Saturday, 27 October 2018

Alagille syndrome : A Rare Liver Disease (Arteriohepatic Dysplasia)

Alagille syndrome is a genetic condition that results in different side effects completely different parts of the body, including the liver. An individual with Alagille syndrome has less than the normal number of small bile ducts inside the liver. The liver is the organ within the abdomen the range between the chest and hips that makes blood proteins and bile, stores energy and nutrients, fights infection and removes harmful chemicals from the blood.

Bile ducts are tubes that carry bile from the liver cells to the gallbladder for capacity and to the small intestine for utilizing in assimilation. Bile is fluid made by the liver that carries toxins and waste products out of the body and makes a difference the body digest fats and the fat-soluble vitamins A, D, E, and K. In individuals with Alagille syndrome, the diminished number of bile ducts causes bile to construct up within the liver, a condition moreover called cholestasis, leading to liver damage and liver illness.

Causes of Alagille syndrome
Alagille syndrome caused by a gene transformation, or defect. Genes give instructions for making proteins within the body. A gene mutation could be a permanent alter within the DNA arrangement that produces up to a quality. DNA, or deoxyribonucleic acid, is the material interior cells that carries hereditary information and passes qualities from parent to child. Roughly 30 to 50 percent of individuals with Alagille disorder have an acquired quality change, meaning it has been passed on by a parent. Within the remaining cases, the gene transformation creates spontaneously. In spontaneous cases, not one or the other parent carries a duplicate of the mutated quality.


Signs and Symptoms of Alagille Syndrome
Jaundice: Jaundice, when the skin and whites of the eyes turn yellow, is a result of the liver not evacuating bilirubin from the blood. Bilirubin could be a reddish-yellow substance formed when hemoglobin breaks down. Hemoglobin is an iron-rich protein that gives blood its ruddy color. Bilirubin is retained by the liver, processed, and discharged into bile. Blockage of the bile channels strengths bilirubin and other elements of bile to construct up within the blood.
Jaundice may be difficult for parents and indeed health care providers to distinguish. Numerous healthy newborns have mellow jaundice amid the primary 1 to 2 weeks of life due to a youthful liver. This typical sort of jaundice disappears by the second or third week of life, whereas the jaundice of Alagille disorder deepens. Newborns with jaundice after 2 weeks of life should be seen by a health care provider to check for a possible liver issue.
Dark urine and gray or white stools. Tall levels of bilirubin within the blood that passes into the urine can make the urine darker, whereas stool lightens from a lack of bilirubin coming to the intestines. Gray or white bowel developments after 2 weeks of age are a solid sign of a liver problem and should provoke a visit to a health care provider.
Pruritus. The buildup of bilirubin within the blood may cause itching, also called pruritus. It usually starts after 3 months of age and can be severe.
 Xanthomas: Xanthomas are fatty deposits that show up as yellow bumps on the skin. They are caused by abnormally high cholesterol levels within the blood, common in individuals with liver disease. Xanthomas may appear anywhere on the body. In any case, xanthomas are usually found on the elbows, joints, ligaments, knees, hands, feet, or buttocks.

Saturday, 20 October 2018

Interaction between periodontitis and liver diseases

Routine oral care to treat gum infection also known as the periodontitis may play a part in lessening inflammation and toxins within the blood also known as endotoxemia and progressing cognitive work in individuals with liver cirrhosis. Cirrhosis, which may be a developing epidemic is due to the presence of scar tissue on the liver. When severe, it can lead to liver failure. The complications of cirrhosis may include infections throughout the body and can cause hepatic encephalopathy, a buildup of toxins in the brain caused by the advanced liver disease. Symptoms of hepatic encephalopathy incorporate impeded cognitive function, confusion, and mood changes.


The previous research appears that individuals with cirrhosis have changes in the intestine and salivary microbiota - microbes that populate the gastrointestinal tract and mouth - which can lead to gum infection and a better chance of cirrhosis-related complications. In the expansion, considers have found that people with cirrhosis have increased levels of inflammation all through the body, which is related to hepatic encephalopathy. Researchers considered two groups of volunteers that had cirrhosis and mild-to-moderate periodontitis. One group has gotten periodontal care, counting teeth cleaning and expulsion of microbes’ toxins from the teeth and gums and the other group was not treated for gum disease. The research group collected blood, saliva and stool samples before and 30 days after treatment. Each volunteer took standardized tests to measure cognitive work sometime recently and after treatment.

The treated group, particularly those with hepatic encephalopathy, had increased levels of useful gut microbes that may decrease inflammation, as well as lower levels of endotoxin-producing bacteria within the saliva when compared to the untreated group. The untreated group, on the other hand, demonstrated an increase in endotoxin levels within the blood over the same time period. The change within the treated group may be related to a diminishment in oral inflammation leading to lower systemic inflammation, or due to being swallowed and affecting the intestine microbiota. Cognitive function too progressed within the treated group, recommending that the reduced inflammation levels within the body may minimize a few of the symptoms of hepatic encephalopathy in people who are already accepting standard-of-care therapies for the condition. This finding is significant since there are no further therapies approved by the U.S. Food and Drug Administration to reduce cognition problems in this population.

