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Blood tests that can show elevated levels of liver enzymes, which may indicate problems in the liver or biliary tract. Also called liver enzyme tests.

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Bile, produced in the liver and stored temporarily in the gallbladder, is released into the small bowel on eating fatty food. The common bile duct is the tube through which bile flows from the gallbladder to the small bowel. Stones in the common bile duct (common bile duct stones), usually formed in the gallbladder before migration into the bile duct, can obstruct the flow of bile leading to jaundice (yellowish discolouration of skin, white of the eyes, and dark urine); infection of the bile (cholangitis); and inflammation of the pancreas (pancreatitis), which can be life threatening. Various diagnostic tests can be performed for the diagnosis of common bile duct stones. Depending upon the availability of resources, these stones are removed endoscopically (usually the case) or may be removed as a part of the operation performed to remove the gallbladder (it is important to remove the gallbladder since the stones continue to form in the gallbladder and can cause recurrent problems). Non‐invasive tests such as ultrasound (use of sound waves higher than audible range to differentiate tissues based on how they reflect the sound waves) and blood markers of bile flow obstruction such as serum bilirubin and serum alkaline phosphatase are used to identify people at high risk of having common bile duct stones. Using non‐invasive tests means that only those people at high risk can be subjected to further tests. We reviewed the evidence on the accuracy of ultrasound and liver function tests for detection of common bile duct stones. The evidence is current to September 2012.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: February 26, 2015

Ischaemic preconditioning is a mechanism for reducing organ ischaemia reperfusion injury by a brief period of organ ischaemia, ie, decrease the injury caused by return of blood supply to the organ after a period of decreased or absent blood supply by exposing the organ to shorter periods of decreased blood supply. There is considerable controversy regarding whether ischaemic preconditioning during donor liver retrieval has beneficial effect on the outcome of liver transplantation. This systematic review includes five randomised clinical trials assessing the advantages and disadvantages of ischaemic preconditioning during donor hepatectomy for liver transplant recipients. In four trials, 270 cadaveric liver donor retrievals were randomised; 131 to ischaemic preconditioning and 139 to no ischaemic preconditioning; and in one trial, 15 living donor liver retrievals were randomised; 10 to ischaemic preconditioning and 5 to no ischaemic preconditioning. All the trials were high bias‐risk trials. There was no statistically significant difference in mortality, initial poor function, re‐transplant, primary graft non‐function, or in any other outcome other than enzyme markers of liver injury, which was in different directions in different trials. There is currently no evidence to support or refute the use of ischaemic preconditioning in donor liver retrievals. Further studies are necessary to identify the optimal ischaemic preconditioning stimulus.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 23, 2008

Probiotics have been proposed as a treatment option for patients with non‐alcoholic fatty liver disease and non‐alcoholic steatohepatitis because of their balancing role on the flora of the gut that may act as a potential source of hepatotoxic oxidative injury. This review did not identify any randomised clinical trials with probiotics in non‐alcoholic fatty liver disease and non‐alcoholic steatohepatitis. Even if the results from pilot studies seem promising, randomised clinical trials are necessary to asses the clinical implication of probiotics therapy in non‐alcoholic fatty liver disease and non‐alcoholic steatohepatitis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 24, 2007

Non‐alcoholic fatty liver disease is a condition characterised by fatty deposition in the hepatocytes in patients with minimal or no alcohol intake. Hepatic injury might be improved by bile acids. This systematic review identified four randomised clinical trials. Bile acids did not cause any liver‐related deaths and were associated with only minor, non‐specific adverse events. However, these agents did not show any significant amelioration of common liver function tests as compared with placebo. Moreover, data on the radiological (ultrasonography and computer tomography scan) and/or histological response were too limited to draw any conclusions. Further randomised placebo‐controlled trials are necessary.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 24, 2007

Hepatic cirrhosis is a severe disease with scars and nodules on the liver tissue. As a result, the normal function of the liver is impaired. Whatever the cause of cirrhosis, changes in the structure of and blood flow within the liver increase pressure in the portal vein (called portal vein hypertension), which is the vein that drains blood from the bowels to the liver. Portal hypertension induces dilatation (extension) of veins within the wall of the oesophagus (food pipe or gullet), which often rupture (break) with severe bleeding. Thus, when liver cirrhosis is diagnosed, an oesophago‐gastro‐duodenoscopy (OGD) is recommended to detect the presence of oesophageal varices (areas of abnormal dilatation of veins). During OGD, a small camera at the end of a tube is inserted down the oesophagus from the mouth and pictures are relayed back to a screen. Large varices or red signs on even small varices show high risks of rupture and bleeding. If high‐risk varices are found, treatment with beta‐blockers is effective in reducing the risk of bleeding. Three simple non‐invasive tests could be used to identify people with liver diease at high risk of having oesophageal varices: platelet count ‐ a simple laboratory test on a blood sample by which the number of platelets (a blood element ensuring coagulation) is measured; length (maximal diameter) of the spleen measured during ultrasound examination of the abdomen; and ratio of platelet count to spleen length.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 26, 2017

Heavy alcohol consumption causes alcoholic liver disease and may lead to a number of other concomitant diseases. Alcohol may damage the function of body organs and can cause cancer. Liver damage due to excessive alcohol consumption is usually presented as fatty liver (build‐up of fats in the liver), steatohepatitis (inflammation of the liver with concurrent fat accumulation in the liver), fibrosis (fibrous degeneration), alcoholic cirrhosis (scarring of the liver), and hepatocellular carcinoma (most common type of liver cancer). When liver fibrosis progresses, alcoholic cirrhosis occurs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 2, 2016

Expert-reviewed information summary about the treatment of childhood liver cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: December 7, 2017

Expert-reviewed information summary about the treatment of adult primary liver cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: March 30, 2018

Background: Children who are born with heart defects often undergo heart surgery at a young age. They are at risk for reduced heart function and death after surgery. Milrinone is a medication that may be used in this situation to make the heart stronger and make it easier for the heart to pump blood into the body.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 25, 2015

Most people will have already given a urine sample at some point in their lives. Urine samples are needed for urine tests, which are used for things like testing for particular diseases or monitoring their progress. For instance, urine test strips can be used to indicate whether you have a urinary tract infection.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 30, 2016

How do we know whether a particular treatment really works? How reliable is the evidence? And how do we ensure that research into medical treatments best meets the needs of patients? These are just a few of the questions addressed in a lively and informative way in Testing Treatments. Brimming with vivid examples, Testing Treatments will inspire both patients and professionals.

