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Genetic background of liver cirrhosis complications
Šenkeříková, Renáta ; Špičák, Julius (advisor) ; Brůha, Radan (referee) ; Husová, Libuše (referee)
Liver cirrhosis represents the end stage of most chronic liver diseases. The course of the disease and its complications can be significantly influenced by host genetic factors and the severity of portal hypertension (PH). The aim of the study was to describe the role of genetic factors influencing the progression and complications of liver disease and to determine the role of non-invasive assessment of the stage of liver fibrosis and severity of PH and their correlation with portosystemic gradient (HVPG) measurements. We first focused on the role of allelic variants in TLR4 signalling pathway genes in the risk of occurrence of severe bacterial infections in patients with advanced liver cirrhosis, liver transplant (LT) candidates. We found that the TNFA c.-238G/A promoter variant significantly reduced the risk of bacterial infections and was associated with a decreased mortality rate. We further investigated the role of the variant G allele in PNPLA3 gene in the progression of chronic liver failure and the need for LT in patients with liver cirrhosis due to HCV infection. As a result, we found that the carriage of the variant G allele led to a faster progression of chronic liver failure and the need for LT at a younger age. Third, we investigated whether the efficacy of triple combination treatment...
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Nutritional status assessment in patients with hepatopathy
Pirklová, Kristýna ; Novák, František (advisor) ; Ševela, Stanislav (referee)
In patients with liver cirrhosis, a high prevalence of malnutrition should be expected. Although the early diagnosis of malnutrition and well-chosen nutritional support have a positive effect on the patient's prognosis, early diagnosis of malnutrition might be difficult. There is currently no standardized diagnostic protocol for the nutritional status assessment of patients with liver cirrhosis. In patients with liver cirrhosis fluid retention occurs, which distorts the otherwise commonly used diagnostic criteria. The aim of the study: We wanted to evaluate the nutritional status of patients with liver cirrhosis in comparison with a acontrol group without severe comorbidity using anthropometric measurements, electrical bioimpedance, functional tests and laboratory parameters using diagnostic criteria GLIM (Global Leadership Initiative On Malnutrition) and various malnutrition screening tools. The work also focused on evaluating the quality of life of patients with chronic liver disease. Methods: The observational study included 11 patients with Child-Pugh stage cirrhosis A (n = 10) and B (n = 1), who were compared with a control group of 11 study participants without severe comorbidities. An examination panel consisting of anthropometric measurements, indirect calorimetry, electrical bioimpedance,...
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Effect of malnutrition on prognosis of patients with liver cirrhosis after bleeding from esophageal varices
Zagrebelná, Valérie ; Hrabák, Petr (advisor) ; Brůha, Radan (referee)
Liver cirrhosis is the final stage of chronic liver disease that arises from various causes (mainly chronic alcohol abusus, autoimmune and chronic viral hepatitis B and C, NAFLd - non-alcoholic fatty liver disease, bile duct disease or congenital metabolic disease - haemochromatosis and Wilson's disease). During development of liver cirrhosis, inflammatory liver cell damage, their necrosis and their conversion to fibrotic tissue occur. Most of the complications of hepatic cirrhosis are based in hepatic insufficiency and portal hypertension. Major complications of hepatic cirrhosis include bleeding from esophageal varices (the most serious complication that is fatal), hepatic encephalopathy, ascites, hepatorenal syndrome and hepatocelular cancer. The aim of the work was to determine how many patients suffered from protein-calorie malnutrition, and what effect malnutrition had on the survival and condition of patients. The work also dealt with bleeding from esophageal varices, reccurrence of varicose bleeding and complications associated with liver cirrhosis. One of the goal was to see if fit matched the predicted survival of patients, according to Child-Pugh's classification. The methodology of the work was retrospective research with the help of obtaining data from histories and findings obtained...
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The role of oxidative stress in hepatocarcinogenesis.
Kubíčková, Kristýna ; Vítek, Libor (advisor) ; Zelenka, Jaroslav (referee) ; Fraňková, Soňa (referee)
This thesis focuses on the importance of heme catabolic pathway in hepatic carcinogenesis. Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumour. It is primarily caused by hepatic cirrhosis or chronic viral hepatitis. Hepatic carcinogenesis is associated with increased oxidative stress. Thus, our study aimed to assess the expression of the genes involved in the homeostasis of oxidative stress in patients with HCC. The study was performed on patients with primary HCC (n = 29) and control subjects (n = 11), gene expressions of heme oxygenase 1 (HMOX1), biliverdin reductase A/B (BLVRA/B), endothelial growth factor (VEGFA), NADPH oxidase 2 (NOX2) and p22phox were analyzed in the liver tissue; the identical gene expressions were analyzed in peripheral blood leukocytes (PBL) in HCC patients (n = 32) and in healthy controls (n = 27). Expression of BLVRA in liver tissue and PBL was significantly increased in cancer patients, as was NOX2 expression in PBL. Expression of VEGFA in liver tissue and PBL was significantly decreased in cancer patients. The expression of the other genes studied did not differ between HCC patients and controls. These data are consistent with the results of our previous study on patients with chronic hepatitis C, in which BLVRA expression was also...
