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At least 19 recordsLinked to original sources

Hepatic complications.

Hepatic dysfunction is one of the most common complications following major surgical intervention, and it presents a wide spectrum of clinical manifestations as discussed. Recent progress in hepatology has provided better knowledge in etiology and pathophysiology of hepatic dysfunction and its sequelae. In addition, modern medical technology has made the diagnosis of liver disease easier and more precise. Underlying liver disease should be disclosed precisely prior to surgery and surgical complication minimized for patients with hepatic impairment. If hepatic complications occur following surgical intervention, the most logical etiology and pathophysiologic explanation should be found, utilizing all the clinical and laboratory data and diagnostic procedures in order to institute proper treatment. Specific complications in hepatic surgery are also discussed. A good understanding of pathophysiologic alterations following hepatic surgery is mandatory together with detailed anatomic knowledge and surgical skill in order to prevent and to treat serious complications.

Acute Kidney Injury↗

Viral hepatitis complicating pregnancy: mortality trends in Saudi Arabia.

The striking mortality in viral hepatitis associated with pregnancy, regularly observed in developing countries, has shown a significant decrease in Saudi Arabia during a period of unprecedented economic growth. However, the risk of fatal hepatitis in the pregnant Saudi woman remains approximately four times that for the nonpregnant woman. The explanation for the observed mortality trend is not apparent, but is unlikely to be the result of improved nutritional status of the population alone, or because of treatment of severe hepatitis with adrenal corticosteroids. Disseminated intravascular coagulation may be one factor that decisively influences the outcome of hepatitis in the pregnant woman.

Adrenal Cortex Hormones↗

The use of steroid suppositories in the treatment of chronic active hepatitis complicated by peptic ulceration.

Because of intolerance to oral steroids, a patient with Chronic Active Hepatitis and an active gastric ulcer was treated with rectal steroids in addition to azathioprine and carbenoxolone sodium. The liver function tests showed a marked improvement with this therapy, and the gastric ulcer healed. The possible advantages of steroid administration by suppositories are discussed.

Adult↗

Hepatic complications of antituberculous therapy.

Drug hepatitis occurred in 0-32 per cent of 7492 patients receiving antituberculous therapy, while the overall incidence of drug reactions was estimated at 9 per cent. PAS was the most common cause of drug hepatitis among the 38 patients analysed. The clinical, biochemical and haematological picture of antituberculous drug hepatitis was found to be fairly uniform. However, the patients with definite PAS hepatitis had lower SGOT values than those in whom there was uncertainty whether PAS or INH was implicated. Premonitory symptoms were present in all but four patients before the onset of jaundice. One or more of the features associated with dry hypersensitivity reactions, such as fever, rashes, lymphadenopathy, arthralgia, leucocytosis, eosinophilia and atypical monocytes were present in 89 per cent of cases so that confusion with viral hepatitis seldom arose. Sensitization time was less than three months in all except three patients, who were considered to be suffering from viral hepatitis. While no patients with PAS hepatitis died, the overall mortality was 17 per cent. A review of the literature stresses the frequency of asymptomatic elevations of SGOT, the value of clinical surveillance during the early months of therapy and the importance of stopping all therapy immediately warning symptoms appear.

Aminosalicylic Acids↗

[Complications of acupuncture: viral hepatitis].

Complications arising in association with acupuncture are frequently reported. Some are strictly technical, others--including viral hepatitis--are the result of hygienic problems. A statistical assessment of the frequency of HB antigen in out-patients treated during 1975 is reported.

Acupuncture Therapy↗

Autotransfusion following cardiac operations: a randomized, prospective study.

To evaluate the safety and effectiveness of the collection and retransfusion of postoperatively shed mediastinal blood as part of a multifaceted approach to blood conservation following cardiac operation, 113 patients were randomized into either an autotransfusion group (54 patients) or a control group (59 patients). Intraoperative and postoperative hemodilution was practiced in all patients. The clinical safety of this technique was confirmed by the lack of septic, hematological, pulmonary, renal, or hepatic complications. However, in this setting where blood conservation is already aggressively practiced, the ability of the technique to further reduce the use of banked blood following cardiac surgical procedures was not demonstrated.

Adult↗

Liver disease in early syphilis.

Atypical manifestations of early syphilis, although uncommon, may represent diagnostic difficulties and delay therapy. We describe two cases of hepatitis complicating early syphilis. Clues to the diagnosis of early syphilitic hepatitis include the presence of perianal lesions and disproportionate increases in the serum alkaline phosphatase level. Biopsy results were nonspecific. The major differential diagnostic consideration is hepatitis B with false-positive serologic findings. The abnormalities of liver function respond to standard therapy for secondary syphilis. Follow-up of patients and their contacts is essential.

Alkaline Phosphatase↗

Protein malnutrition following intestinal bypass for morbid obesity.

