DOCSLIB.ORG

Drugs&Liver Prelims

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Drugs&Liver Prelims Drugs and the Liver Drugs and the Liver A guide to drug handling in liver dysfunction Edited by Penny North-Lewis BPharm, MRPharmS, ClinDipPharm, MSc Lead Paediatric Liver Pharmacist, Leeds Teaching Hospitals NHS Trust, Leeds, UK London • ChicagoM Published by the Pharmaceutical Press An imprint of RPS Publishing 1 Lambeth High Street, London SE1 7JN, UK 100 South Atkinson Road, Suite 200, Grayslake, IL 60030-7820, USA © Pharmaceutical Press 2008 is a trade mark of RPS Publishing RPS Publishing is the publishing organisation of the Royal Pharmaceutical Society of Great Britain First published 2008 Typeset by Photoprint, Torquay, Devon Printed in Great Britain by TJ International, Padstow, Cornwall ISBN 978 0 85369 710 7 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, without the prior written permission of the copyright holder. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. Although the authors have made every effort to ensure that the information contained in this reference is correct, no responsibility can be accepted for any errors. The right of Penny North-Lewis to be identified as the author of this work has been asserted by her in accordance with the Copyright, Designs and Patents Act, 1988. A catalogue record for this book is available from the British Library Contents Preface vii About the editor ix Contributors xi Acknowledgements xv Introduction xvii Part One: Understanding liver function 1 1 An introduction to the anatomy of the liver 3 2 Functions of the liver 23 3 Causes of liver disease and dysfunction 49 4 Assessing liver function 73 Part Two: Principles of drug use in liver disease 101 5 Pharmacokinetics of drugs in liver disease 103 6 Undesirable side effects 135 Part Three: Putting the theory into practice 145 7 Applying the principles – introduction 147 8 The aide mémoire 157 9 Scenario 1 – Choice of analgesic 171 10 Scenario 2 – Choice of antiemetic 211 11 Scenario 3 – Choice of anti-hyperlipidaemic agent 225 12 Scenario 4 – Choice of hormone replacement therapy (HRT) 257 13 Scenario 5 – Choice of contraceptive 275 Appendix 1: Detailed description of the patient cases 295 Appendix 2: Drugs in liver dysfunction blank aide mémoire form 305 Index 309 Preface It is well recognised that the majority of medicines pass through the liver on their journey around the body, but little is published on how differ- ent types and degrees of liver dysfunction affect the body’s ability to handle those medicines. This is because clinical studies are typically con- ducted in small numbers of patients with a specific liver disease, usually classified generically as ‘mild to moderate’. The results of these studies are often misguidedly extrapolated to all types of liver dysfunction. To exacerbate the problem, because of the scarcity of data, pharmaceutical companies frequently suggest dose reductions or the avoidance of a par- ticular medicine in liver dysfunction. These effects combine to leave patients with liver disease disenfranchised from medicine use by the lack of information available to assist prescribers. To make a judgement on medicine and choice of dose in an indi- vidual patient with a certain type of liver dysfunction, one must often return to first principles to make an educated guess. The aim of this book is therefore: • To enable the practitioner to assess liver function using biochemical markers (e.g. liver function tests), other tests, signs, symptoms and disease knowledge • To identify which pharmacokinetic and pharmacodynamic parameters of a drug are likely to be affected by different types of liver disease • To consider the impact of a drug’s side effects on a patient with liver disease. This book is written by pharmacists and clinicians in the field of hepatology and is designed to assist practitioners to make these deci- sions. It is aimed primarily at clinical pharmacists, but may be of value to anyone making medicine choices in patients with liver impairment, as well as to students of pharmacokinetics. It is not aimed at academics and does not negate the need for further investigation, but it will enable practitioners to make pragmatic choices for their patients. Penny North-Lewis June 2007 About the