299217045307,
0.08162998408079147,
0.0843384712934494,
0.09635316580533981,
0.013615639880299568
] |
quadrant\tabdominal\tpain,\tdark\turine,\tand\tjaundice\t(icterus).\nRecovery\tis\tusually\tcomplete,\tand\tlong-term\tconsequences\n\tare\nrare.\tSerious\tcomplications\tmay\toccur\tin\thigh-risk\tpatients;\nsubsequently,\tgreat\tattention\tmust\tbe\tgiven\tto\tadequate\nnutritional\tintake.\nHepatitis\tB\nand\tC\nHBV\tand\tHCV\tare\ttransmitted\tvia\tblood,
|
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] |
Hepatitis\tB\nand\tC\nHBV\tand\tHCV\tare\ttransmitted\tvia\tblood,\nblood\tproducts,\tsemen,\tand\tsaliva.\nFor\texample,\tthey\tcan\tbe\tspread\tfrom\ncontaminated\tneedles,\tblood\ntransfusions,\topen\tcuts\tor\twounds,\nsplashes\tof\tblood\tinto\tthe\tmouth\tor\neyes,\tor\tsexual\tcontact.\nHBV\tand\tHCV\tcan\tlead\tto\tchronic\tand\tcarrier\tstates.\tChronic\tactive
|
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] |
HBV\tand\tHCV\tcan\tlead\tto\tchronic\tand\tcarrier\tstates.\tChronic\tactive\nhepatitis\talso\tcan\tdevelop,\tleading\tto\tcirrhosis\tand\tliver\tfailure.\nHepatitis\tD\nHDV\tis\trare\tin\tthe\tUnited\tStates\tand\ndepends\ton\tHBV\tfor\tsurvival\tand\npropagation\tin\thumans.\nHDV\tmay\tbe\ta\tcoinfection\t(occurring\tat\tthe\tsame\ttime\tas\tHBV)\tor\ta
|
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] |
HDV\tmay\tbe\ta\tcoinfection\t(occurring\tat\tthe\tsame\ttime\tas\tHBV)\tor\ta\nsuperinfection\t(superimposing\titself\ton\tthe\tHBV\tcarrier\tstate).\nThis\tform\tof\thepatitis\tusually\n\tbecomes\tchronic.\nHepatitis\tE\nHEV\tis\ttransmitted\tvia\tthe\toral-fecal\nroute.\nHEV\tis\trare\tin\tthe\tUnited\tStates\t(typically\tonly\toccurs\twhen
|
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] |
route.\nHEV\tis\trare\tin\tthe\tUnited\tStates\t(typically\tonly\toccurs\twhen\nimported),\tbut\tit\tis\treported\tmore\tfrequently\tin\tmany\tcountries\nof\tsouthern,\teastern,\tand\tcentral\tAsia;\tnorthern,\teastern,\tand\nwestern\tAfrica;\tand\tMexico.\tContaminated\twater\tappears\tto\tbe\nthe\tsource\tof\tinfection,\twhich\tusually\tafflicts\tpeople\tliving\tin\ncrowded
|
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] |
crowded\n\tand\tunsanitary\tconditions.\tHEV\tis\tgenerally\tacute\nrather\tthan\tchronic.\nHepatitis\nG/GB\nHGV\tand\ta\tvirus\tlabeled\tGBV-C\tappear\nto\tbe\tvariants\tof\tthe\tsame\tvirus.\nAlthough\tHGV\tinfection\tis\tpresent\tin\ta\tsignificant\tproportion\tof\nblood\tdonors\tand\tis\ttransmitted\tthrough\tblood\ttransfusions,\tit\ndoes\tnot\tappear\tto\tcause\tliver\tdisease.\nHBV
|
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does\tnot\tappear\tto\tcause\tliver\tdisease.\nHBV\n,\tHepatitis\tB\tvirus;\t\nHCV\n,\thepatitis\tC\tvirus;\t\nHDV\n,\thepatitis\tD\tvirus;\n\t\nHEV\n,\thepatitis\tE\tvirus;\t\nHGV,\n\thepatitis\tG\tvirus.\nThe\tclinical\tmanifestations\tof\tacute\tviral\thepatitis\tare\tdivided\tinto\tfour\tphases.\tThe\tfirst\tphase,\tthe\tincubation
|
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] |
phase,\toften\tis\tcharacterized\tby\tnonspecific\tsymptoms\tsuch\tas\tmalaise,\tloss\tof\tappetite,\tnausea,\tand\tright\tupper\nquadrant\tpain\t(\nPawlotsky,\t2016\n).\tThis\tis\tfollowed\tby\tthe\tpreicteric\tphase,\tin\twhich\tthe\tnonspecific\tsymptoms\ncontinue.\n\tIn\taddition,\tabout\t10%\tto\t20%\tof\tpatients\tcan\thave\timmune-mediated\tsymptoms\tsuch\tas\tfever,\tarthralgia,