Pinter & Martin.

Version: 2011

This book aims to help consumers and practitioners develop the skills to assess health advice – and hopefully to make decisions that will improve the quality of their care. For some people, making better-informed decisions could be life saving. We hope that it will be useful if you are struggling to come to terms with an illness or injury, and the best ways of managing it. Or you may simply want to lead a healthier life, and may be wondering how to make sense of the often conflicting flood of health information that deluges us every day, through the media, and from our friends and health practitioners.

Hammersmith Press.

Version: 2008

Uncomplicated malaria is the milder form of malaria which usually causes fever, with or without headache, tiredness, muscle pains, abdominal pains, nausea, and vomiting. If left untreated, uncomplicated malaria can rapidly develop into severe malaria with kidney failure, fitting, unconsciousness, and eventually death. Plasmodium falciparum is the most common parasite causing malaria in sub‐Saharan Africa and causes most of the severe malaria worldwide.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 4, 2014

Primary biliary cirrhosis is a chronic progressive cholestatic liver disease of presumed autoimmune aetiology. The clinical course might be improved by glucocorticosteroids. Only two small randomised clinical trials on this topic were identified. The trials were not large enough in terms of sample size or length of follow up to allow changes in mortality to be adequately evaluated. Glucocorticosteroids were associated with improvement in serum markers of inflammation and liver histology, both of which were of uncertain clinical significance. Glucocorticosteroids were also associated with adverse events, including reduced bone mineral density. Further trials are necessary if the effectiveness of glucocorticosteroids is to be properly evaluated.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 20, 2005

‐ Leflunomide probably improves pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 22, 2002

Neuropathic pain is caused by nerve damage, often accompanied by changes in the central nervous sytem, and fibromyalgia is a related complex pain syndrome. Many people with these conditions are disabled with moderate or severe pain for many years. Conventional analgesics are usually not effective treatment options. In light of the fact that there are similarities between the pathophysiologic and biochemical mechanisms observed in epilepsy and in neuropathic pain, it is not surprising that antiepileptic agents can be used to treat neuropathic pain. The aim of this review was to investigate the efficacy and adverse events associated with use of sodium valproate and valproic acid for the treatment of chronic neuropathic pain and fibromyalgia. We identified three relevant studies, two in diabetic neuropathy and a third in post‐herpetic neuralgia. Two of the three studies report significantly greater reduction in pain for valproate than placebo, but studies were small (≤ 45 participants) and provided insufficient data for pooled analysis, and the methods of analysis used may have overestimated treatment effect. Adverse events such as nausea, sedation, drowsiness, vertigo, and abnormal liver function are more common with valproate than placebo, but these studies were unsuitable to allow for a comprehensive assessment of harm.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 5, 2011

Alzheimer's disease (AD) is the commonest cause of dementia affecting older people. One of the therapeutic strategies aimed at ameliorating the clinical manifestations of Alzheimer's disease is to enhance cholinergic neurotransmission in relevant parts of the brain by the use of cholinesterase inhibitors to delay the breakdown of acetylcholine released into synaptic clefts. Tacrine, the first of the cholinesterase inhibitors to undergo extensive trials for this purpose, was associated with significant adverse effects including hepatotoxicity. Velnacrine is a derivative of tacrine. There is evidence that it is toxic in a similar way to tacrine and all research stopped in 1994. The FDA peripheral and CNS drug advisory board voted unanimously against recommending approval.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 19, 2004

Bile, produced in the liver and stored temporarily in the gallbladder, is released into the small bowel on eating fatty food. The common bile duct (CBD) is the tube through which bile flows from the gallbladder to the small bowel. Stones in the CBD (CBD stones) are usually formed in the gallbladder before migration into the bile duct. They can obstruct the flow of bile leading to jaundice (yellowish discolouration of skin, whites of the eyes, and dark urine), infection of the bile (cholangitis), and inflammation of the pancreas (pancreatitis), which can be life threatening. Various diagnostic tests can be performed for the diagnosis of CBD stones. Depending upon the availability of resources, these stones are removed endoscopically (usually the case) or may be removed as part of the operation performed to remove the gallbladder (it is important to remove the gallbladder since the stones continue to form in the gallbladder and can cause recurrent problems). Prior to removal, invasive tests such as endoscopic retrograde cholangiopancreatography (ERCP) or intraoperative cholangiography (IOC) can be performed to detect CBD stones. However, before performing such invasive tests to diagnose CBD stones, non‐invasive tests such as endoscopic ultrasound (EUS) (using ultrasound attached to the endoscope) and magnetic resonance cholangiopancreatography (MRCP) are used to identify people at high risk of having CBD stones so that only those at high risk can be subjected to further tests.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: February 26, 2015

Expert-reviewed information summary about the treatment of gallbladder cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: March 22, 2018

Expert-reviewed information summary about the treatment of bile duct cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: March 22, 2018

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