editor Penny North-Lewis graduated from Nottingham University in 1989 with a BPharm(Hons). She went on to complete the London School of Pharmacy Clinical Diploma in 1992, and a Master of Science in Clinical Pharmacy at Brighton University in 1998. Penny has been working in the field of hepatology since 1993, when she became the first clinical pharmacist to work with the paediatric liver unit at King’s College Hospital, London. She remained there until 1998, and, after a short period working in adult medicine, moved to Leeds in 2000 to establish the clinical pharmacy service for the new Paediatric Liver and GI Unit at St James’s University Hospital, where she has remained ever since. Her role entails close liaison with the consultants, including participation in their daily ward rounds and attendance at out- patient clinics. She has also been closely involved with the development of guidelines for managing patients with liver disease. Penny has been involved with a wide range of clinical studies in children with liver disease. These include several that relate to pharma- cokinetics, in both liver disease and after liver transplantation. She has presented her research work and given lectures and workshops at national and international congresses, including the International Pediatric Transplant Association, the European Society of Clinical Pharmacy and the Neonatal and Paediatric Pharmacists Group (NPPG) conferences. She is a founder member of the UK and Eire Liver Transplant Pharmacists Group, which was set up in 1994 to provide pharmacists in this field with the opportunity to learn, share ideas and help solve prob- lems. She is also on the committee of the NPPG. Contributors Michael Bowe, BPharm, MRPharmS, ClinDipPharm Lead GI and Liver Pharmacist (at the time of writing) Pharmacy Department, Freeman Hospital Newcastle-upon-Tyne, UK Faye Croxen, BPharm, MRPharmS, ClinDipPharm Lead Adult Liver Pharmacist Pharmacy Department, Leeds Teaching Hospitals NHS Trust Leeds, UK Bridget Featherstone, BSc(Hons), MRPharmS, DipClinPharm, SP Lead Pharmacist Transplantation and Surgery Pharmacy Department, Cambridge University Teaching Hospitals NHS Trust, Cambridge, UK Kylies Foot, BPharm(Hons) (University of South Australia), MRPharmS Liver Specialist Medicines Information Pharmacist (at the time of writing) Medicines Information Centre, Pharmacy Department Leeds Teaching Hospitals NHS Trust Leeds, UK Andrew Holt, MBChB(Hons), MRCP Honorary Clinical Fellow in Hepatology Liver Research Laboratory, MRC Centre for Immune Regulation University of Birmingham, UK xii Contributors Catherine Hughes, BPharm(Hons), MRPharmS, DipClinPharm Lead Adult Liver Pharmacist (at the time of writing) Pharmacy Department, Leeds Teaching Hospitals NHS Trust Leeds, UK Trevor N Johnson, BPharm, MSc, PhD, MRPharmS, MCPP Senior Pharmacist, Pharmacy Department, Sheffield Children’s Hospital and Senior Scientist, Simcyp Limited Sheffield, UK Fionnuala Kennedy, BSc(Pharm), BA(Econ), MA(Healthcare Manag), MPSI Clinical Pharmacy Manager/Lead Liver Pharmacist Pharmacy Department, St Vincent’s University Hospital Dublin, Ireland Sarah Knighton, MPharm, MRPharmS, DipClinPharm Liver Pharmacy Team Leader Pharmacy Department, King’s College Hospital London, UK Saw Keng Lee, MPharm, MRPharmS, DipPharmPrac Senior Liver Pharmacist (at the time of writing) Pharmacy Department, King’s College Hospital London, UK Penny North-Lewis, BPharm, MRPharmS, DipClinPharm, MSc Lead Paediatric Liver Pharmacist Pharmacy Department, Leeds Teaching Hospitals NHS Trust Leeds, UK Aileen Parke, MRPharmS, SP, MSc Women and Children’s Pharmacy Team Leader Pharmacy Department King’s College Hospital London, UK Contributors xiii Amanda Smith, BPharm, MRPharmS, DipClinPharm Lead Pharmacist, Liver and Solid Organ Transplantation Pharmacy Department, University Hospital Birmingham NHS Foundation Trust Birmingham, UK Alison H Thomson, MSc, PhD, MRPharmS, MCPP Area Pharmacy Specialist, Western Infirmary and Senior Lecturer Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, UK Janet Tweed, BPharm, MRPharmS, DipClinPharm, Certificate in Pharmaceutical Information Management Medicines Information Service Development Manager Medicines Information Centre, Pharmacy Department Leeds Teaching Hospitals NHS Trust Leeds, UK Sheetal (Tina) Vaghjiani, BSc(Hons)Pharm, MRPharmS, DipClinPharm Senior Pharmacist – Hepatology, Gastroenterology and Nutrition Pharmacy Department, Royal Free Hampstead NHS Trust London, UK Acknowledgements This book could not have been written without the enormous commit- ment of my fellow collaborators in the UK and Eire Liver Transplant Pharmacists Group. My thanks go to every member for their role in ensuring this goal has been realised. I would especially like to extend my thanks to Katherine Davidson for reviewing chapters with a fresh eye, to Helen Whiteside for helping at the planning stage, to Janet Tweed (nee Darlington) for being unstintingly conscientious despite staffing shortages and getting married, to Catherine Hughes for being endlessly supportive,
Load more

Recommended publications
  • Infantile Cirrhosis of the Liver
    INFANTILE CIRRHOSIS OF THE LIVER P. KRISHNA RAO, B.SC., M.B.B.S., D.T.M. • H. (Eng.) (Pathologist, Victoria, Vani Vilas and Minta Hospitals, and Lecturer in Pathology and Bacteriology, University Medical School, Bangalore) Received July 16, 1941 CONTENTS PAGE INTRODUCTION .... 310 CLINICAL FEATURES .... 313 LABORATORY FINDINGS .. 314 MORBID ANATOMY AND HISTOLOGY 318 DISCUSSION .... 321 iEtiology .... 321 Type of Cirrhosis .... 326 Formation of Cirrhosis .. 332 SUMMARY .... 335 ACKNOWLEDGMENT .... 336 BIBLIOGRAPHY .... 337 Introduction PHYSICIANS and Pathologists in India have interested themselves in the study of the "Infantile Cirrhosis of the Liver" in view of the appalling mortality of the children claimed by this disease; yet our knowledge of the a~tiology and pathology of the disease is singularly defective. A case report by Sen in 1887 at the Calcutta Medical Association is, so far as I am aware, the first contribution to the literature on the subject, and he has described the disease as " a peculiar enlargement of the liver in young children only, both male and female, without any enlarge- ment of the spleen and associated with low fever, gradual emaciation, loss of appetite, sallow complexion and very slight jaundice, but not in all" In the discussion that followed the case report, Ghose, Coomer, Rakhaldas Ghose, Devendranath Dey, Bannerjee, Ahmed, Gibbons, Mcleod and Birch participated and the conclusions arrived at were as follows :-- (i) Infantile Cirrhosis of the liver was undoubtedly a peculiar disease found only amongst Indian children of the rich and the poor families alike. 310 Infantile Cirrhosis of tke Liver 311 (ii) The probable causative factors were the over-feeding of the children and bad hygenic conditions in which they were brought up.
    [Show full text]
  • Points to Remember
    Points To Remember Digestion : The process in alimentary canal by which the complex food is converted mechanically and biochemically into simple substances suitable for absorption and assimilation. Food : A substance which on taken and digested in the body provides material for growth, repair, energy, reproduction, resistance from disease or regulation of body processes. Thecodont : The teeth embedded in the sockets of the jaw bone, e.g., in mammals. Diphyodont : The teeth formed twice in life time e.g., in mammals. Heterodont : An adult human has 32 permanent teeth which are of four different types. Different Types of Teeth (a) Canine—for tearing (b) Incisors —for cutting (c) Premolars for grinding (d) Molars for churning and grinding Digestion and Absorption 143 Dental formula of man : Permanent Teeth) 1 C PM M 32 = 2 × 2 1 2 3 Upper Jaw 2 1 2 3 Lower Jaw Dental formula of man : (Milk Teeth) 1 C PM 20 = 2 × 2 1 2 Upper Jaw 2 1 2 Lower Jaw Peristalsis : The involuntary moveent of the gut by which the food bolus is pushed forward. Deglutition : The process of swallowing of food bolus. It is partly voluntary and partly involuntary. Ruminants : The herbivours animals ( e.g., cow, buffalo etc.) which have symbiotic bacteria in the rumen ! of their stomach which synthesize enzymes to hydrolyse cellulose into monosaccharides. Diarrhoea : The abnormal frequent discharge of semisolid or fluid faecal matter from the bowel. Vomitting : The ejection of stomach contents through the mouth, caused by antiperistalsis. Dysentery : Frequent watery stools often with blood and mucus and with pain, fever and causes dehydration.