|
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] |
arthritis,\trash,\tand\tangioedema\tin\tthe\tpreicteric\tphase.\tThe\tthird\tphase\tis\tthe\t\nicteric\n\tphase,\tin\twhich\t\njaundice\n\t(a\nyellowing\tof\tthe\tskin,\tmucous\tmembranes,\tand\tthe\teyes)\tappears\tand\tthe\tnonspecific\tsymptoms\tworsen\tand\tweight\nloss,\tdysgeusia\t(distortion\tof\ttaste),\tand\tpruritus\t(itchy\tskin)\tmay\n\tdevelop.\tFinally,\tduring\tthe\tconvalescent\tor
|
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] |
develop.\tFinally,\tduring\tthe\tconvalescent\tor\nrecovery\tphase,\tjaundice\tand\tother\tsymptoms\tbegin\tto\tsubside.\nComplete\tspontaneous\trecovery\tis\texpected\tin\tall\tof\thepatitis\tA\tcases,\tin\tnearly\t99%\tof\tacute\thepatitis\tB\tcases\nacquired\tas\tan\tadult,\tbut\tin\tonly\t20%\tto\t50%\tof\tacute\thepatitis\tC\tcases.\tChronic\thepatitis\tusually\tdoes\tnot\tdevelop
|
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] |
with\thepatitis\tE\t(\nPawlotsky,\t2016\n).\tVaccines\texist\tonly\tfor\n\thepatitis\tA\tand\tB;\thowever,\trecent\tadvances\thave\tresulted\nin\teffective\tantiviral\tdrugs\tto\ttreat\tchronic\thepatitis\tB\tand\tC.\nNonalcoholic\tfatty\tliver\tdisease\nNonalcoholic\tfatty\tliver\tdisease\t(NAFLD)\n\tis\ta\tspectrum\tof\tliver\tdisease\tranging\tfrom\tsteatosis\tto\tsteatohepatitis
|
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] |
and\tcirrhosis.\tIt\tinvolves\tthe\taccumulation\tof\tfat\tdroplets\tin\tthe\thepatocytes\tand\tcan\tlead\tto\tinflammation,\tfibrosis,\ncirrhosis,\n\tand\teven\thepatocellular\tcarcinoma.\tCauses\tof\tNAFLD\tcan\tinclude\tdrugs,\tinborn\terrors\tof\tmetabolism,\tand
|
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] |
acquired\tmetabolic\tdisorders\t(type\t2\tdiabetes\tmellitus,\tlipodystrophy,\tjejunal\tileal\tbypass,\tobesity,\tand\tmalnutrition).\nHowever,\tNAFLD\tis\tassociated\tmost\tcommonly\twith\tobesity,\ttype\t2\tdiabetes\tmellitus,\tdyslipidemia,\tand\tmetabolic\nsyndrome\t(\nChalasani,\t2016\n).\tInsulin\tresistance\twith\thyperinsulinism
|
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] |
syndrome\t(\nChalasani,\t2016\n).\tInsulin\tresistance\twith\thyperinsulinism\n\tand\televated\tnonesterified\tfatty\tacid\tlevels\tin\nhepatocytes\tcharacterize\tmetabolic\tdefects\tassociated\twith\tNAFLD.\nThe\tinitial\tstage\tof\tNAFLD\tis\tsteatosis,\twhich\tis\tcharacterized\tby\tthe\tsimple\taccumulation\tof\tfat\twithin\tthe\tliver.\nSome\tpatients\twill\tprogress\tto
|
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Some\tpatients\twill\tprogress\tto\t\nnonalcoholic\tsteatohepatitis\t(NASH)\n,\twhich\tis\tan\tinflammatory\tcondition\nassociated\twith\thepatocyte\tinjury\twith\tor\twithout\tfibrous\ttissue\n\tin\tthe\tliver.\tNASH\tcan\tdevelop\tinto\tchronic\tliver\ndisease\tand\tNASH\tcirrhosis\tup\tto\t20%\tof\tthe\ttime.\tThe\tprogression\tto\tcirrhosis\t(permanent\tdamage\tand\tscaring)\tis
|
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0.014417980797588825,
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0.045092303305864334,
0.13265973329544067,
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0.07354801893234253,
0.0853227972984314,
0.09915374219417572,
-0.0028544701635837555
] |
variable\tdepending\ton\tage\tand\tthe\tpresence\tof\tobesity\tand\ttype\t2\tdiabetes\tmellitus,\twhich\tcontribute\tto\ta\tworsening\nprognosis\t(\nChalasani,\t2016\n).\nThe\ttreatment\tsuggestions\tfor\tNAFLD\tfrom\tthe\tAmerican\tAssociation\tfor\tthe\tStudy\tof\tLiver\n\tDiseases\t(AASLD)
