scholarly journals A complex obstetric case

2017 ◽  
Vol 18 (3) ◽  
pp. 239-243
Author(s):  
Michael Hoy ◽  
Kate Flavin ◽  
Venkat Prasad
Keyword(s):  
Severe Sepsis ◽  
Liver Enzymes ◽  
Care Physician ◽  
Peripartum Cardiomyopathy ◽  
Confounding Factors ◽  
Intensive Care Physician ◽  
Sequence Of Events ◽  
Elevated Liver Enzymes ◽  
Physician Awareness ◽  
Difficult Sequence

A 33-year-old primigravida presented with severe sepsis, severe pre-eclampsia, peripartum cardiomyopathy and the haemolysis, elevated liver enzymes and low platelets syndrome manifesting over the course of 24 h causing a diagnostic conundrum and a difficult sequence of physiological problems to overcome. We describe a previously unreported sequence of events involving a pre-eclamptic, septic parturient to improve anaesthetic and intensive care physician awareness of confounding factors that complicate assessment and management of these patients.

scholarly journals An interesting case of a twin pregnancy complicated with happy hypoxia, peripartum cardiomyopathy and haemolysis, elevated liver enzymes, low platelet count syndrome during the COVID-19 pandemic situation

2020 ◽  
Vol 9 (12) ◽  
pp. 5150
Author(s):  
Ramna Banerjee ◽  
Farheen Rahman
Keyword(s):  
Oxygen Saturation ◽  
Twin Pregnancy ◽  
Liver Enzymes ◽  
Clinical Symptoms ◽  
Interesting Case ◽  
Peripartum Cardiomyopathy ◽  
Low Oxygen ◽  
Elevated Liver Enzymes ◽  
Number Of Patients ◽  
Low Platelet Count

Ever since the beginning of the COVID-19 pandemic in December 2019, the focus has been on studying the varying clinical symptoms and signs of the disease. A condition which has been alarmingly occurring in quite a number of patients is a state of hypoxemia, of which the patient is blissfully unaware and does not have any symptoms of breathlessness or respiratory discomfort in spite of having low oxygen saturation levels. Hence the term coined for it- “happy hypoxemia”. We are reporting a case of a pregnant woman with twin pregnancy and pregnancy induced hypertension who rapidly progressed to hemolysis, elevated liver enzymes, low platelets syndrome without having proteinuria along with features of peripartum cardiomyopathy and also had low oxygen saturation levels (less than 72%) though she did not have any complaints of dyspnea, orthopnea, hemoptysis, chest pain, cough or peripheral oedema. She was tested for COVID-19 with real-time polymerase chain reaction on 2 occasions a week apart and was found to be negative. Her recovery was also unexpectedly rapid and progressive.

Concurrent terbinafine-induced acute generalised exanthematous pustulosis and hepatitis

2021 ◽  
Vol 14 (1) ◽  
pp. e238930 ◽  
Author(s):  
Lorenzo R Carnio ◽  
Mary E Johnson Shaw ◽  
Jack Schnur ◽  
Damian Casadesus
Keyword(s):  
Primary Care ◽  
Side Effects ◽  
Primary Care Physician ◽  
Liver Enzymes ◽  
Care Physician ◽  
Medical Community ◽  
Left Flank ◽  
Elevated Liver Enzymes ◽  
Laboratory Results ◽  
Exanthematous Pustulosis

Terbinafine is a commonly used antifungal medication. Its side effects, while widely known, are rarely described and can be missed by the medical community. We present a 55-year-old woman who visited her primary care physician with onychomycosis. She started treatment with terbinafine, and 1 week later developed a rash in the left flank that extended to the chest, back, and upper part of lower extremities. Laboratory results showed elevated liver enzymes. A treatment with steroids did not improve the rash and she was admitted to our institution. She was started with intravenous dexamethasone, topical hydrocortisone and triamcinolone. Seven days later the liver enzymes normalised, and the rash resolved on the chest and back. Our patient had concurrent acute generalised exanthematous pustulosis and hepatitis that together has been very rarely associated with terbinafine.

Hepatitis A Antigen in Liver, Bile and Stool

1975 ◽  
Vol 33 ◽  
pp. 340-341
Author(s):  
D.R. Jackson ◽  
J.H. Hoofnagle ◽  
A.N. Schulman ◽  
J.L. Dienstag ◽  
R.H. Purcell ◽  
...  
Keyword(s):  
Hepatitis A ◽  
Liver Enzymes ◽  
Hepatitis A Virus ◽  
Type A ◽  
Initial Study ◽  
Virus Like Particle ◽  
Elevated Liver Enzymes ◽  
Ag Particles ◽  
Ag Particle ◽  
Human Stool

Using immune electron microscopy Feinstone et. al. demonstrated the presence of a 27 nm virus-like particle in acute-phase stools of patients with viral hepatitis, type A, These hepatitis A antigen (HA Ag) particles were aggregated by convalescent serum from patients with type A hepatitis but not by pre-infection serum. Subsequently Dienstag et. al. and Maynard et. al. produced acute hepatitis in chimpanzees by inoculation with human stool containing HA Ag. During the early acute disease, virus like particles antigenically, morphologically and biophysically identical to the human HA Ag particle were found in chimpanzee stool. Recently Hilleman et. al. have described similar particles in liver and serum of marmosets infected with hepatitis A virus (HAV). We have investigated liver, bile and stool from chimpanzees and marmosets experimentally infected with HAV. In an initial study, a chimpanzee (no.785) inoculated with HA Ag-containing stool developed elevated liver enzymes 21 days after exposure.

