LIVER DISEASE
See also "Viral Hepatitis"
and "Wilson's Disease"
In a study in 173 adults with acute liver failure not due to acetaminophen overdose randomized to N-acetylcysteine vs. placebo, there was no sig. diff. in overall survival at 3wks, but for pts with coma grades I-II, transplant-free survival at 1y was sig. higher in the N-acetylcysteine group (52% vs. 30%) (Gastroent. 137:856, 2009-JW)
Screening for hepatocellular carcinoma in pts with chronic
liver disease (Am. J. Gastroenterol. 91:1189, 1996; cited in
Journal Watch)
- 360 pts with chronic liver disease (254 with cirrhosis,
106 with "chronic hepatitis") followed for 56
mos
- Did screening with ultrasound and serum AFP every 6 mos
- 6.6% of pts were dx'd with hepatocellular Ca over study
period; only 50% of these had elevated serum AFP; all but
one case occurred in pts with cirrhosis
- Unknown if such screening will improve clinical outcomes
or be cost-effective
MRCP, in a meta-analysis of 67 studies, was
found to have an overall sensitivity and specificity of 95% and 97%,
respectively, for biliary tree abnormalities. For stones, the sensitivity
was 92%; for malignancy, 88%, for biliary obstruction, 99% (Ann. Int. Med.
139:547, 2003--abst)
Noninvasive assessment for hepatic fibrosis:
- A device ("Fibroscan") which measures liver stiffness by
"transient elastography" (mild amplitude-low frequency vibrations
tracked with pulse-echo ultrasound) may provide some capability of assessing
for hepatic fibrosis without a biopsy (reported in FP News 3/15/05)
- Noninvasive biochemical tests, measuring multiple parameters (e.g.
alpha-2-macroglobulin, haptoglobulin, gamma-glutamyl transpeptidase, total
bilirubin, and apolipoprotein A1) and subjecting them to an arithmetic
formula to determine likelihood of hepatic fibrosis