|
[
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3.386029477300846e-33,
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0.0535462386906147,
0.07652391493320465,
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0.0039702546782791615,
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0.08619700372219086,
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0.02736746147274971,
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0.06488921493291855,
0.05557830631732941,
0.05922766774892807,
-0.017653362825512886
] |
Diseases\t(AASLD)\ninclude\tlifestyle\tchange\t(diet\tand\texercise),\tweight\tloss,\tinsulin-sensitizing\tdrugs\tsuch\tas\tthiazolidinediones,\tand\nvitamin\tE\t(\nChalasani,\t2016\n).\tBased\ton\tthe\tAASLD\tpanel,\ta\t3%\tto\t5%\tweight\tloss\tcan\timprove\tsteatosis,\tbut\tup\tto\t10%
|
[
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0.016885578632354736,
0.04138604551553726,
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0.07675562053918839,
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0.0913475975394249,
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] |
patients\twithout\tdiabetes\tmellitus\t(\nChalasani,\t2016\n).\tBecause\tdisease\tprogression\tand\thepatocellular\tinjury\tappears\nto\tbe\tlinked\tto\toxidative\tstress,\tVitamin\tE,\tas\tan\tantioxidant,\tis\tthought\tto\tbe\tbeneficial\t(\nChalasani\tet\tal,\t2018\n).\nOmega-3\tfatty\tacids\tcould\tbe\tconsidered\tto\ttreat\thypertriglyceridemia\tin\tindividuals\twith\tNAFLD\t(
|
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] |
Chalasani\tet\tal,\n2018\n).\tEmerging\tdata\tsuggest\tdrinking\tmoderate\tamounts\tof\tunsweetened\tcoffee\tis\tprotective\tagainst\tchronic\tliver\ndisease,\tNAFLD,\tand\thepatocellular\tcarcinoma\t(\nMorisco\tet\tal,\t2014\n;\t\nChen\tet\tal,\t2014\n;\t\nSetiawan\tet\tal,\t2015\n).\nAlcoholic\tliver\tdisease\nAlcoholic\tliver\tdisease\n\tis\tone
|
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] |
).\nAlcoholic\tliver\tdisease\nAlcoholic\tliver\tdisease\n\tis\tone\n\tof\tthe\tmost\tcommon\tliver\tdiseases\tin\tthe\tUnited\tStates,\twith\t1%\tof\tNorth\tAmericans\nhaving\talcoholic\tliver\tdisease.\tForty\tpercent\tof\tdeaths\tfrom\tcirrhosis\tare\tattributed\tto\talcohol\t(\nChalasani,\t2016\n).
|
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] |
Chalasani,\t2016\n).\nAcetaldehyde\tis\ta\ttoxic\tbyproduct\tof\talcohol\tmetabolism\tthat\tcauses\tdamage\tto\tmitochondrial\tmembrane\tstructure\nand\tfunction.\tAcetaldehyde\tis\tproduced\tby\tmultiple\tmetabolic\tpathways,\tone\tof\twhich\tinvolves\n\talcohol\ndehydrogenase\t(see\t\nFocus\tOn:\n\tMetabolic\tConsequences\tof\tAlcohol\tConsumption\n).\n\t\nFocus\tOn
|
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Metabolic\tConsequences\tof\tAlcohol\tConsumption\n).\n\t\nFocus\tOn\nMetabolic\tConsequences\tof\tAlcohol\tConsumption
|
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] |
Ethanol\tis\tmetabolized\tprimarily\tin\tthe\tliver\tby\talcohol\tdehydrogenase.\tThis\tresults\tin\tacetaldehyde\tproduction\nwith\tthe\ttransfer\tof\thydrogen\tto\tnicotinamide\tadenine\tdinucleotide\n\t(NAD),\treducing\tit\tto\tNADH.\tThe\tacetaldehyde\nthen\tloses\thydrogen\tand\tis\tconverted\tto\tacetate,\tmost\tof\twhich\tis\treleased\tinto\tthe\tblood.
