B.Pharm Lab. Instruction Manuals

Pharmacology I

APHE Anatomy, Physiology, and Health Education

Pharmaceutical Analysis

Pharmacy study material

General Pharmacology

Bones and Skeleton System

Bone disease (Gout) (Rheumatoid arthritis) (Osteoarthritis) (Osteoporosis)

Cancer and music therapy

Memory of water

Clinical representation of liver cirrhosis

Signs and symptoms of liver cirrhosis

  • nausea
  • vomiting
  • loss of appetite
  • weight loss
  • abdominal pain
  • ascites and oedema
  • bleeding diasthesis
  • gastric and esophageal bleeding
  • skeletal muscle paralysis
  • mental confusion, impaired sense of touch, impaired reflex
  • enlarged liver and spleen
  • jaundice
  • anaemia
  • Laboratory diagnosis

  • hypoalbuminemia
  • thrombocytopenia
  • elevated prothrombin time
  • elevated alkaline phosphatase
  • elevated aspartate transaminase (AST), alanine transaminase (ALT) and $\gamma$ glutamyl transpeptidase (GGT)
  • serum bilirubin level may increase
  • erythropoietin and thrombopoietin counts may decrease
  • Radiological diagnosis

  • Medical imaging to assess enlargement of liver, spleen, dilatation of veins in esophageal or gastro intestinal tract.
  • Treatment approach of liver cirrhosis

  • identify and eliminate cause eg. alcohol, hepatitis B or C)
  • Assess the risk for variceal bleeding and start prophylaxix
  • Treat HE
  • Treat portal hypertension
  • Manage cirrhosis induced ascites
  • Treat anaemia and thrombocytopenia
  • Treat jaundice, if required
  • Classification of liver cirrhosis

    Phenomena associated with liver cirrhosis

    Treatment algorithm of liver cirrhosis

    Ref. [Barbara 2009]. Treatment algorithm of liver cirrohsis

    Mechanism of action of drugs, used to manage or treat liver cirrhosis

    Management of portal hyopertension

  • Adrenergic $\beta$ blockers: Propanolol, Nadolol, Timolol (these agents act as vasodilators, lower cardiac output, thereby reduce blood flow in liver).
  • Endoscopic band ligation (EBL) should be considered in patients with contraindications or intolerance to $\beta$-adrenergic blockers.

    Management of variceal haemorrhage

  • Antibiotic, Non selective $\beta$ blockers, Somatostatin (vasoactive agent, causes vasoconstriction), Octreotide (mimics somatostatin action).
  • Reference

    [Barbara 2009] Barbara GW, Joseph TD, Terry LS, Cecily VD, Pharmacotherapy Handbook, $7^{th}$ Edition, Mc Growhill, 239-320, 2009.

    Anatomy and Physiological roles of liver

    Classification of liver cirrhosis

    Phenomena associated with liver cirrhosis

    Clinical representation and management of liver cirrhosis