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Related Concept Videos

Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test01:22

Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test

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In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
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Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow01:26

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Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug...
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Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment01:08

Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment

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Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...
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Effect of Hepatic Disease on Pharmacokinetics: Active Drug, Metabolite and Fraction of Metabolized Drug01:14

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In pharmacotherapy, monitoring drug concentrations is paramount, especially for drugs whose therapeutic effects hinge on both the active compound and its metabolite. Hepatic impairment profoundly influences drug potency by altering liver function. If the drug is more potent than its metabolite, impaired liver function amplifies drug activity due to elevated drug concentration levels. Conversely, if the metabolite holds greater potency, diminished liver function diminishes drug activity by...
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Esophageal Varices-II: Clinical Features and Management01:28

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Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
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Hepatic Drug Excretion: Influencing Factors01:16

Hepatic Drug Excretion: Influencing Factors

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The biliary system of the liver, crucial for bile secretion and drug excretion, comprises intrahepatic bile ducts that merge to form the common hepatic duct. This duct, carrying hepatic bile, combines with the cystic duct, draining the gallbladder and forming the common bile duct, which empties into the duodenum. Bile, produced by hepatic cells lining the bile canaliculi, is composed primarily of water, bile salts, pigments, electrolytes, and lesser amounts of cholesterol and fatty acids. Bile...
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Minimal hepatic encephalopathy: A review.

Raffaele Nardone1, Alexandra C Taylor2, Yvonne Höller2

  • 1Department of Neurology, Christian Doppler Klinik and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Franz Tappeiner Hospital, Italy.

Neuroscience Research
|May 8, 2016
PubMed
Summary

Minimal hepatic encephalopathy (MHE) is early cognitive impairment in cirrhosis patients. Diagnosis uses neuroimaging, neurophysiology, and psychometric tests, impacting quality of life.

Keywords:
ElectroencephalographyEvent related potentialsHepatic encephalopathyMagnetic resonance imagingMinimal hepatic encephalopathyNeuropsychological testing

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Area of Science:

  • Hepatology
  • Neurology
  • Psychiatry

Background:

  • Minimal hepatic encephalopathy (MHE) is the earliest stage of hepatic encephalopathy, affecting up to 80% of liver cirrhosis patients.
  • MHE presents with cognitive deficits in attention, vigilance, and executive function, yet lacks obvious clinical signs.
  • It significantly impacts daily life, quality of life, driving ability, and mortality.

Purpose of the Study:

  • To provide an updated review of minimal hepatic encephalopathy (MHE).
  • To cover epidemiology, burden, quality of life, diagnostic methods, and therapeutic strategies for MHE.

Main Methods:

  • Review of current literature on MHE.
  • Analysis of diagnostic tools including neuropsychological tests, psychometric tests (e.g., critical flicker frequency), and neurophysiological procedures (e.g., event-related potentials, EEG spectral analysis).
  • Inclusion of neuroimaging findings (MRI) and therapeutic approaches (e.g., ammonia-lowering agents, probiotics, rifaximin).

Main Results:

  • MHE is characterized by subtle cognitive impairments detectable by specialized tests.
  • EEG and MRI reveal early cerebral dysfunction and altered brain connectivity in MHE patients.
  • Current treatments focus on reducing ammonia, but liver transplantation may not fully reverse cognitive deficits.

Conclusions:

  • MHE is a prevalent and impactful condition in liver cirrhosis patients.
  • Early diagnosis and management are crucial for improving patient outcomes and quality of life.
  • Further research into effective therapies is warranted, as current treatments have limitations.