|
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] |
Many\tmetabolic\tdisturbances\toccur\tbecause\tof\tthe\texcess\tof\tNADH,\twhich\toverrides\tthe\tability\tof\tthe\tcell\tto\nmaintain\ta\tnormal\tredox\tstate.\tThese\tinclude\thyperlacticacidemia,\tacidosis,\thyperuricemia,\tketonemia,\tand\nhyperlipemia.\tThe\ttricarboxylic\tacid\t(TCA)\tcycle\n\tis\tdepressed\tbecause\tit\trequires\tNAD.\tThe\tmitochondria,\tin\tturn,
|
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is\tdepressed\tbecause\tit\trequires\tNAD.\tThe\tmitochondria,\tin\tturn,\nuse\thydrogen\tfrom\tethanol\trather\tthan\tfrom\tthe\toxidation\tof\tfatty\tacids\tto\tproduce\tenergy\tvia\tthe\tTCA\tcycle,\nwhich\tleads\tto\ta\tdecreased\tfatty\tacid\toxidation\tand\taccumulation\tof\ttriglycerides.\tIn\taddition,\tNADH\tmay\tactually
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] |
promote\tfatty\tacid\tsynthesis.\tHypoglycemia\talso\tcan\toccur\tin\tearly\talcoholic\tliver\tdisease\tsecondary\tto\tthe\nsuppression\tof\tthe\tTCA\tcycle,\tcoupled\twith\tdecreased\tgluconeogenesis\tresulting\tfrom\tethanol.\nSeveral\tvariables\tpredispose\tsome\tpeople\tto\talcoholic\tliver\tdisease.\tThese\tinclude\tamount\tand\tduration\tof\talcohol
|
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intake,\tgenetic\tpolymorphisms\tof\talcohol-metabolizing\tenzymes,\tgender\t(females\tmore\tthan\tmales),\tsimultaneous\nexposure\tto\tother\tdrugs,\tinfections\twith\thepatotropic\tviruses,\timmunologic\n\tfactors,\tobesity,\tand\tpoor\tnutrition\tstatus.\nThe\tpathogenesis\tof\talcoholic\tliver\tdisease\tprogresses\tin\tthree\tstages\t(\nFig.\t28.2\n):\thepatic\tsteatosis\t(\nFig.\t28.3\n),
|
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] |
Fig.\t28.2\n):\thepatic\tsteatosis\t(\nFig.\t28.3\n),\nalcoholic\thepatitis,\tand\tfinally\tcirrhosis.\nFIG.\t28.2\nComplications\tof\texcessive\talcohol\tconsumption\tstem\tlargely\tfrom\texcess\thydrogen\tand\tfrom\tacetaldehyde.\tHydrogen\nproduces\tfatty\tliver\tand\thyperlipemia,\thigh\tblood\tlactic\tacid,\tand\tlow\tblood\tsugar.\tThe\taccumulation\tof\tfat,\tthe\teffect\tof\tacetaldehyde
|
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] |
on\tliver\tcells,\tand\tother\tfactors\tas\tyet\tunknown\tlead\tto\talcoholic\thepatitis.\tThe\tnext\tstep\tis\tcirrhosis.\tThe\tconsequent\timpairment\tof\nliver\n\tfunction\tdisturbs\tblood\tchemistry,\tnotably\tcausing\ta\thigh\tammonia\tlevel\tthat\tcan\tlead\tto\tcoma\tand\tdeath.\tCirrhosis\talso\tdistorts
|
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] |
liver\tstructure,\tinhibiting\tblood\tflow.\tHigh\tpressure\tin\tvessels\tsupplying\tthe\tliver\tmay\tcause\truptured\tvarices\tand\taccumulation\tof\nfluid\tin\tthe\tabdominal\tcavity.\tResponse\tto\talcohol\tdiffers\tamong\tindividuals;\tin\tparticular,\tnot\tall\theavy\tdrinkers\tdevelop\thepatitis\n\tand\ncirrhosis.\nFIG.\t28.3\nA,
|
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] |
and\ncirrhosis.\nFIG.\t28.3\nA,\n\tMicroscopic\tappearance\tof\ta\tnormal\tliver.\tA\tnormal\tportal\ttract\tconsists\tof\tthe\tportal\tvein,\thepatic\tarteriole,\tone\tto\ttwo\ninterlobular\tbile\tducts,\tand\toccasional\tperipherally\tlocated\tductules.\t\nB,\n\tAcute\tfatty\tliver.\tThis\tphotomicrograph\ton\tlow\tpower\texhibits
|
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] |
B,\n\tAcute\tfatty\tliver.\tThis\tphotomicrograph\ton\tlow\tpower\texhibits\nfatty\tchange\tinvolving\tvirtually\tall\tthe\thepatocytes,\twith\tslight\tsparing\tof\tthe\tliver\tcells\timmediately\tadjacent\tto\tthe\tportal\n\ttract\n(\ntop\n).\n\t\nSource:\n\t(From\tKanel\tG,\tKorula\tJ,\teditors:\t\nAtlas\tof\tliver\tpathology\n,\tPhiladelphia,\t1992,\tSaunders.)\nFatty\tinfiltration,\tknown\tas
