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• .
• Principles Of Treatment of Liver disease
• 1. Replacement of Depleted Constituents
• 3 Categories of Deficiencies:
a. vitamins and minerals that are depleted due
to dietary deficiencies
b. vitamins and nutrients that are diminished as
a result of impairment of
the enterohepatic circulation
• C. endogenous substances that become
• depleted as a results of impairment
• of hepatic function
• 2. Temporizing
• - deliberate decision not to treat with
• drugs
• - allowing normal physiologic processes
• to reestablish homeostasis
Acetaminophen Poisoning
- causes severe centrilobular hepatic
necrosis
- single dose of 10-15 gms can cause liver injury
- 25 gms or more causes fatal fulminant
disease
- blood level of more than 300ug/ml 4 hrs after
ingestion-severe liver injury
- Blood levels less than 150ug/ml liver injury unlikely
• Acetaminophen Metabolism:
• Ac-glucuronide---Ac---Ac sulfate
• Cytochrome P450
• N-acetyl-p-benzoquinoneime
•
• GSH cell protein
• Ga-Ac Ac-protein
• Treatment:
- Large supportive
- Specific treatment is directed at particular
• variceal bleeding and ascites
BILIARY SYSTEM:
• Gallbladder:
• - where bile from the liver is stored
a. Cholesterol gallstones
b. Calcium pigment gallstone
• Four Factors in Gallstone Formation:
1. Bile must be supersaturated with cholesterol
2. Precipitation of cholesterol as solid crystals must
occur
3. Crystals must be trapped within a mucin gel in
which they grow and fuse to form macroscopic
stones
4. Crystal-containing gel must be retained in the
gallbladder for a substantial period of time
Measures for Gallstone Dissolution: