hepatic insufficiency

肝不全[[]]

WordNet

1. a lack of competence; "pointed out the insufficiencies in my report"; "juvenile offenses often reflect an inadequacy in the parents" (同)inadequacy
2. (pathology) inability of a bodily part or organ to function normally
3. lack of an adequate quantity or number; "the inadequacy of unemployment benefits" (同)inadequacy, deficiency
4. pertaining to or affecting the liver; "hepatic ducts"; "hepatic cirrhosis"

PrepTutorEJDIC

1. 不十分な[点],不足;不適当,不向き
2. 肝臓の;肝臓にきく,肝臓のような色の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/01/20 20:06:27」(JST)

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Hepatic disease
Micrograph of non-alcoholic fatty liver disease
Classification and external resources
Specialty	Gastroenterology
MedlinePlus	000205

Liver disease (also called hepatic disease) is a type of damage to or disease of the liver.

Associated medical conditions

Types

Ground glass hepatocytes

Primary biliary cirrhosis

Budd-chiari syndrome

There are more than a hundred kinds of liver disease, these are some of the most common:

• Fascioliasis, a parasitic infection of liver caused by a Liver fluke of the Fasciola genus, mostly the Fasciola hepatica.
• Hepatitis, inflammation of the liver, is caused by various viruses (viral hepatitis) also by some liver toxins (e.g. alcoholic hepatitis), autoimmunity (autoimmune hepatitis) or hereditary conditions.
• Alcoholic liver disease is a hepatic manifestation of alcohol overconsumption, including fatty liver disease, alcoholic hepatitis, and cirrhosis. Analogous terms such as "drug-induced" or "toxic" liver disease are also used to refer to disorders caused by various drugs.
• Fatty liver disease (hepatic steatosis) is a reversible condition where large vacuoles of triglyceride fat accumulate in liver cells. Non-alcoholic fatty liver disease is a spectrum of disease associated with obesity and metabolic syndrome.
• Hereditary diseases that cause damage to the liver include hemochromatosis, involving accumulation of iron in the body, and Wilson's disease. Liver damage is also a clinical feature of alpha 1-antitrypsin deficiency and glycogen storage disease type II.
• In transthyretin-related hereditary amyloidosis, the liver produces a mutated transthyretin protein which has severe neurodegenerative and/or cardiopathic effects. Liver transplantation can give a curative treatment option.
• Gilbert's syndrome, a genetic disorder of bilirubin metabolism found in a small percent of the population, can cause mild jaundice.
• Cirrhosis is the formation of fibrous tissue (fibrosis) in the place of liver cells that have died due to a variety of causes, including viral hepatitis, alcohol overconsumption, and other forms of liver toxicity. Cirrhosis causes chronic liver failure.
• Primary liver cancer most commonly manifests as hepatocellular carcinoma and/or cholangiocarcinoma; rarer forms include angiosarcoma and hemangiosarcoma of the liver. (Many liver malignancies are secondary lesions that have metastasized from primary cancers in the gastrointestinal tract and other organs, such as the kidneys, lungs.)
• Primary biliary cirrhosis is a serious autoimmune disease of the bile capillaries.
• Primary sclerosing cholangitis is a serious chronic inflammatory disease of the bile duct, which is believed to be autoimmune in origin.
• Budd–Chiari syndrome is the clinical picture caused by occlusion of the hepatic vein.

Mechanism

Liver disease can occur through several mechanisms. A common form of liver disease is viral infection. Viral hepatitides such as Hepatitis B virus and Hepatitis C virus can be vertically transmitted during birth via contact with infected blood. According to a 2012 NICE publication, "about 85% of hepatitis B infections in newborns become chronic". In occult cases, Hepatitis B virus is present by HBV DNA, but testing for HBsAg is negative. High consumption of alcohol can lead to several forms of liver disease including alcoholic hepatitis, alcoholic fatty liver disease, cirrhosis, and liver cancer. In the earlier stages of alcoholic liver disease, fat builds up in the liver's cells due to increased creation of triglycerides and fatty acids and a decreased ability to break down fatty acids. Progression of the disease can lead to liver inflammation from the excess fat in the liver. Scarring in the liver often occurs as the body attempts to heal and extensive scarring can lead to the development of cirrhosis in more advanced stages of the disease. Approximately 3-10% of individuals with cirrhosis develop a form of liver cancer known as hepatocellular carcinoma.

Diagnosis

A number of liver function tests (LFTs) are available to test the proper function of the liver. These test for the presence of enzymes in blood that are normally most abundant in liver tissue, metabolites or products. serum proteins, serum albumin, serum globulin, alanine transaminase, aspartate transaminase, prothrombin time, partial thromboplastin time.