|
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] |
,\tPhiladelphia,\t1992,\tSaunders.)\nFatty\tinfiltration,\tknown\tas\t\nhepatic\tsteatosis\n\tor\t\nfatty\tliver\n,\tis\tcaused\tby\ta\tculmination\tof\tthese\tmetabolic\ndisturbances:\t(1)\tan\tincrease\tin\tthe\tmobilization\tof\tfatty\tacids\tfrom\tadipose\ttissue;\t(2)\tan\tincrease\tin\thepatic\nsynthesis\tof\tfatty\tacids;\t(3)\ta\tdecrease\tin\tfatty\tacid\toxidation;
|
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alcohol\tabuse\tcontinues,\tcirrhosis\tcan\tdevelop.\tPatients\twith\talcoholic\tfatty\tliver\tdisease\tusually\tare\tasymptomatic\nbut\tcan\thave\tsymptoms\tsuch\tas\tfatigue,\tpoor\tappetite,\tright\tupper\tquadrant\tdiscomfort,\tor\thepatomegaly.\nAlcoholic\n\thepatitis\tgenerally\tis\tcharacterized\tby\tan\tenlarged\tliver\t(hepatomegaly),\tmodest\televation\tof\tserum
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transaminase\tlevels\t(ALT\tand\tAST),\tincreased\tserum\tbilirubin\tconcentrations,\tnormal\tor\tdepressed\tserum\talbumin\nconcentrations,\tor\tanemia.\tPatients\talso\tmay\thave\tabdominal\tpain,\tanorexia,\tnausea,\tvomiting,\tweakness,\tdiarrhea,\nweight\tloss,\tor\tfever.\tSome\tpatients\tcan\tdevelop\tjaundice,\tcoagulopathy,\n\t\nascites\n\t(abdominal\tfluid\tretention),\tor
|
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] |
ascites\n\t(abdominal\tfluid\tretention),\tor\nmental\timpairment\t(\nencephalopathy\n).\tIf\tpatients\tdiscontinue\talcohol\tintake,\thepatitis\tmay\tresolve;\thowever,\tthe\ncondition\toften\tprogresses\tto\tthe\tthird\tstage.
|
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] |
Clinical\tfeatures\tof\talcoholic\tcirrhosis,\tthe\tthird\tstage,\tvary.\tSymptoms\tcan\tmimic\tthose\tof\talcoholic\thepatitis;\tor\npatients\tcan\tdevelop\tcomplications\tof\tcirrhosis\tsuch\tas\tgastrointestinal\tbleeding,\n\thepatic\tencephalopathy,\tor\t\nportal\nhypertension\n\t(elevated\tblood\tpressure\tin\tthe\tportal\tvenous\tsystem\tcaused\tby\tthe\tobstruction\tof\tblood\tflow\tthrough
|
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] |
the\tliver).\tPatients\twith\talcoholic\tcirrhosis\toften\tdevelop\tascites,\tthe\taccumulation\tof\tfluid,\tserum\tprotein,\tand\nelectrolytes\twithin\tthe\tperitoneal\tcavity\tcaused\tby\tincreased\tpressure\tfrom\tportal\thypertension\tand\tdecreased\nproduction\tof\talbumin\t(which\n\tmaintains\tserum\tcolloidal\tosmotic\tpressure).\tA\tliver\tbiopsy\tusually\treveals
|
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] |
micronodular\tcirrhosis,\tbut\tit\tcan\tbe\tmacronodular\tor\tmixed.\tPrognosis\tdepends\ton\tabstinence\tfrom\talcohol\tand\tthe\ndegree\tof\tcomplications\talready\tdeveloped.\tEthanol\tingestion\tcreates\tspecific\tand\tsevere\tnutritional\tabnormalities\n(see\t\nClinical\tInsight:\n\tMalnutrition\tRelated\tto\tAlcoholic\tLiver\tDisease\n).\nCLINICAL\tINSIGHT
|
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Malnutrition\tRelated\tto\tAlcoholic\tLiver\tDisease\n).\nCLINICAL\tINSIGHT\nMalnutrition\tRelated\tto\tAlcoholic\tLiver\tDisease\nSeveral\tfactors\tcontribute\tto\tthe\tmalnutrition\tcommon\tin\tindividuals\twith\tchronic\talcoholic\tliver\tdisease:\n1.\t\nAlcohol\tcan\treplace\tfood\tin\tthe\tdiet\tof\tmoderate\tand\theavy\tdrinkers,\tdisplacing\tthe\tintake\tof\tadequate
|
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] |