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Prognostic Siginificance of Sarcopenia in Patients with Liver Cirrhosis
Kozlova, Marina ; Brůha, Radan (advisor) ; Meisnerová, Eva (referee)
Introduction: Sarcopenia is a common complication of liver cirrhosis and has a significant negative effect on the clinical outcome and prognosis of patients. Sarcopenia is manifested by a loss of muscle mass and a decline in muscle strength and overall physical performance. X-ray examination is the most accurate method in the diagnosis of sarcopenia, but it is unknown to what extent the prognosis of liver cirrhosis can be predicted by non-invasive and broadly available anthropometric measurements and functional tests combined with the analysis of routine laboratory data. The aim of the work is to find factors related to the severity of liver cirrhosis, the occurrence of complications and survival of patients with a focus on muscle mass, muscle strength and physical performance. Methods: The observational study included 20 patients of the IV. Department of Internal Medicine of the General University Hospital in Prague (VFN) - Clinics of Gastroenterology and Hepatology diagnosed with liver cirrhosis. The progress of cirrhosis was assessed with MELD and Child-Pugh scores. Patients were examined twice, once during hospitalization and 3 months later. Functional tests of hand grip strength, chair stand test, NCT test and quality of life questionnaire were performed. Other measurements included...
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Issues of women suffering from liver cirrhosis
PASÁKOVÁ, Karla
The theoretical part of this bachelor thesis is devided into five parts. The first one deals with the historical context of alcohol consumption, pathology and liver function. The second one is devoted to cirrhosis of liver. It describes its causes, metabolism of methyl alcohol excretion as well as its treatment options. The third part describes types and development of alcohol addiction as socio pathological phenomena. The fourth part forcuses on lifestyle as a summary of different features of ways of life. The last part refers to the possibilities of using leisure time as a signifiant part of lifestyle, based on individual needs and interests. This bachelor thesis can serve as a motivation to create self-help groups in the Pisek region as well as by the form of educational dialogue it can improve awarness of this problem among women and it can also contribute to its decrease.
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Awareness of patients with liver cirrhosis
MLEZIVOVÁ, Petra
Liver cirrhosis is disease caused by restructuring of healthy liver to the pathological tissue. It is an irreversible disease, but it can be positively affected by the adjustment of life style and diet in the meaning of its course, prognosis and complications. Awareness of patients with liver cirhosis is ofe of key aspects influencing not only the treatment, bat also life of the patients. Nurses have irreplaceble part in diagnostics, treatment and also in education of patients about change of life style and diet provisions. Bachelor's thesis is divided in theoretical and empirical part. Theoretical part is focused on pathogenesis, classification, clinical signs, diagnostics, complications and treatment of liver cirhosis. First goal of the thesis was to determine the knowledge of the liver cirrhosis patient about heir disease. Second goal to find out what is the level of adherence to diet measures. Related to these goals, there are four main research tasks: What information do the liver cirrhosis patinets have about their disease? What is the source of information for patients with liver cirrhosis abot their disease? How are the liver cirrhosis patients informed about life style measures? What are the life stayle measures that liver cirrhosis patients stick to? Bachelor's thesis was processed by a qualitative research, using method of interviewing. Technique used was gathering of data by semi-structured interview with patients with liver cirrhosis. Qualitative data were organized to categorization groups. Research sample included 6 patients with the diagnosis of liver cirhosis. Results of research proved, that patientsd with liver cirrhosis have information abou their disease. The knew what had been the cause of hospital admission, symptoms of tehir disease, complications, some were also aware of the fact that complications could be life threatening. Only aspect with low awarness level was knoledge of character and course of the disease. Results also show that all patients were informed by physician after the diagnosis was made. Vast majority of patient do not seek for inforamtion about liver cirhosis themselves. research also showed, that patients were informed about life styles measures not only by doctors, but also by nurses. Nurses informed patients mainly about diet measures. Patients were informed mainly verbally, but some also received information leaflets. All patients found information provided understandable. Majority of patients stich to life style measures. In the field of diet, it is restriction of salt and smoked meat products. They eat more often, small portions. Majority reduced volume of alcohol or stopped drinking at all. They do not perform physically demanding activities. They try to attend physicians regularly. They all try to stick to measures, but everyone of them has some weakneses. Only one respondent ignores life style measures. This thesis was focused on information provided to patients with liver cirrhosis. Level of awareness of this patient is important part of their treatment. Education is one of the key roles of nurses. Nurses therefore need to have sufficient amount of information about diet and life style measures in patients with liver cirrhosis. This thesis could be used as form of information booklet not only for nurses, but also for common people who get in touch with liver cirrhosis patients. Based on results of this thesis, we creted the leaflet, that summarizes basic data about disease as wel as about life style and diet measures.
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Lifestyl at patients with liver cirhosis
VAVŘINOVÁ, Petra
Abstract: Theoretical part of my bachelor thesis is divided into four parts. The first parts deal with anatomy and physiology of livers. In the second parts is described cirrhosis of the liver its definition, etiology, morphologic classification and prognosis with complications and treatment. The third part is focused on health, lifestyle, determinants which influence health, importance of health promotion and preventive which is connected with health education. The fourth parts point to an alcohol and its harmfulness, addiction to an alcohol and impact of using alcohol in Europe. The fourth parts also mention a food, which support liver function. Cirrhosis of liver disease limits individual. This disease disadvantage and limit in many cases of life. Intervene into physical, mental and social life. The extent and intensity affecting the way of life is dependent on various factors and circumstances which is described in the practical part. The aim of the bachelor work with help of the qualitative tools is to find out which aspects of life changes have occurred in patients with liver cirrhosis. In this part are interpreted results which show lifestyle issues in form of personal testimonies of people with liver cirrhosis in the widest possible complexity. The research work was undertaken by interviewing with technique of in-depth semi - controlled interview with the narrative elements. It was supplemented by placing additional questions with necessity of analysis of personal data. From very different perspectives are here described public servants who are involved in the development of liver cirrhosis. Was found that this cause of disease is result from oversized use of alcohol and infected by Hepatitis C as in drug addicts. In this sense healthy lifestyle is very timely because of the risk of alcohol dependence already in children and adolescents. This bachelor thesis should lead for thought of using alcohol and drugs and on its negative impact in the future.
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