Treatment

Ursodeoxycholic acid

Anti-viral medications are available to treat infections such as hepatitis B. Other conditions may be managed by slowing down disease progression, for example:

• By using steroid-based drugs in autoimmune hepatitis.
• Regularly removing a quantity of blood from a vein (venesection) in the iron overload condition, hemochromatosis.
• Wilson’s disease, a condition where copper builds up in the body, can be managed with drugs which bind copper allowing it to be passed from your body in urine.
• In cholestatic liver disease, (where the flow of bile is affected due to cystic fibrosis) a medication called ursodeoxycholic acid (URSO, also referred to as UDCA) may be given.

References

Further reading

• Friedman, Lawrence S.; Keeffe, Emmet B. (2011-08-03). Handbook of Liver Disease. Elsevier Health Sciences. ISBN 1455723169. 

UpToDate Contents

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• 1. 成人における急性肝不全：マネージメントおよび予後 acute liver failure in adults management and prognosis
• 2. 成人における抗癌剤の投与 dosing of anticancer agents in adults
• 3. 成人における肝性脳症：治療 hepatic encephalopathy in adults treatment
• 4. 2型糖尿病の治療のためのジペプチジルペプチダーゼ4（DPP-4）阻害剤 dipeptidyl peptidase 4 dpp 4 inhibitors for the treatment of type 2 diabetes mellitus
• 5. Surgical resection of sporadic pancreatic neuroendocrine tumors

English Journal

• Treat chronic hepatitis C virus infection in decompensated cirrhosis - pre- or post-liver transplantation? the ironic conundrum in the era of effective and well-tolerated therapy.

• Bunchorntavakul C1, Reddy KR2.
• Journal of viral hepatitis.J Viral Hepat.2016 Jun;23(6):408-18. doi: 10.1111/jvh.12534. Epub 2016 Mar 28.
• The management of hepatitis C virus (HCV) infection in patients with decompensated cirrhosis has evolved dramatically over the past few years mainly due to the availability of all-oral antiviral regimens. The currently approved all-oral direct-acting antivirals (DAA) containing sofosbuvir, ledipasvi
• PMID 27018088

• Clinical score to predict the risk of bile leakage after liver resection.

• Kajiwara T1, Midorikawa Y2, Yamazaki S1, Higaki T1, Nakayama H1, Moriguchi M1, Tsuji S3, Takayama T1.
• BMC surgery.BMC Surg.2016 May 6;16(1):30. doi: 10.1186/s12893-016-0147-0.
• BACKGROUND: In liver resection, bile leakage remains the most common cause of operative morbidity. In order to predict the risk of this complication on the basis of various factors, we developed a clinical score system to predict the potential risk of bile leakage after liver resection.METHODS: We a
• PMID 27154038

• Hepatic artery aneurysms: open and endovascular repair.

• Melissano G1, Mascia D, Gabriel SA, Bertoglio L, Venturini M, DE Cobelli F, Del Maschio A, Chiesa R.
• The Journal of cardiovascular surgery.J Cardiovasc Surg (Torino).2016 May 6. [Epub ahead of print]
• BACKGROUND: describe our experience with endovascular and open repair of hepatic artery aneurysms (HAA).METHODS: A retrospective review of 26 patients (18 males and 8 females; mean age: 62+/- 9 years) who underwent surgical open repair of HAA between 1998 and 2015 was performed. Indications to open
• PMID 27153369

Japanese Journal

• 肝膵同時切除後の肝動脈狭窄と仮性動脈瘤に対しcovered stent留置が有効であった1例

• 中村 直彦,中川 淳,矢澤 武史,川村 純一郎,原田 英樹,山本 秀和,財間 正純,岡田 正治
• 日本消化器外科学会雑誌 47(1), 73-79, 2014
• 　症例は66歳の女性で，局所進行胆囊癌に対し肝膵同時切除術を行った．術後に膵液瘻，門脈血栓症を認め肝不全の進行を認めた．膵液瘻による腹腔内感染に対しては開腹ドレナージ術を行ったが肝不全の改善はなく，術後48日目には腹部造影CTにて肝動脈狭窄と右肝動脈切離断端に仮性動脈瘤形成を認めた．緊急血管造影にて肝動脈にcovered stentを留置し右肝動脈切離断端からの出血を止血し，肝動脈狭窄を解除し肝動 …
• NAID 130004560977

• Splenectomy prolongs the effects of corticosteroids in mouse models of autoimmune hepatitis.

