scholarly journals Acute Liver Injury with Severe Coagulopathy in Marasmus Caused by a Somatic Delusional Disorder

2011 ◽  
Vol 2011 ◽  
pp. 1-2 ◽  
Author(s):  
Lance L. Stein ◽  
Arun B. Jesudian
Keyword(s):  
Anorexia Nervosa ◽  
Liver Injury ◽  
Calorie Restriction ◽  
Acute Liver Injury ◽  
Developed Countries ◽  
Severe Form ◽  
Delusional Disorder ◽  
Protein Calorie Malnutrition ◽  
Fat Stores ◽  
Severe Coagulopathy

Marasmus is a severe form of protein-calorie malnutrition characterized by the depletion of fat stores, muscle wasting, and the lack of edema. In developed countries, marasmus is often the result of anorexia nervosa. Abnormal transaminases with liver synthetic dysfunction have rarely been reported with anorexia nervosa. To our knowledge, we report the first detailed case of acute liver injury with severe coagulopathy (INR>1.5) in a patient with marasmus due to self-induced calorie restriction caused by a somatic delusional disorder. This case highlights the severity of liver injury that may occur with significant weight loss from self-induced calorie restriction and the rapid normalization of this injury with treatment. It is important for clinicians to be aware of patterns of acute liver injury in patients with severe protein-calorie malnutrition, regardless of the underlying cause.

scholarly journals Liver Autophagy in Anorexia Nervosa and Acute Liver Injury

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Marouane Kheloufi ◽  
Chantal M. Boulanger ◽  
François Durand ◽  
Pierre-Emmanuel Rautou
Keyword(s):  
Cell Death ◽  
Anorexia Nervosa ◽  
Liver Injury ◽  
Acute Liver Injury ◽  
Protective Mechanism ◽  
Liver Insufficiency ◽  
Electron Microscopy Analysis ◽  
Microscopy Analysis ◽  
Rescue Mechanism ◽  
Liver Cell Death

Autophagy, a lysosomal catabolic pathway for long-lived proteins and damaged organelles, is crucial for cell homeostasis, and survival under stressful conditions. During starvation, autophagy is induced in numerous organisms ranging from yeast to mammals, and promotes survival by supplying nutrients and energy. In the early neonatal period, when transplacental nutrients supply is interrupted, starvation-induced autophagy is crucial for neonates’ survival. In adult animals, autophagy provides amino acids and participates in glucose metabolism following starvation. In patients with anorexia nervosa, autophagy appears initially protective, allowing cells to copes with nutrient deprivation. However, when starvation is critically prolonged and when body mass index reaches 13 kg/m2or lower, acute liver insufficiency occurs with features of autophagic cell death, which can be observed by electron microscopy analysis of liver biopsy samples. In acetaminophen overdose, a classic cause of severe liver injury, autophagy is induced as a protective mechanism. Pharmacological enhancement of autophagy protects against acetaminophen-induced necrosis. Autophagy is also activated as a rescue mechanism in response to Efavirenz-induced mitochondrial dysfunction. However, Efavirenz overdose blocks autophagy leading to liver cell death. In conclusion, in acute liver injury, autophagy appears as a protective mechanism that can be however blocked or overwhelmed.

scholarly journals Acute liver injury and anorexia nervosa: a case report

2019 ◽  
Vol 13 (2) ◽  
pp. 128-131
Author(s):  
Simona Pascolini ◽  
Michele Cevolani ◽  
Federico Lari ◽  
Luigi Muratori ◽  
Marco Lenzi
Keyword(s):  
Body Weight ◽  
Anorexia Nervosa ◽  
Liver Injury ◽  
Parenteral Nutrition ◽  
Nutritional Assessment ◽  
Acute Liver Injury ◽  
Transaminase Level ◽  
Progressive Increase ◽  
Psychiatric Institute ◽  
History Of

Anorexia nervosa is an eating disorder characterized by restriction of energy intake leading to a significant decrease in body weight. While it is primarily a psychiatric disorder, numerous medical complications can occur. In this article we describe a case of a 25-year-old woman with a 12-year history of severe restrictive anorexia nervosa that was referred to the Emergency Service of our Hospital, transferred from a psychiatric institute, for severe weight loss, dehydration, and progressive increase in transaminases. During the hospital stay she developed an acute liver injury with an increase in transaminase level up to 40× the ULN. Infective and immunological causes of acute hepatitis were excluded. In the suspect of severe starvation acute liver injury, we performed a nutritional assessment and started parenteral nutrition. After 15 days of parenteral nutrition, she gained 2.5 kg of body weight and liver tests were drastically reduced and nearly normal.

scholarly journals Severe Starvation-Induced Hepatocyte Autophagy as a Cause of Acute Liver Injury in Anorexia Nervosa: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
S. Restellini ◽  
L. Spahr ◽  
L. Rubbia Brandt
Keyword(s):  
Anorexia Nervosa ◽  
Liver Injury ◽  
Acute Liver Injury ◽  
Clinical Situation ◽  
Severe Malnutrition ◽  
Hepatic Glycogen ◽  
Glycogen Depletion ◽  
Case Presentation ◽  
Common Causes ◽  
Liver Tests