calories\tand\tnutrients.\tIn\tlight\tdrinkers,\tit\tis\tusually\tan\tadditional\tenergy\tsource,\tor\tempty\tcalories.\nAlthough\talcohol\tyields\n\t7.1\tkcal/g,\twhen\tit\tis\tconsumed\tin\tlarge\tamounts\tit\tis\tnot\tused\tefficiently\tas\ta\tfuel\nsource.\tWhen\tindividuals\tconsume\talcohol\ton\ta\tregular\tbasis\tbut\tdo\tnot\tfulfill\tcriteria\tfor\talcohol\tabuse,
|
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] |
they\tare\toften\toverweight\tbecause\tof\tthe\tincreased\tcalories\t(alcohol\taddiction).\tThis\tis\tdifferent\tfrom\tthe\nheavy\tdrinker\twho\treplaces\tenergy-rich\tnutrients\twith\talcohol\t(alcohol\tsubstitution).\n2.\t\nIn\tthe\n\tperson\twith\talcoholism,\timpaired\tdigestion\tand\tabsorption\tare\trelated\tto\tpancreatic\tinsufficiency,\tas
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well\tas\tmorphologic\tand\tfunctional\talterations\tof\tthe\tintestinal\tmucosa.\tAcute\tand\tchronic\talcohol\tintake\nimpairs\thepatic\tamino\tacid\tuptake\tand\tsynthesis\tinto\tproteins,\treduces\tprotein\tsynthesis\tand\tsecretion\nfrom\tthe\tliver,\tand\tincreases\ttissue\tcatabolism\tin\tthe\tgut.\n3.\t\nUse\tof\tlipids\tand\tcarbohydrates
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0.07434673607349396,
0.11690372228622437,
0.13034911453723907,
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] |
3.\t\nUse\tof\tlipids\tand\tcarbohydrates\n\tis\tcompromised.\tAn\texcess\tof\treduction\tequivalents\t(e.g.,\tnicotinamide\nadenine\tdinucleotide\tphosphate\t[NADH])\tand\timpaired\toxidation\tof\ttriglycerides\tresult\tin\tfat\tdeposition\tin\nthe\thepatocytes\tand\tan\tincrease\tin\tcirculating\ttriglycerides.\tInsulin\tresistance\tis\talso\tcommon.\n4.
|
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] |
4.\t\nVitamin\tand\tmineral\tdeficiencies\toccur\tin\talcoholic\tliver\tdisease\tas\ta\tresult\tof\treduced\tintake\tand\nalterations\tin\tabsorption,\n\tstorage,\tand\tability\tto\tconvert\tthe\tnutrients\tto\ttheir\tactive\tforms.\tSteatorrhea\nresulting\tfrom\tbile\tacid\tdeficiency\tis\talso\tcommon\tin\talcoholic\tliver\tdisease\tand\taffects\tfat-soluble\tvitamin
|
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] |
absorption.\tVitamin\tA\tdeficiency\tcan\tlead\tto\tnight\tblindness.\tThiamin\tdeficiency\tis\tthe\tmost\tcommon\nvitamin\tdeficiency\tin\tpeople\twith\talcoholism\tand\tis\tresponsible\tfor\tWernicke\tencephalopathy.\tFolate\ndeficiency\tcan\toccur\tas\ta\tresult\tof\tpoor\tintake,\timpaired\tabsorption,\taccelerated\texcretion,\tand\taltered
|
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] |
storage\tand\tmetabolism.\tInadequate\tdietary\tintake\tand\tinteractions\tbetween\tpyridoxal-5-phosphate\t(active\ncoenzyme\tof\tvitamin\tB\n6\n)\tand\talcohol\treduce\tvitamin\tB\n6\n\tstatus.\tDeficiency\tof\tall\tB\tvitamins\tand\tvitamins\tC,\nD,\tE,\tand\tK\tis\talso\tcommon.\tHypocalcemia,\thypomagnesemia,\tand\thypophosphatemia\n\tare\tnot\tuncommon
|
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] |
are\tnot\tuncommon\namong\tpeople\twith\talcoholism;\tfurthermore,\tzinc\tdeficiency\tand\talterations\tin\tother\tmicronutrients\tcan\naccompany\tchronic\talcohol\tintake.\nCholestatic\tliver\tdiseases\nCholestatic\tliver\tdiseases\trefer\tto\tconditions\taffecting\tthe\tbile\tducts.\nPrimary\tbiliary\tcirrhosis\nPrimary\tbiliary\tcirrhosis\t(PBC)
|
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] |
Primary\tbiliary\tcirrhosis\nPrimary\tbiliary\tcirrhosis\t(PBC)\n\tis\ta\tchronic\tcholestatic\tdisease\tcaused\tby\tprogressive\tdestruction\tof\tsmall\n\tand\nintermediate-size\tintrahepatic\tbile\tducts.\tThe\textrahepatic\tbiliary\ttree\tand\tlarger\tintrahepatic\tducts\tare\tnormal.
|
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] |
Ninety-five\tpercent\tof\tpatients\twith\tPBC\tare\twomen.\tThe\tdisease\tprogresses\tslowly,\teventually\tresulting\tin\tcirrhosis,\nportal\thypertension,\tthe\tneed\tfor\tliver\ttransplantation,\tor\tdeath\t(\nFogel\tand\tSherman,\t2016\n).\nPBC\tis\tan\tautoimmune\tdisorder\tthat\ttypically\tpresents\twith\tan\televation\n\tof\tserum\tlevels\tof\tAlk\tPhos\tand\tgamma
|
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of\tserum\tlevels\tof\tAlk\tPhos\tand\tgamma\nglutamyl\ttransferase\t(GGT)\twith\tphysical\tsymptoms\tof\tpruritus\tand\tfatigue.\tSeveral\tnutritional\tcomplications\tfrom\ncholestasis\n\t(a\tblockage\tof\tbile\tflow)\tcan\toccur\twith\tPBC,\tincluding\tosteopenia,\thypercholesterolemia,\tand\tfat-\nsoluble\tvitamin\tdeficiencies.\nPrimary\tsclerosing\tcholangitis
|
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0.10893605649471283,
0.0800698846578598,
0.031239666044712067
] |
soluble\tvitamin\tdeficiencies.\nPrimary\tsclerosing\tcholangitis\nPrimary\tsclerosing\tcholangitis\t(PSC)\n\tis\tcharacterized\tby\tfibrosing\tinflammation\n\tof\tsegments\tof\tintra-\tand\nextrahepatic\tbile\tducts.\tThis\tprogressive\tdisease\tcan\tbe\tcharacterized\tby\tthree\tsyndromes.\tThe\tfirst\tis\tcholestasis\nwith\tbiliary\tcirrhosis,\tfollowed\tby\trecurrent\t\ncholangitis
|
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] |
with\tbiliary\tcirrhosis,\tfollowed\tby\trecurrent\t\ncholangitis\n\t(inflammation\tof\tthe\tbile\tducts)\twith\tlarge\tbile\tduct\nstrictures,\tand\tfinally\tcholangiocarcinoma\t(gall\tbladder\tcancer)\t(\nFogel\tand\tSherman,\t2016\n).\tLike\tPBC,\tPSC\tis\nconsidered\tan\tautoimmune\tdisorder.\n\tIn\tpatients\twith\tPSC,\tabout\ttwo\tthirds\talso\thave\tinflammatory\tbowel\tdisease
|
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] |
(especially\tulcerative\tcolitis),\tand\tmen\tare\tmore\tlikely\tthan\twomen\t(2:1)\tto\thave\tPSC\t(\nFogel\tand\tSherman,\t2016\n).\nPatients\twith\tPSC\tare\talso\tat\tincreased\trisk\tof\tfat-soluble\tvitamin\tdeficiencies\tresulting\tfrom\tsteatorrhea\tassociated\nwith\tthis\tdisease.\t\nHepatic\tosteodystrophy\n\tmay\toccur\tfrom\tvitamin\tD\tand\tcalcium\tmalabsorption,\n\tresulting\tin
|
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0.00040591967990621924
] |
may\toccur\tfrom\tvitamin\tD\tand\tcalcium\tmalabsorption,\n\tresulting\tin\nsecondary\thyperparathyroidism,\tosteomalacia,\tor\trickets.\tKnown\tfat-soluble\tvitamin\tdeficiencies\tshould\tbe\ttreated,\nand\tcalcium\tsupplementation\tcould\tbe\tconsidered.\tTreatment\tof\tPSC\tis\tmoderately\tsuccessful\twith\tadministration\tof
|
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] |
cholestyramine,\tursodeoxycholic\tacid,\trifampin,\tor\tphenobarbital\t(\nFogel\tand\tSherman,\t2016\n).\nInherited\tdisorders\nInherited\tdisorders\tof\tthe\tliver\tinclude\n\themochromatosis,\tWilson’s\tdisease,\talpha\n1\n-antitrypsin\tdeficiency,\tand\tcystic\nfibrosis.\tPorphyria,\tglycogen\tstorage\tdisease,\tand\tamyloidosis\tare\tmetabolic\tdiseases\twith\ta\tgenetic\tcomponent.