• Maruoka Ryutaro,Aoki Nobuhiro,Kido Masahiro,Iwamoto Satoru,Nishiura Hisayo,Ikeda Aki,Chiba Tsutomu,Watanabe Norihiko
• Gastroenterology 145(1), 209-220.e9, 2013-07
• … BALB/c mice with disruption of programmed cell death 1 (PD-1^{–/–} mice) that undergo thymectomy 3 days after birth develop a deregulated immune system, have reduced numbers of Foxp3^+ regulatory T cells, and develop fulminant hepatic failure that resembles acute-onset AIH in humans. … We examined whether splenectomy overcomes corticosteroid insufficiency and reduces the severity of AIH in these mice. …
• NAID 120005315980

• プレガバリンを中心とした薬物療法により疼痛管理が可能になった三叉神経痛の一症例

• 安藤 祐子,山﨑 陽子,新美 知子,井村 紘子,細田 明利,川島 正人,嶋田 昌彦
• 日本口腔顔面痛学会雑誌 6(1), 19-23, 2013
• 症例の概要：56歳，男性．左側上下顎および頬部の疼痛を主訴に当科を訪れた．疼痛は食事や洗顔で誘発し，2∼3分間持続した．MRI所見で左側三叉神経根部に脈管の接触が認められた．以上より，左側三叉神経痛（第II·III枝領域）と診断し，カルバマゼピン200 mg/日を処方したところ，疼痛は軽減した．しかし，処方開始6週間後，肝機能障害が出現し疼痛も増強したため，カルバマゼピンを増量せずガバペンチン40 …
• NAID 130004953527

Related Links

• Hepatic insufficiency | definition of hepatic insufficiency by ...

he·pa·tic in·suf·fi·cien·cy defective functional activity of the liver cells. hepatic insufficiency a failure or partial failure of normal liver function. he·pa·tic in·suf·fi·cien·cy (he-patik in-sŭ-fishĕn-sē) Defective functional activity of the liver cells.

• Hepatic insufficiency - RightDiagnosis.com

Hepatic insufficiency information including symptoms, causes, diseases, symptoms, treatments, and other medical and health issues. ... Introduction: Hepatic insufficiency Description of Hepatic insufficiency Hepatic insufficiency: Conditions in which the ...

Related Pictures

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★リンクテーブル★

リンク元	「肝不全」「hepatic dysfunction」「liver dysfunction」
関連記事	「insufficiency」「hepatic」

「肝不全」

　　[★]

英

hepatic failure, liver failure, hepatic insufficiency, liver insufficiency

同

肝機能不全

関

肝障害, 肝機能障害, 肝臓障害, 肝機能異常

• 病態(肝機能の低下)で定義される疾患概念。

病型と病因

• 1. 急性肝不全：劇症肝炎(急激に肝予備能が低下。ウイルス性、薬剤性など)など。
• 2. 慢性肝不全：非代償性肝硬変、末期肝癌など

症候

• 1. 全身倦怠感および消化器症状(悪心、嘔吐など)
• 2. 肝性脳症

• 意識障害などの精神症状、羽ばたき振戦、肝性口臭など
• 肝の機能低下および門脈大循環の側副血行路のため、血中に蓄積した物質が脳代謝障害を起こすと考えられる。
• 血中アンモニア値上昇、フィッシャー比(血中分岐鎖アミノ酸/芳香族アミノ酸比)の低下、脳波の徐波化と三相波出現がみられる。

• 3. 黄疸

• ビリルビンの代謝障害(抱合や輸送)による血中ビリルビン値の上昇。

• 4. 腹水

• 1) 膠質浸透圧低下：↓肝でのアルブミン産生量　→　↓膠質浸透圧　→　↑組織外液
• 2) 門脈圧亢進

• 5. 出血性素因(凝固機能低下)

• 凝固因子産生量低下

「hepatic dysfunction」

　　[★]

• (病名)肝障害、肝機能障害、肝臓障害、肝機能不全

関

hepatic damage, hepatic insufficiency, hepatopathy, impaired liver function, liver damage, liver disorder, liver dysfunction

「liver dysfunction」

　　[★]

肝機能障害、肝機能異常、肝機能不全

関

hepatic dysfunction、hepatic insufficiency、impaired liver function、liver disease

「insufficiency」

　　[★]

• n.

• 不全、不全症、機能不全、機能不全症、不足、不十分、(心臓)弁閉鎖不全、弁閉鎖不全症

関

dearth、deficient、deficit、dysfunction、failing、failure、hypofunction、imperfecta、in short、inadequate、incompetence、insufficient、insufficiently、lack、low、malfunction、paucity、poorly、regurgitation、scanty、scarce、scarcity、short、shortage、shortness、stun

　 　 　 　

「hepatic」

　　[★]

• adj.

• 肝臓の、肝性の、肝の

関

hepato、hepatogenic、liver