Differential diagnosis of elevated liver enzymes: case reports

2008 ◽  
Vol 46 (05) ◽  
Author(s):  
T Korom ◽  
I Nagy ◽  
É Csajbók ◽  
T Wittmann
Keyword(s):  
Differential Diagnosis ◽  
Liver Enzymes ◽  
Case Reports ◽  
Elevated Liver Enzymes

THE NUCLEAR FACTOR OF HEPATOCYTES 1β (HNF1β)–ASSOCIATED DISEASE. CLINIC, DIAGNOSTIC, TREATMENT (LITERATURE REVIEW AND CLINICAL OBSERVATION)

2019 ◽  
Vol 23 (2) ◽  
pp. 100-108
Author(s):  
S. V. Papizh ◽  
O. R. Piruzieva
Keyword(s):  
Sanger Sequencing ◽  
Clinical Observation ◽  
Liver Enzymes ◽  
Renal Ultrasound ◽  
Nuclear Factor ◽  
Hepatocyte Nuclear Factor ◽  
Renal Hypoplasia ◽  
Unilateral Renal Agenesis ◽  
Elevated Liver Enzymes ◽  
Medullary Nephrocalcinosis

Hepatocyte nuclear factor 1β (HNF1β)-associated disease is a rare autosomal dominant disease caused by various mutations in the HNF1β gene coding the hepatocyte nuclear factor 1β. HNF1β is a transcription factor that is critical for the development of kidney urogenital tract, pancreas, liver, brain, and parathyroid gland. Renal phenotype or HNF1β- nephropathy appeared to be extremely heterogenic: multicystic renal dysplasia, renal hypoplasia, unilateral renal agenesis, horseshoe kidney, atypical familial juvenile hyperuricemic nephropathy, urinary tract malformations and tubular dysfunction. Extrarenal phenotype of HNF1β-associated disease could be maturity-onset diabetes of the young (MODY), pancreatic atrophy and exocrine pancreatic dysfunction, elevated liver enzymes, neonatal cholestasis, congenital abnormalities of the genital tract, hyperparathyroidism, neurological symptoms. The multisystem phenotype makes clinical verification of the diagnosis extremely difficult. In this article, we present a clinical observation of a child with HNF1β – associated disease. The first clinical presentation of HNF1β-associated disease was ultrasound changes in the kidneys (hyperechogenic kidneys?), which were detected by prenatal ultrasonography in pregnancy. Renal ultrasound revealed polycystic kidney disease in the first days of life and bilateral medullary nephrocalcinosis by the age of three. The clinical examination showed a reduced renal function and developed Fanconi syndrome (glycosuria, low molecular proteinuria, hypophosphatemia, aminoaciduria, hyperuricosuria) in the first year of life. Also the child had a non-constant asymptomatic elevation of liver enzymes, hyperparathyroidism, osteoporosis. The diagnosis was confirmed by the results of next generation sequencing which revealed novel heterozygous mutation in exon 4 of the HNF1b gene (chr17: 36091813C>T), p.Cys273Tyr (c.818G>A). The identified mutation was validated by Sanger sequencing. Validation by Sanger sequencing did not reveal a chr17: 36091813C>T mutation in parents, which suggested the appearance of a mutation in the child de novo.

Organ Donor Issues for the Intensive Care Physician

1998 ◽  
Vol 13 (6) ◽  
pp. 269-279 ◽  
Author(s):  
Francis L. Delmonico ◽  
Jeffrey C. Reese ◽  
Keyword(s):  
Intensive Care ◽  
Organ Donor ◽  
Care Physician ◽  
Intensive Care Physician

scholarly journals Haemolysis, elevated liver enzymes and low platelets: Diagnosis and management in critical care

2021 ◽  
pp. 175114372110254
Author(s):  
Evangelia Poimenidi ◽  
Yavor Metodiev ◽  
Natasha Nicole Archer ◽  
Richard Jackson ◽  
Mansoor Nawaz Bangash ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critical Care ◽  
Liver Failure ◽  
Hellp Syndrome ◽  
Seizure Control ◽  
Liver Enzymes ◽  
Kidney Injury ◽  
Definitive Treatment ◽  
Multisystem Disease ◽  
Elevated Liver Enzymes