Intestinal bypass surgery, performed for weight reduction in the morbidly obese patient, is frequently complicated by the development and hepatic complications. In 44 morbidly obese individuals, 55 inches of proximal jejunum were anastomosed, end to side, to 5 inches of distal ileum. All the patients were followed with body composition measurements, performed by multiple isotope dilution, prior to and at regular time intervals following bypass surgery. In 33 patients a decrease in body fat accounted for the entire postbypass weight loss, while the lean body mass remained normal in both size and composition. In these patients, at 1 year, body weights had decreased by 24.4 +/- 2.1%, while the body cell masses had decreased by 2.1 +/- 7.1%. In the remaining 11 patients, the postbypass weight loss resulted from a loss of both body fat and body cell mass. Their body weights at 1 year had decreased by 27.0 +/- 3.0%, while the body fat and body cell mass. Their body weights at 1 year had decreased by 27.0 +/- 3.0%, while the body cell masses decreased by 22.0 +/- 6.1%. Furthermore, their body compositions were characteristic of protein malnutrition with a contracted body cell mass and an expanded extracellular mass. Six of these 11 patients have required admission to hospital on 10 occasions because of malaise, anorexia, debilitating weakness, hypokalemia, and abnormal liver function. They were treated for 14.5 +/- 1.9 days with an intravenous infusion of amino acids without additional nonprotein calories. The body composition, initially characteristic of malnutrition, became normal. Their symptoms disappeared and hepatic function returned to normal. Subsequently a high-protein diet was required to prevent a recurrence of symptoms and to maintain a normal body composition. The data indicate that protein malnutrition developed in 11 of 44 patients undergoing jejunoileal bypass for weight reduction.

Adult↗

[Acute fatty infiltration of the liver in pregnancy. One case (author's transl)].

Acute fatty infiltration of the liver in pregnancy is characterised by microvacuolar fatty infiltration, without necrosis, occuring at the end of pregnancy. This syndrome, defined by Sheehan in 1940, remains rare. The authors were able to find 62 authentic cases in the french, english and german literature. The course is fatal in 75% of cases for the mother and 70% for the child. The gravity is related to hepatocellular failure, but also to extra-hepatic complications (renal failure, haemorrhagic syndrome, infectious complications, acute haemorrhagic and/or necrosing pancreatitis). When the course is favourable, the hepatic lesions disappear in a few weeks and there is no recurrence during subsequent pregnancies. The histological lesions of acute fatty infiltration of the liver in pregnancy are identical to those of fatty infiltration of the liver induced by cyclines and of Reye syndrome.

Acute Disease↗

Pregnancy in chronic active hepatitis.

The outcome of pregnancy in chronic active hepatitis (CAH) was studied retrospectively, together with a survival analysis of patients and a comparison of fertility with that expected from controls drawn from the normal Australian population. Clinical records of 73 cases of CAH included 37 women who were potentially fertile (aged 15-45 years) and there were 30 pregnancies among 16 of these women. Hepatic and obstetric complications and the outcome for the foetus and the mother were compared with the results from 36 reports accumulated from the literature. The results showed an incremental increase in survival of patients with CAH according to decade of diagnosis from 1950 and similar severity of liver disease in those who did, or did not, become pregnant. Fertility was reduced in patients with CAH. Relapse of CAH occurred during pregnancy in only two patients, hepatic complications were minimal, and there was no consistent pattern of alteration in liver function; 12 of 16 mothers are alive for a mean period of eight years after pregnancy. Obstetric complications included urinary tract infections (six), toxaemia of pregnancy (nine) and prematurity (seven); of the 30 pregnancies, four were terminated on medical advice in the early years of the study, three ended in spontaneous abortion, and there were four perinatal deaths giving a foetal loss rate of 33 per cent. Despite the maternal disease and use of prednisolone and azathioprine during pregnancy, the single congenital abnormality was pyloric stenosis. We conclude that in CAH fertility is reduced but pregnancies which occur can proceed without detriment to the mother provided that prednisolone treatment is maintained; that a higher than normal foetal loss can be expected; and that babies may be born prematurely but will be normal.

Abortion, Spontaneous↗

Jaundice and eosinophilia associated with amitriptyline.

Eosinophilia and jaundice occured in a depressed patient treated with amitriptyline, an association which is previously unreported. These complications cleared with withdrawal of the drug. This clinical picture should be added to the known hepatic complications of amitriptyline.

Amitriptyline↗

[Anaesthesia for cesarean section in a patient with acute viral hepatitis (author's transl)].

Acute viral hepatitis is hazardous in the obstetric patient because of associated multi-system involvement which may include coagulation defects. The fetus may be compromised by maternal complications as well as by high levels of indirect bilirubin which crosses the placenta. Cesarean section is frequently indicated for fetal distress or failed progress of labor. An elderly primigravida with severe acute viral hepatitis complicated by gastrointestinal bleeding, hypofibrinogenemia, thrombocytopenia and prolonged prothrombin and partial thromboplastin times required emergency cesarean section. Clotting factors were replenished prior to surgery. General anesthesia with low-dose ketamine induction and high inspired oxygen fraction was considered the method of choice for the specific maternal and fetal problems.

Adult↗