MF Sorrell | PubMed Health

PubMed1999

Fulminant Hepatic Failure.

The initial approach to a patient with fulminant hepatic failure includes assessment of the grade of encephalopathy and the cause of hepatic failure. Aggressive supportive therapy with early referral to a transplantation center is recommended for patients with advancing encephalopathy. A critical component of the transplant decision process is the ongoing clinical assessment of reversibility of neurologic status; liver transplantation continues to be the only successful intervention in patients with advanced encephalopathy. Emerging therapies such as auxiliary transplantation and extracorporeal liver assist devices are being perfected or rigorously evaluated.

Journal Article↗

PubMed1999

Non-Alcoholic Steatohepatitis (NASH).

Non-alcoholic steatohepatitis (NASH) is an increasingly common cause of persistently abnormal liver tests. Establishing a diagnosis of NASH requires the secure exclusion of alcohol abuse and hepatitis C as an alternate cause of liver injury. The gold standard of diagnosis is liver biopsy. Unfortunately, NASH, although a common entity, is without a satisfactory treatment. Weight reduction, optimum blood glucose control, and elimination of medications implicated in causing the disorder are sensible first steps in treatment. Drug therapy should not be used unless there is histologic evidence of necro-inflammatory injury and/or fibrosis. Ursodeoxycholic acid (UDCA) has been reported to be of benefit in non-controlled trials and anecdotal case reports. Our approach is to use ursodeoxycholic acid in a dose of 15 mg/kg, and to monitor serial liver enzyme tests. Predictable normalization of liver tests often results, but relentless progression of liver injury can occur in the face of consistently normal liver tests. Close follow-up is mandatory after establishing a diagnosis of NASH. Newer, more effective drugs are needed to treat NASH in a controlled trial environment.

Journal Article↗