By Satish Keshav; John D Firth; Royal College of Physicians of London. Education Department
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(IARC Press) finished textual content of tumors within the frightened method. Illustrated with full-color slides, photographs, and images. wide references. past variation: c1997. For practitioners and researchers. Softcover.
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7). Beware of the patient with alcoholic liver disease and urea or creatinine at the upper limit of normal: very low levels are expected and a ‘normal’ value almost certainly indicates significant renal impairment. • Alpha-fetoprotein (AFP): in patients with known liver disease who decompensate (become jaundiced, encephalopathic or develop ascites) unexpectedly consider hepatocellular carcinoma. Ferritin levels are often elevated in liver disease irrespective of causation. Assessment of liver function The best indicators of liver function are prothrombin time, serum albumin and bilirubin: it would be highly unlikely that there is a hepatic cause for ascites if these are all normal.
Does the patient have any other medical or surgical conditions? She was admitted with chest pain, which might be attributable to angina provoked by anaemia, and since acute intestinal obstruction may require surgical intervention it is very important to identify comorbid risks such as ischaemic heart disease at an early stage. It will be important to ask carefully about current medications and any recent changes in these: drugs are a common cause of nausea and vomiting, and patients taking drugs that affect vascular responses (eg beta-blockers) may be susceptible to smaller losses in circulating volume than would otherwise be the case.
TABLE 11 CAUSES OF CHRONIC LIVER DISEASE Frequency Condition Common • Cushingoid features: suggest long-term steroid treatment. Alcoholic liver disease Chronic viral hepatitis: hepatitis C or hepatitis B Non-alcoholic steatohepatitis Less common • Pigmentation: consider haemochromatosis (‘bronze diabetes’). Autoimmune liver diseases: primary biliary cirrhosis, autoimmune hepatitis, primary sclerosing cholangitis Cryptogenic or idiopathic (represents probably <20% of cases now) Rare Metabolic and genetic liver diseases: α1-antitrypsin deficiency, haemochromatosis, Wilson’s disease Infiltrative liver disease: sarcoidosis, amyloidosis Miscellaneous: secondary biliary cirrhosis, prolonged total parenteral nutrition, cystic fibrosis, chronic heart failure Also look for the following.