A thirty-year-old pregnant woman was admitted to hospital with headache and gastrointestinal discomfort. She developed peripheral oedema and had an emergency caesarean section following an episode of tonic-clonic seizures. Her delivery was further complicated by postpartum haemorrhage and she was admitted to the Intensive Care Unit (ICU) for further resuscitation and seizure control which required infusions of magnesium and multiple anticonvulsants. Despite haemodynamic optimisation she developed an acute kidney injury with evidence of liver damage, thrombocytopenia and haemolysis. Haemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome, a multisystem disease of advanced pregnancy which overlaps with pre-eclampsia, was diagnosed. HELLP syndrome is associated with a range of complications which may require critical care support, including placental abruption and foetal loss, acute kidney injury, microangiopathic haemolytic anaemia, acute liver failure and liver capsule rupture. Definitive treatment of HELLP is delivery of the fetus and in its most severe forms requires admission to the ICU for multiorgan support. Therapeutic strategies in ICU are mainly supportive and include blood pressure control, meticulous fluid balance and possibly escalation to renal replacement therapy, mechanical ventilation, neuroprotection, seizure control, and management of liver failure-related complications. Multidisciplinary input is essential for optimal treatment.

scholarly journals Long-term mortality due to infection associated with elevated liver enzymes: a population-based cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tak Kyu Oh ◽  
Eun Sun Jang ◽  
In-Ae Song
Keyword(s):  
Cohort Study ◽  
Liver Enzymes ◽  
Adult Population ◽  
Population Based ◽  
Study Data ◽  
Point Increase ◽  
Elevated Liver Enzymes ◽  
Glutamyl Transpeptidase ◽  
Long Term Mortality

AbstractWe aimed to investigate whether elevated liver enzymes in the adult population were associated with mortality due to infection. As a population-based cohort study, data from the National Health Insurance Service Health Screening Cohort were used. Adult individuals (aged ≥ 40 years) who underwent standardized medical examination between 2002 and 2003 were included, and infectious mortality was defined as mortality due to infection between 2004 and 2015. Aspartate transaminase (AST), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (γ-GTP), AST/ALT ratio, and dynamic AST/ALT ratio (dAAR) were included in multivariable Cox modeling. A total of 512,746 individuals were included in this study. Infectious mortality occurred in 2444 individuals (0.5%). In the multivariable model, moderate and severe elevation in AST was associated with 1.94-fold [hazard ratio (HR):1.94, 95% confidence interval (CI) 1.71–2.19; P < 0.001] and 3.93-fold (HR: 3.93, 95% CI 3.05–5.07; P < 0.001) higher infectious mortality respectively, compared with the normal AST group. Similar results were observed for moderate and severe elevation in ALT and mild, moderate, and severe elevation in γ-GTP. Additionally, a 1-point increase in the AST/ALT ratio and dAAR was associated with higher infection mortality. Elevated liver enzymes (AST, ALT, AST/ALT ratio, γ-GTP, and dAAR) were associated with increased infectious mortality.

scholarly journals Assessment of the relationship of serum liver enzymes activity with general and abdominal obesity in an urban Bangladeshi population

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nurshad Ali ◽  
Abu Hasan Sumon ◽  
Khandaker Atkia Fariha ◽  
Md Asaduzzaman ◽  
Rahanuma Raihanu Kathak ◽  
...  
Keyword(s):  
General Population ◽  
Abdominal Obesity ◽  
Liver Enzymes ◽  
Serum Levels ◽  
General Obesity ◽  
Enzymes Activity ◽  
Elevated Liver Enzymes ◽  
Bangladeshi Population ◽  
Relationship Of ◽  
The Relationship

AbstractObesity is a global health concern because of its increasing trend both in developed and developing countries. A limited number of studies have evaluated the association of liver enzymes with both general and abdominal obesity in the general population; data for the Bangladeshi population are not available yet. This study aimed to assess the relationship of serum liver enzymes activity with both general and abdominal obesity in Bangladeshi adults. In total, 540 blood samples were obtained from the participants (388 males and 152 females) and analyzed for serum levels of ALT, AST, GGT, and ALP using standard methods. General obesity was defined as body mass index (BMI) ≥ 27.5 kg/m2 and abdominal obesity was defined as waist circumference (WC) ≥ 90 cm in males and ≥ 80 cm in females. The relationship between liver enzymes and obesity was evaluated by multivariate logistic regression models. Overall, 58% of participants in the general obesity group and 55% of the participants in the abdominal obesity group had at least one or more elevated levels of liver enzymes. The prevalence of elevated liver enzymes was significantly higher in the obesity group compared to the normal BMI and WC groups (p < 0.05 for all cases). The mean level of serum ALT, AST and GGT were significantly higher in the obesity group than the normal BMI group (p < 0.05). In the WC groups, mean AST and GGT were significantly higher in the obesity group compared to the normal group (p < 0.05). In regression analysis, serum levels of ALT showed an independent and significant association with general obesity, whereas, serum GGT showed a significant association with both general and abdominal obesity. In conclusion, a high prevalence of elevated liver enzymes was observed among participants included in the present study. Of the four enzymes, serum GGT was independently associated with both general and abdominal obesity. Further studies are required to understand the complex relationship between liver enzymes and obesity in the general population.

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