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Take a look at the early warning signs that arise due to a case of sepsis. Find out how to detect and diagnose the common symptoms of sepsis today.
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20 hours ago · Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, and end-stage liver disease, is the impaired liver function caused by the formation of scar tissue known as fibrosis due to damage caused by liver disease. Damage causes tissue repair and subsequent formation of scar tissue, which over time can replace normal functioning tissue ...
Itchiness (pruritus). Pruritus is the primary symptom of cholestasis and is thought to be due to interactions of serum bile acids with opioidergic nerves. In fact, the opioid antagonist naltrexonei...
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Possible causes: 1. pregnancy 2. androgens 3. birth control pills 4. antibiotics (such as TMP/SMX) 5. abdominal mass (e.g. cancer) 6. pediatric liver diseases 7. biliary trauma 8. congenital anomalies of the biliary tract 9. gallstones 10. biliary dyskinesia 11. acute hepatitis 12. cystic fibrosis 13. primary biliary cholangitis,an autoimmune disorder 14. primary sclerosing cholangitis, associated with inflammatory bowel disease 15. some drugs (e.g. flucloxacillin and erythromycin): 208 Drugs such as gold salts, nitrofurantoin, anabolic steroids, sulindac, chlorpromazine, erythromycin,: 208 prochlorperazine, cimetidine, estrogen, and statins can cause cholestasis and may result in damage to the liver.
Bile is secreted by the liver to aid in the digestion of fats. Bile formation begins in bile canaliculi that form between two adjacent surfaces of liver cells (hepatocytes) similar to the terminal branches of a tree. The canaliculi join each other to form larger and larger structures, sometimes referred to as the canals of Hering, which themselves join to form small bile ductules that have an epithelial surface. The ductules join to form bile ducts that eventually form either the right main hepatic duct that drains the right lobe of the liver, or the left main hepatic duct draining the left lobe of the liver. The two ducts join to form the common hepatic duct, which in turn joins the cystic duct from the gall bladder, to give the common bile duct. This duct then enters the duodenum at the ampulla of Vater. In cholestasis, bile accumulates in the hepatic parenchyma.
Cholestasis can be suspected when there is an elevation of both 5'-nucleotidase and ALP enzymes. With a few exceptions, the optimal test for cholestasis would be elevations of serum bile acid levels. However, this is not normally available in most clinical settings necessitating the use of other biomarkers. If 5’ nucleosidase and ALP enzymes are elevated, imaging studies such as computed tomography (CT) scan, ultrasound, and magnetic resonance imaging (MRI) are used to differentiate intrahepatic cholestasis from extrahepatic cholestasis.Additional imaging, laboratory testing, and biopsies might be conducted to identify the cause and extent of cholestasis.
Extrahepatic cholestasis can usually be treated by surgery. Pruritus in cholestatic jaundice is treated by antihistamines, ursodeoxycholic acid, and phenobarbital.Nalfurafine hydrochloridecan also treat pruritus caused by chronic liver disease and was recently approved in Japan for this purpose. A significant portion of patients with cholestasis (80%) will experience pruritus at some point during their disease. This is a condition that can severely decrease a patient’s quality of life as it can impact sleep, concentration, work ability, and mood. Many treatments exist, but how effective each option is depends on the patient and their condition. Assessment using a scale, such as a visual analogue scaleor a 5-D itch scale will be useful to identify an appropriate treatment. Bile acid binding resins like cholestyramine is the most common treatment. Its side effects are limited and include constipation and bloating. Other commonly used treatments include rifampin, naloxone, and sertrali...
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