    [Show full text]
  • Difficult Gallbladder Surgery, Improving Patient Outcomes Through Appropriate Surgical Decisions
    e text] Difficult Gallbladder Surgery, Improving Patient Outcomes Through Appropriate Surgical Decisions. P. G Jani1, H. Gill 2, V. Kotecha3 1.Associate professor, Department of Surgery University of Nairobi 2Fellow of college of surgeons South Africa, Surgeon Groote Schuur Hospital 3M.D, Resident Department of Surgery University of Nairobi Correspondence to: Pankaj G. Jani. Email: [email protected] Background: Cholecystectomy is becoming a common operation in Africa. The right upper quadrant is regarded by many as the most difficult area of the abdomen because of the variable anatomy, small sized ducts and the irritant nature of bile. The fact that patients present late also adds to the difficulty with identification of structures in this area. A good working knowledge of the incidence and types of anatomical variations is key to a safe cholecystectomy. About 50% of patients presenting with gallbladder pathology show a significant anatomical variations. This study aimed to improve awareness amongst surgeons, both consultants and those in training to improve patient outcomes with gall bladder pathology. Case presentations: Four patients who had re-do surgeries at three different private hospitals in Nairobi are presented and discussed. None of the primary surgery in the four cases was done any of the authors. The re-do surgery in the four cases was performed by the principal author. The four patients respectively had a bile duct injury post open cholecystectomy, cholecystostomy done for gall bladder empyema, a stricture from a previous biliary-enteric anastomosis and obstructive jaundice from chronic pancreatitis. Conclusion: The large number of variations in the anatomic structure of biliary tree imposes an imperative need for surgeons to have an adequate knowledge and understanding of those variations, in order to control the safety of the surgical procedure in this field.
    [Show full text]
  • The Short History of Gastroenterology
    JOURNAL OF PHYSIOLOGY AND PHARMACOLOGY 2003, 54, S3, 921 www.jpp.krakow.pl A. RÓDKA THE SHORT HISTORY OF GASTROENTEROLOGY Department of History of Medicine, Jagiellonian University Medical College Cracow, Poland In this paper research on the stomach and bowel physiology is presented in a historical perspective. The author tries to show how digestive processes were interpreted by the ancients and how they tried to adjust them to the dominating humoral theory of disease. It is pointed out that the breakthrough which created a new way of understanding of the function of the digestive system was made by Andreas Vesalius and his modern model of anatomy. The meaning of acceptance of chemical processes in digestion by iatrochemics representatives in XVII century is shown. Physiological research in XIX century, which decided about a rapid development of physiology, especially the physiology of the gastrointestinal tract, is discussed. Experiments were performed by all main representatives of this discipline: Claude Bernard, Jan Ewangelista Purkynì, Rudolph Heidenhain and especially Ivan Pavlov, who, thanks to the discoveries in the secretion physiology, explained basic functions of the central nervous system. The XX century was dominated by the research showing the important role of the endocrine system and biological agents in the regulation of secretion and motility of the digestive system. The following discoveries are discussed: Ernest Sterling (secretin), John Edkins (gastrin) and André Latarjet and Lester Dragstedt (acetylcholine). It is underlined that Polish scientists play an important role in the development of the gastroenterological science - among others; Walery Jaworski, who made a historical suggestion about the role of the spiral bacteria in etiopathogenesis of the peptic ulcer, Leon Popielski, who stated the stimulating influence of histamine on the stomach acid secretion, Julian Walawski, who discovered enterogastrons - hormones decreasing secretion.
