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Related Concept Videos

Oxidation of Alcohols02:37

Oxidation of Alcohols

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In this lesson, the oxidation of alcohols is discussed in depth. The various reagents used for oxidation of primary and secondary alcohols are detailed, and their mechanism of action is provided.
The process of oxidation in a chemical reaction is observed in any of the three forms:
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Ethers from Alcohols: Alcohol Dehydration and Williamson Ether Synthesis02:29

Ethers from Alcohols: Alcohol Dehydration and Williamson Ether Synthesis

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Overview
Ethers can be prepared from organic compounds by various methods. Some of them are discussed below,
Preparation of Ethers by Alcohol Dehydration
In this method, in the presence of protic acids, alcohol dehydrates to produce alkenes and ethers under different conditions. For example, in the presence of sulphuric acid, dehydration of ethanol at 413 K yields ethoxyethane, whereas it yields ethene at 443 K.
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Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment01:08

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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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Protection of Alcohols02:31

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This lesson delves into the concept of protection and deprotection of a functional group fundamental to synthetic organic chemistry. These phenomena are explained in the context of aliphatic and aromatic alcohols.
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Hepatic Portal System01:21

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The hepatic portal system, a critical part of our circulatory framework, transports nutrient-laden, deoxygenated blood from the gastrointestinal tract and spleen to the liver. This ingenious system plays an indispensable role in maintaining our body's metabolic equilibrium.
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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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Related Experiment Video

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Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
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Grand Rounds: Alcoholic Hepatitis.

Ashwani K Singal1, Alexandre Louvet2, Vijay H Shah3

  • 1Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL. USA.

Journal of Hepatology
|May 14, 2018
PubMed
Summary

This case study highlights a patient with severe alcoholic hepatitis who initially responded to steroids but relapsed, leading to a fatal second episode. It underscores the challenges in managing severe alcoholic hepatitis and the critical need for sustained alcohol abstinence.

Keywords:
Alcoholic liver diseaseCorticosteroidsLiver biopsyLiver transplantation

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Area of Science:

  • Hepatology
  • Gastroenterology
  • Internal Medicine

Background:

  • Severe alcoholic hepatitis is a critical condition often requiring intensive management.
  • Alcoholic liver disease poses significant global health challenges.
  • Recurrence of severe alcoholic hepatitis indicates poor prognosis and treatment difficulties.

Purpose of the Study:

  • To present a case of severe alcoholic hepatitis with a complicated clinical course.
  • To discuss the management challenges and outcomes of corticosteroid treatment in recurrent severe alcoholic hepatitis.
  • To highlight the importance of sustained alcohol abstinence in patients with alcoholic liver disease.

Main Methods:

  • A case report detailing a 33-year-old male with severe alcoholic hepatitis.
  • Treatment with prednisolone for the first episode and corticosteroids for the second episode.
  • Assessment of treatment response using Maddrey discriminant function score and Lille score.
  • Monitoring for complications including alcohol withdrawal, spontaneous bacterial peritonitis, pneumonia, and acute kidney injury.

Main Results:

  • Initial treatment with prednisolone led to symptomatic and biochemical improvement in the first episode.
  • The patient relapsed to alcohol use, leading to alcohol withdrawal and a second episode of severe alcoholic hepatitis.
  • The second episode was refractory to corticosteroids (Lille score 0.6), complicated by multiorgan failure, and resulted in death.
  • The patient's Model for End-Stage Liver Disease (MELD) score was 32 in the second admission.

Conclusions:

  • Recurrent severe alcoholic hepatitis, even after initial response to steroids, can have a fatal outcome.
  • Sustained alcohol abstinence is paramount for successful management and improved prognosis in alcoholic hepatitis.
  • This case underscores the limitations of corticosteroid therapy in severe, recurrent alcoholic hepatitis and the need for comprehensive addiction support.