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] |
Hemochromatosis\nAlthough\tiron\toverload\tcan\tbe\tassociated\twith\tother\tconditions,\thereditary\t\nhemochromatosis\n\tis\tan\tinherited\ndisease\tof\tiron\toverload\tusually\tassociated\twith\tthe\tgene\tHFE\t(\nMartin,\t2015\n;\t\nBacon,\t2015\n).\tPatients\twith\thereditary
|
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] |
Martin,\t2015\n;\t\nBacon,\t2015\n).\tPatients\twith\thereditary\nhemochromatosis\tabsorb\tand\tstore\texcessive\tiron\tfrom\tthe\tgut\tin\tthe\tliver\theart,\tpancreas,\tjoints,\tand\tendocrine\norgans\t(\nBacon,\t2015\n;\tsee\t\nChapter\t30\n).\tIncreased\ttransferrin\tsaturation\t(at\tleast\t45%)\tand\tferritin\t(more\tthan\ttwo
|
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] |
times\tnormal)\tsuggest\themochromatosis.\tHepatomegaly,\tesophageal\tbleeding,\tascites,\timpaired\thepatic\tsynthetic\nfunction,\tabnormal\tskin\tpigmentation,\n\tglucose\tintolerance,\tcardiac\tinvolvement,\thypogonadism,\tarthropathy,\tand\nhepatocellular\tcarcinoma\tmay\tdevelop.\tEarly\tdiagnosis\tincludes\tclinical,\tlaboratory,\tand\tpathologic\ttesting,\tincluding
|
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elevated\tserum\ttransferrin\tlevels.\tLife\texpectancy\tis\tnormal\tif\tphlebotomy\t(or\tregular\tblood\tdonation)\tis\tinitiated\nbefore\tthe\tdevelopment\tof\tcirrhosis\tor\tdiabetes\tmellitus.\tPatients\twith\themachromotosis\n\tshould\tavoid\tdietary\nsupplements\tthat\tcontain\tiron,\tavoid\tcooking\tin\tcast\tiron\tpans,\tand\tshould\tlimit\tfoods\thigh\tin\tiron\tsuch\tas\tliver\tand
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] |
red\tmeats\t(see\t\nAppendix\t42\n).
|
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] |
Wilson’s\tdisease\nWilson’s\tdisease\n\tis\tan\tautosomal-recessive\tdisorder\tassociated\twith\timpaired\tbiliary\tcopper\texcretion\t(\nKaler\tand\nSchilsky,\t2015\n).\tCopper\taccumulates\tin\tvarious\ttissues,\tincluding\tthe\tliver,\tbrain,\tcornea,\tand\n\tkidneys.\t\nKayser-\nFleischer\trings
|
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] |
kidneys.\t\nKayser-\nFleischer\trings\n\tare\tgreenish-yellow\tpigmented\trings\tencircling\tthe\tcornea\tjust\twithin\tthe\tcorneoscleral\tmargin,\nformed\tby\tcopper\tdeposits.\tPatients\tcan\tpresent\twith\tacute,\tfulminant\t(occurring\tsuddenly\twith\tgreat\tseverity),\tor
|
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] |
chronic\tactive\thepatitis\tand\tneuropsychiatric\tsymptoms.\tLow\tserum\tceruloplasmin\tlevels,\televated\tcopper\nconcentration\tin\ta\tliver\tbiopsy,\tand\thigh\turinary\n\tcopper\texcretion\tconfirm\tthe\tdiagnosis.\nCopper-chelating\tagents\t(such\tas\td-penicillamine,\ttrientine,\tor\ttetrathiomolybdate)\t(\nKaler\tand\tSchilsky,\t2015\n)\tand
|
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] |
Kaler\tand\tSchilsky,\t2015\n)\tand\nzinc\tsupplementation\t(150\tmg\telemental\tzinc\tdaily\tgiven\tin\tthree\tdivided\tdoses\tto\tinhibit\tintestinal\tcopper\nabsorption\tand\tbinding\tin\tthe\tliver)\tare\tused\tto\ttreat\tWilson’s\tdisease\tonce\tit\tis\tdiagnosed\t(\nSchilsky,\t2017\n).\tVitamin\nB\n6\n\tsupplementation
|
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] |
Schilsky,\t2017\n).\tVitamin\nB\n6\n\tsupplementation\n\tshould\tbe\tconsidered\twhen\tpenicillamine\tis\tgiven\tto\tprevent\tvitamin\tB\n6\n\tdeficiency\t(\nKaler\tand\nSchilsky,\t2015\n).\tOngoing\tintravenous\tcopper\tchelation\tis\trequired\tto\tprevent\trelapses\tand\tliver\tfailure;\tliver
|
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] |
transplantation\tcorrects\tthe\tmetabolic\tdefect.\tA\tlow-copper\tdiet\tis\tno\tlonger\trequired\tbut\tmay\tbe\thelpful\tin\tthe\ninitial\tphase\tof\ttreatment.\tHigh-copper\tfoods\tinclude\torgan\tmeats,\tshellfish,\tchocolate,\n\tnuts,\tand\tmushrooms.\tFor\ta\ncomprehensive\tlist\tof\tcopper\tcontent\tof\tfood,\trefer\tto\tthe\tU.S.\tDepartment\tof\tAgriculture\tNational\tNutrient
|
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] |
Database.\tIf\tthis\tdisease\tis\tnot\tdiagnosed\tuntil\tonset\tof\tfulminant\tfailure,\tsurvival\tis\tnot\tpossible\twithout\tliver\ntransplantation.\nAlpha\n1\n-antitrypsin\tdeficiency\nAlpha\n1\n-antitrypsin\tdeficiency\tis\tan\tinherited\tdisorder\tthat\tcan\tcause\tliver\tand\tlung\tdisease.\n\tAlpha\n1\n-antitrypsin\tis\ta
|
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] |
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