    [Show full text]
  • On the Stages and Forms of Syphilis with More Especial Reference to the Hepatic Manifestations of the Disease
    ON THE STAGES AND FORMS OF SYPHILIS, WITH MORE ESPECIAL REFERENCE TO THE HEPATIC MANIFESTATIONS OF THE DISEASE. BY J. G. ADAMI, M.A., M.D., F.R.S.E., PROFESSOR OF PATHOLOGY, McGILL UNIVERSITY, MONTREAL. REPRINTED FROM THE MONTREAL MEDICAL '.lO URN AT,, JUNK; WW. ON THE STAGES AND FORMS OF SYPHILIS WITH MORE ESPECIAL REFERENCE TO THE HEPATIC MANIFESTATIONS OF THE DISEASE. 1 BY J. G. Adami, M.A., M.D., F.R.S.E., Professor of Pathology, McGill University, Montreal. It is remarkable how during all these centuries, syphilis has remained sharply distinguished from all other forms of human disease, constituting a class apart. There are many other contagious maladies, not a few chronic infectious disorders, and, now-a-days, we are able to group these together ; we can recognise common principles govern- ing their course and effects upon the organism, and can see, or think we see, a common principle underlying the morbid changes in one or other tissue from the onset of the disease to its culmination—a prin- ciple identical in the infant and in the aged. So we can with syphilis —only habitually we do not. We treat and regard it as a something distinct. Take for instance that disease which in its chronicity as in the lesions which characterise it, most closely resembles syphilis—tuber- culosis. From the onset to the end, at every stage, from the primary lesion to the most extensive generalisation ofthe process, we see one morbid change at work, namely, the focal multiplication of the bacilli leading to the development of tubercles.
    [Show full text]
  • Ta2, Part Iii
    TERMINOLOGIA ANATOMICA Second Edition (2.06) International Anatomical Terminology FIPAT The Federative International Programme for Anatomical Terminology A programme of the International Federation of Associations of Anatomists (IFAA) TA2, PART III Contents: Systemata visceralia Visceral systems Caput V: Systema digestorium Chapter 5: Digestive system Caput VI: Systema respiratorium Chapter 6: Respiratory system Caput VII: Cavitas thoracis Chapter 7: Thoracic cavity Caput VIII: Systema urinarium Chapter 8: Urinary system Caput IX: Systemata genitalia Chapter 9: Genital systems Caput X: Cavitas abdominopelvica Chapter 10: Abdominopelvic cavity Bibliographic Reference Citation: FIPAT. Terminologia Anatomica. 2nd ed. FIPAT.library.dal.ca. Federative International Programme for Anatomical Terminology, 2019 Published pending approval by the General Assembly at the next Congress of IFAA (2019) Creative Commons License: The publication of Terminologia Anatomica is under a Creative Commons Attribution-NoDerivatives 4.0 International (CC BY-ND 4.0) license The individual terms in this terminology are within the public domain. Statements about terms being part of this international standard terminology should use the above bibliographic reference to cite this terminology. The unaltered PDF files of this terminology may be freely copied and distributed by users. IFAA member societies are authorized to publish translations of this terminology. Authors of other works that might be considered derivative should write to the Chair of FIPAT for permission to publish a derivative work. Caput V: SYSTEMA DIGESTORIUM Chapter 5: DIGESTIVE SYSTEM Latin term Latin synonym UK English US English English synonym Other 2772 Systemata visceralia Visceral systems Visceral systems Splanchnologia 2773 Systema digestorium Systema alimentarium Digestive system Digestive system Alimentary system Apparatus digestorius; Gastrointestinal system 2774 Stoma Ostium orale; Os Mouth Mouth 2775 Labia oris Lips Lips See Anatomia generalis (Ch.
    [Show full text]
  • Short Communication on Lobes of Liver
    Polampelli, J Liver Disease Transplant 2020, 9:3 DOI: 10.37532/jldt.2020.9(3).173 Journal of Liver: Disease & Transplantation Short Communication A SciTechnol Journal needed]) may be a distinctive arrangement among lobules. It consists Short communication on Lobes of the subsequent 5 structures: proper arteria hepatica, AN capillary artery branch of the arteria hepatica that provides atomic number 8 of Liver hepatic portal vein, a venous blood vessel branch of the vena, with Anusha Polampelli* blood wealthy in nutrients however low in atomic number 8 one or 2 little digestive fluid duct of cubiform animal tissue, branches of the Abstract digestive fluid conducting system. lymphatic vessels branch of the cranial nerve The name “portal triad” historically has enclosed solely The lobules of liver, or viscus lobules, square measure little divisions the primary 3 structures, and was named before humour vessels were of the liver outlined at the microscopic (histological) scale. The discovered within the structure. It will refer each to the biggest branch viscus lobe may be a building block of the liver tissue, consisting of every of those vessels running within the hepatoduodenal ligament, of a portal triad, hepatocytes organized in linear cords between a capillary network, and a central vein. and to the smaller branches of those vessels within the liver. In the smaller portal triads, the four vessels consist a network of animal Keywords tissue and square measure enclosed on all sides by hepatocytes. The Viscus lobules; Liver tissue; Central vein ring of hepatocytes adjoining the animal tissue of the triad is termed the periportal limiting plate.