The oral cavity might represent a treatment target to decrease inflammation and endotoxemia in patients with cirrhosis to progress clinical outcomes. The treated group, especially those with hepatic encephalopathy a buildup of toxins within the brain caused by advanced liver disease had increased levels of useful gut microscopic organisms that could decrease inflammation, as well as reduced levels of endotoxin-producing bacteria within the saliva when compared to controls. In the expansion, the untreated group experienced an increase in endotoxin levels within the blood over the same time period. Periodontitis treatment was moreover detailed to improve cognitive work within the treated group.

Friday, 12 October 2018

Liver disease drug could help restore cells damaged by Alzheimer's

 A drug which has been utilized to treat liver disease for decades could offer assistance restore cells damaged by Alzheimer's. Researchers discovered the drug ursodeoxycholic corrosive (UDCA) progresses mitochondrial dysfunction which is known to be a causative factor for both sporadic and familial Alzheimer's disease. Mitochondria play a significant role in both neuronal cell survival and death as they control the vitality metabolism and cell death pathways acting as a cell's battery, concurring to the research.


Mitochondrial abnormalities have been distinguished in numerous cell sorts in Alzheimer’s illness, with deficits occurring before the advancement of the classical pathological accumulations. The energy changes have been found in many diverse cells from people with Alzheimer’s. It is thought they are one of the earliest changes to occur within the brain cells, maybe even before side effects are detailed by individuals living with the disease. The vitality changes have been found in numerous distinctive cells from individuals with Alzheimer's. For the primary time in actual Alzheimer's persistent tissue, this consider has appeared that the medicate UDCA corrosive can boost the performance of the cells' batteries, the mitochondria conjointly known as the powerhouse of the cell.

We too found that the drug, which is as of now in clinical utilize for the liver disease, acts by changing the shape of the batteries which might tell us more approximately how other drugs can be useful in Alzheimer's. Most importantly we found the drug to be dynamic in cells from individuals with the most common sort of the obliterating illness sporadic Alzheimer's which may mean it has the potential for thousands of patients As the drug is as of now in clinical use for liver illness; this speeds up the potential time it might take to get this drug to the clinic for patients.


Alzheimer’s disease is the driving cause of dementia around the world and is the most common neurodegenerative disorder. Utilizing tissue collected from diverse patients with Alzheimer's disease, the researchers who conducted the later study affirmed that the existing drug did progress mitochondrial function. The current medicines for Alzheimer's focus on abating down the progression of a few of these symptoms and overseeing the condition's effect on a person's behavior and mental state.

Saturday, 6 October 2018

FONTANA ASSOCIATED LIVER DISEASE

Fontan-associated liver disease (FALD) comprises a wide range of structural and functional modifications of the liver caused by hemodynamic disturbances following Fontan surgery. As in all forms of the chronic liver disease, FALD advances through a few stages sometime recently reaching the last stage, when the most complications of portal hypertension and hepatocellular carcinoma occur. In spite of the fact that liver damage in Fontan patients is widespread, it likely begins some time recently surgery and its progression differs in each patient.
Fontan‐associated liver disease (FALD) is a process universal to the post‐Fontan population and includes a spectrum of pathology that ranges from mild liver fibrosis (LF) to liver cirrhosis (LC) and hepatocellular carcinoma (HCC). FALD is a non-cardiac complication of the Fontan circulation, which has been recognized with increasing frequency in adolescents and adults.

The etiology of FALD is not entirely known but is likely multifactorial, with physiological derangements, particularly elevation in central venous pressures, medical complications, and surgical interventions likely contributing to liver pathology.




PATHOPHYSIOLOGY OF FONTAN-ASSOCIATED LIVER DISEASE
The pathogenesis of liver fibrosis in the Fontan population is not well-documented. Fibrogenesis is thought to be driven by a non-inflammatory mechanism, as the inflammatory infiltrates in biopsy and autopsy samples is minimal or absent.
The key point in the pathophysiology of FALD is a disturbance in the liver's vascular supply and drainage. Elevated systemic venous pressure leads to inefficient blood drainage of the liver, determining a state of chronic passive congestion. This state promotes sinusoidal dilation and blood hyperfiltration causing per sinusoidal edema and hypoxia in centrilobular hepatocytes. Finally, it should be highlighted that Fontan patients feature additional risk factors for the chronic liver disease which are unrelated to this unique vascular system. These include a higher prevalence of hepatitis C virus infection.



DIAGNOSIS AND TREATMENT
Risk factors for FALD include higher Fontan pressures, increasing age, longer duration of Fontan, underlying, alcohol use, hepatitis B or C and hepatotoxic drug use.
Prevention of FALD is an important consideration. This can be attempted by optimization of anatomy and physiology, as well as prevention of liver injury both prior to and after the Fontan. Examples of prevention of liver injury include an aggressive approach towards immunization against and treatment of viral hepatitis, as well as avoidance of and obesity (steatohepatitis) and hepatotoxins.
Treatment of FALD (patients with cirrhosis or stage III/IV fibrosis) is based on optimization of the Fontan circulation and hepatology consultation. Testing serum alpha-fetoprotein and liver imaging every 6 months should be considered because of the increased risk of hepatocellular carcinoma.


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