Introduction. Mild elevation of transaminase may be observed in anorexia nervosa, but acute liver injury is uncommon. A complex programmed cell death in response to starvation, called autophagy, has been described in experimental and human studies.Case Presentation. A 24-year-old woman suffering from anorexia nervosa was hospitalized for severe malnutrition. At admission, there were biological signs of acute liver injury but no electrolytic imbalance. After having ruled out the most common causes of liver injury, the patient was carefully refed. As liver tests remained abnormal, liver biopsy was performed. At histology and electron microscopy, numerous signs suggestive of starvation-induced hepatocyte autophagy were found.Discussion. Severe starvation can be associated with acute liver injury that is slowly reversible with careful enteral nutrition. In this clinical situation, profound hepatic glycogen depletion in association with autophagy appears as the leading cause of liver injury.

Assessment of Serious Acute and Chronic Idiosyncratic Drug-Induced Liver Injury in Clinical Practice

2019 ◽  
Vol 39 (03) ◽  
pp. 381-394 ◽  
Author(s):  
Fernando Bessone ◽  
Mercedes Robles-Diaz ◽  
Nelia Hernandez ◽  
Inmaculada Medina-Caliz ◽  
M. Isabel Lucena ◽  
...  
Keyword(s):  
Liver Injury ◽  
Injury Risk ◽  
Acute Liver Injury ◽  
Developed Countries ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Injury Risk Factors ◽  
Variable Phenotype ◽  
Hy’S Law ◽  
Scoring Algorithms

AbstractDrug-induced liver injury (DILI) is the leading cause of acute liver failure (ALF) in developed countries. The extremely variable phenotype of DILI, both in presentation and in severity, is one of the distinctive characteristics of the disease and one of the major challenges that hepatologists face when assessing hepatotoxicity cases. A new Hy's law that more accurately predicts the risk of ALF related to DILI has been proposed and validated. Other prognostic scoring algorithms for the early identification of DILI patients who may go on to develop ALF have been developed as it is of most clinical relevance to stratify patients for closer monitoring. Recent data indicate that acute DILI often presents a more prolonged resolution or evolves into chronicity at a higher frequency than other forms of acute liver injury. Risk factors for chronicity, specific phenotypes, and histological features are discussed in this study. Biomarkers to predict DILI outcome are in need.

scholarly journals Severe toxic acute liver injury

2019 ◽  
Vol 147 (7-8) ◽  
pp. 479-483
Author(s):  
Nikola Mitrovic ◽  
Ksenija Bojovic ◽  
Jasmina Simonovic ◽  
Natasa Nikolic ◽  
Aleksandar Urosevic ◽  
...  
Keyword(s):  
Liver Injury ◽  
Acute Hepatitis ◽  
Signs And Symptoms ◽  
Developed Countries ◽  
Severe Form ◽  
Significant Research ◽  
High Doses ◽  
Branched Chain ◽  
Biochemical Analyses ◽  
Toxic Liver Injury

Introduction. Toxic liver injury is becoming greater problem in today?s hepatology. Until today more than 900 drugs, toxins and herbs have been identified that can cause different liver injury. There was no significant research of this problem in Serbia so far. The aim of this study is to present the patient with severe form of acute hepatitis, whose etiology is exclusively toxic. Case outline. A 23-year-old male, from Belgrade, previously healthy, got sick with signs and symptoms that correlated with acute hepatitis. Biochemical analyses pointed to severe form of acute hepatitis with impending hepatocellular failure. The diagnosis of toxic liver injury was set. It was caused by the use of number substances and supplements: ecstasy, whey protein, branched-chain amino acid (BCAA), creatine, high doses of vitamin D, glutamine, and multivitamin complex. He was treated with infusion, gastroprotective, and substitution therapy. During hospitalization, the patient?s symptoms disappeared with gradual normalization of biochemical analyses of the liver. When the patient?s condition was satisfying, blind percutaneous liver biopsy was performed, with the following pathohistological findings: lobular hepatitis, with no fibrosis, etiology correlates to toxic. After a month and a half since the disease had begun, the patient fully recovered. Conclusion. Increased number of persons with toxic liver injury is being registered in developed countries worldwide. Similar trend can be noted in Serbia as well. By presenting young previously healthy man with the severe form of toxic acute hepatitis and impending liver failure, we are pointing out the significance of this problem. Multidisciplinary approach is needed to reach the most effective solutions.

Aloe-Emodin Quinone Pretreatment Reduces Acute Liver Injury Induced by Carbon Tetrachloride

2000 ◽  
Vol 87 (5) ◽  
pp. 229-233 ◽  
Author(s):  
Beatrice Arosio ◽  
Nicoletta Gagliano ◽  
Lorena Maria Pia Fusaro ◽  
Luciano Parmeggiani ◽  
Jacopo Tagliabue ◽  
...  
Keyword(s):  
Carbon Tetrachloride ◽  
Liver Injury ◽  
Acute Liver Injury ◽  
Aloe Emodin
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