    [Show full text]
  • Hepatic Cirrhosis Associated with Fibrocystic Disease of the Pancreas Clinical and Pathological Reports of Five Patients
    Arch Dis Child: first published as 10.1136/adc.28.141.343 on 1 October 1953. Downloaded from HEPATIC CIRRHOSIS ASSOCIATED WITH FIBROCYSTIC DISEASE OF THE PANCREAS CLINICAL AND PATHOLOGICAL REPORTS OF FIVE PATIENTS BY REGINALD WEBSTER and HOWARD WILLIAMS From the Children's Hospital, Melbourne (RECEIVED FOR PUBLICATION MARCH 29, 1953) The purpose of this paper is to describe five palpable three fingerbreadths below the right costal patients who developed an unusual type of hepatic margin, its edge and surface feeling hard and nodular. cirrhosis in the course of fibrocystic disease of the The tip of the spleen was palpable. The patient's stools pancreas, and to comment on the aetiology of the were large, pale, of the consistency of a thick porridge cirrhosis. These five were 116 and malodorous. Analysis showed that there was 430h patients among of fat by weight in the dried faeces and 670o of this children who were treated for fibrocystic disease at quantity was split fat. The Mantoux test, performed with the Children's Hospital, Melbourne, during the 0 1 ml. of 1 in 1,000 old tuberculin, and the Wassermann period January, 1946, to January, 1953. reaction were negative. The child coughed much yellow Protected by copyright. While hepatic cirrhosis has been noted in children mucopus, from which Staphylococcus aureus was grown. dying from fibrocystic disease, references are un- Radiological examination revealed widespread and common and only one detailed record (Pugsley and uniform mottling in the lung fields, diffuse emphysema, Spence, 1949) of cirrhosis of the type observed in thick, heavy bronchovascular markings and enlarged, these patients has been found.
    [Show full text]
  • The Three Cases Here Reported Afford an Excellent Opportunity for the Study of the Disease
    HEMOCHROMATOSIS A REPORT OF THREE CASES AND A DISCUSSION OF THE PATHOGENESIS T. P. SPRUNT, M.D. BALTIMORE Hemochromatosis is the name given by von Recklinghavsen1 to a rare disease of metabolism, the etiology of which remains wrapped in obscurity. In the English literature there are few articles on this sub- ject, which is one of great interest pathologically. Therefore, the three cases of this series are reported in detail with the impressions which I have derived from the study of them, in the hope that they may be of aid in the ultimate solution of the problem. SUMMARY AND COMPARISON OF CASES The three cases here reported afford an excellent opportunity for the study of the disease. The first case is one of simple hemochromatosis with the complication of tuberculous peritonitis forming a prominent part of the clinical picture. The other two cases are quite typical of the more frequently described form usually designated as bronzed diabetes. In all three cases there were the associated signs of asthenia, enlargement of the liver, and skin pigmentation which served to make the diagnosis clear in the two cases in which diabetes was present. In Case 1, without diabetes, the diagnosis was made more difficult by the presence of the tuberculous peritonitis, but in this case, too, the association of the signs just mentioned was considered very suggestive of hemochromatosis. Alcohol cannot be cited as an important factor in the etiology of these cases, although none of the patients was a total abstainer. In Cases 1 and 3 there is a history of attacks of dysentery which occurred, however, at least ten years before there were any symptoms of hemochromatosis.
    [Show full text]
  • Research Journal of Pharmaceutical, Biological and Chemical Sciences
    ISSN: 0975-8585 Research Journal of Pharmaceutical, Biological and Chemical Sciences Palliative Effect of Piracetam on Valproate Induced Liver Injury. Shamsher Shrestha, Mandavi Singh, Uttam Shrestha, and Anand Mishra* Department of Anatomy, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh-221005, India. ABSTRACT Valproic acid is one of the main antiepileptic drug which is a branched chain carboxylic acid used for absence seizures. The depletion of β-oxidation as well as increased synthesis of toxic unsaturated valproic acid derivatives results in severe hepatotoxicity. Piracetam is a nootropic or cognitive enhancing agent which is used to treat cognitive impairment in aging, brain injuries as well as dementia. The objective of the present study is to observe the ameliorative effect of piracetam in valproic acid induced liver injury. Experimental mice were divided into four groups. Group I mice termed as control received distilled water. Group II mice was administered valproic acid at the dose of 500mg/kg/body, group III mice was given piracetam at the dose of 800 mg/kg while group IV mice received both valproic acid and piracetam in the same dose for 6 days. The mice were sacrificed and their liver was collected for histological study. There was marked degeneration and destruction of laminar pattern of hepatocytes as well as reduction in glycogen granules. The intensity of the toxic effects of valproic acid was considerably reduced by piracetam. This shows that piracetam act as a protective agent in Valproic acid induced insult to the liver. Key words: antiepileptic, hepatotoxicity, cytoprotective, glycogen granules *Corresponding author May-June 2014 RJPBCS 5(3) Page No.
    [Show full text]
  • Chapter-16 DIGESTION and ABSORPTION POINTS to REMEMBER
    Chapter-16 DIGESTION AND ABSORPTION POINTS TO REMEMBER Digestion : The process in alimentary canal by which the complex food is converted mechanically and biochemically into simple substances suitable for absorption and assimilation. Food : A substance which on taken and digested in the body provides mate- rials for growth, repair, energy, reproduction, resistance from disease or regula- tion of body processes. Thecodont : The teeth embedded in the sockets of the jaw bone. e.g., in mammals. Diphyodont : The teeth formed twice in life time e.g., in mammals. 2123 Dental formula of man : ×=232 2123 Peristalsis : The involuntary movement of the gut by which the food bolus is pushed forward. Degluttition : The process of swallowing of food bolus. It is partly volun- tary and partly involuntary. Ruminants : The herbivours animals (e.g., cow, buffalo etc.) which have symbiotic bacteria in the rumen of their stomach which synthesize enzymes to hydrolyse cellulose into short chains fally acids. Diarrhoea : The abnormal frequent discharge of semisolid or fluid faecal matter from the bowel. Vomitting : The ejection of stomach contents through the mouth, caused by antiperistalsis. Dysentry : Frequent watery stools often with blood and mucus and with pain, fever and causes dehydration. Chyme : The semifluid mass into which food is converted by gastric secre- tion and which passes from the stomach into the small intestine. [ 104 ] Goblet cells : The cells of intestinal mucosal epithelium which secrete mucus. Glissons capsule : The connective tissue sheath which covers the hepatic lobules of liver. Hepatic lobules : The structural and functional units of liver containing hepatic cells which are arranged in the form of cords.
    [Show full text]
  • 9990 East Cent. Afr. J. Surg. (Online) E Text] Difficult Gallbladder Surgery, Improving Patient Outcomes Through Appropriate Surgical Decisions
    ISSN 20732073----99909990 East Cent. Afr. J. surg. (Online) e text] Difficult Gallbladder Surgery, Improving Patient Outcomes Through Appropriate Surgical Decisions. P. G Jani 1, H. Gill 2, V. Kotecha 3 1. Associate professor, Department of Surgery University of Nairobi 2Fellow of college of surgeons South Africa, Surgeon Groote Schuur Hospital 3M.D, Resident Department of Surgery University of Nairobi Correspondence to : Pankaj G. Jani. Email: [email protected] Background: Cholecystectomy is becoming a common operation in Africa. The right upper quadrant is regarded by many as the most difficult area of the abdomen because of the variable anatomy, small sized ducts and the irritant nature of bile. The fact that patients present late also adds to the difficulty with identification of structures in this area. A good working knowledge of the incidence and types of anatomical variations is key to a safe cholecystectomy. About 50% of patients presenting with gallbladder pathology show a significant anatomical variations. This study aimed to improve awareness amongst surgeons, both consultants and those in training to improve patient outcomes with gall bladder pathology. Case presentations: Four patients who had re-do surgeries at three different private hospitals in Nairobi are presented and discussed. None of the primary surgery in the four cases was done any of the authors. The re-do surgery in the four cases was performed by the principal author. The four patients respectively had a bile duct injury post open cholecystectomy, cholecystostomy done for gall bladder empyema, a stricture from a previous biliary-enteric anastomosis and obstructive jaundice from chronic pancreatitis.
    [Show full text]