Title: Navigating the Complexity of Literature Review for Liver Disease: Let Us Help You

Embarking on a literature review journey for liver disease research can often feel like traversing a
labyrinth of complexities. The vast array of studies, divergent findings, and evolving understandings
within the field can overwhelm even the most seasoned researchers. Crafting a comprehensive and
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The Challenges of Literature Review in Liver Disease Research

1. Vast Amount of Literature: Liver disease is a multifaceted domain encompassing various

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landscape to identify seminal studies and pertinent research can be a daunting task.
2. Complexity of Findings: The intricate interplay between genetic predispositions,
environmental factors, and the pathophysiology of liver diseases adds layers of complexity to
understanding the research findings. Synthesizing contradictory or inconclusive evidence
poses a significant challenge.
3. Constant Evolution of Knowledge: Medical science is dynamic, with new studies,
treatments, and insights emerging regularly. Staying abreast of the latest developments and
integrating them into a literature review requires continuous effort and expertise.
4. Technical Writing Skills: Crafting a literature review demands not only a deep
understanding of the subject matter but also proficiency in academic writing conventions,
such as proper citation, referencing, and structuring of arguments.

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Journal of Functional Morphology and Kinesiology (JFMK). Conduct a follow-up nutrition
assessment and report in ADIME format for. According to the ROBINS-I guidance, if a study is
ranked low in all domains, it is considered low risk of bias; if it is ranked low or moderate in all
domains, it is considered moderate risk of bias; if it is ranked serious in at least one domain, it is
considered serious risk of bias; if it is ranked critical in at least one domain, it is considered critical
serious risk of bias ( Reference Sterne, Hernan and Reeves 29 ). Two decades ago, most cases of
SBP were attributed to third generation cephalosporin-sensitive Enterobacteriaceae. In conclusion,
scientific data suggests that nutrition can have a direct impact on HBV replication, transcription, and
expression of viral antigens. It may be required to take nutritional supplements over the long term to
meet the recommended protein and calorie needs. Its pathogenesis is thought to be complex and is
governed by a wide range of mechanisms, including variables from the environment, metabolism,
genetics, and gut microbes. Previous Article in Journal Non-Coding RNAs in Hepatocellular
Carcinoma. Such findings support weight-management strategies based on low-fat, plant-based
diets, which often result in healthy and long-lasting weight control as opposed to those based on
formula diets with extremely low calorie intake. 3.11. Nonalcoholic Fatty Liver (NAFLD) A clinic-
pathologic condition called nonalcoholic fatty liver disease includes a number of different clinical
entities. Persistently raised aspartate aminotransferase (AST) due to macro-AST in a rheumatology
clinic. The antibiotic duration should be a maximum of 7 days (consider discontinuing when
hemorrhage has resolved or when vasoactive drugs are discontinued). Dietary approach for
hepatocellular carcinoma, according to Barcelona Clinic Liver Cancer classification. Moreover, each
of these abnormalities can individually predispose cirrhotic patients to prolonged bacteremia and
peritoneal infection. 5. Bacteriology Bacterial translocation (BT) from the GI tract is the most
common source of SBP. International Journal of Molecular Sciences. 2018; 19(12):4070. An
unhandled exception was generated during the execution of the current web request. From 1988 to
2010, viral hepatitis was the underlying cause of liver disease in 39% of liver transplant
recipients—hepatitis B in one-third of cases, and hepatitis C in two-thirds ( e1 ). Consider past and
present alcohol use (see: “ A spotlight on the key causes of liver disease ”). Multiple requests from
the same IP address are counted as one view. Journal of Functional Morphology and Kinesiology
(JFMK). Editor’s Choice articles are based on recommendations by the scientific editors of MDPI
journals from around the world. Additionally, haem Fe intake reduces insulin sensitivity through
cellular oxidation stress ( Reference Zhao, Li and Liu 57 ). Journal of Low Power Electronics and
Applications (JLPEA). The microbial pathogens in saltwater can concentrate when shellfish are
harvested from waters that have been polluted by sewage. Cholestasis can be sub-classified as being
intra-hepatic (e.g. due to hepatocyte injury, intra-hepatic bile duct or bile canaliculi abnormalities) or
extra-hepatic (e.g. abnormalities associated with the extra-hepatic ducts, the common bile duct or
common hepatic duct): 26. Weigh the patient, ask for a food recall and look to see that eating
behaviors have improved. In Germany, cirrhosis is often a consequence of fatty liver disease due to
alcoholism or other causes, but can also be caused by hepatitis B and hepatitis C. An “abnormal” LFT
result is a value that falls outside the range expected for 95% of a healthy reference population. 8
This reference range can differ based on factors such as the patient’s sex and age. When compared to
using a caloric daytime supplement, a study found that taking a nutritional supplement at night
increased total body protein reserves. After the scheduled course, patients should be reassessed.
Lifestyle changes can prevent at least 60% of all Cancers - By Dr Sanjiv Hari.
Zinc deficiency is typical in cirrhotic individuals and has been linked to dysgeusia, which may
increase aversion to certain foods. The antibiotic duration should be a maximum of 7 days (consider
discontinuing when hemorrhage has resolved or when vasoactive drugs are discontinued). Journal of
Experimental and Theoretical Analyses (JETA). Alcohol abstinence is the only treatment for ALD
that has been proven effective. Patients with steatohepatitis and fibrosis are only allowed to receive
NASH. Hepatic encephalopathy (HE), in addition to the mental state changes that can be observed,
limits the ability to eat. Prevention of SBP recurrence through antibiotic prophylaxis is another
important consideration that will be discussed in the following literature review. 2. Materials and
Methods This article aims to help clinicians and other healthcare professionals in reviewing,
studying, and assisting with the management of SBP patients. Feature papers represent the most
advanced research with significant potential for high impact in the field. A Feature. As such, learning
to recognise certain biochemical signatures in the context of specific patient types becomes an
important skill that general practitioners develop over time. Nervous system disorders include
depression, mood changes, especially anger and irritability, poor concentration and. It should start
with an early screening for all patients, followed by prevention or control of major risk factors,
especially for the high-risk groups (iron overload, hepatitis infection, cirrhosis), and ending up with
proper medical or surgical treatment. Nursing Care of Patients with Life Threatening Conditions,
High Acuity Situat. The thresholds for these cardiometabolic factors differ between adults and
children. Also ask about use of any over-the-counter (OTC) medicines or herbal or dietary
supplements. 1, 17 See: “ Always consider a possible pharmacological cause ”. Cirrhosis and HCC
due to chronic hepatitis C are among the main indications for liver transplantation in Western
industrialized countries. Risk of hepatocellular carcinoma across a biological gradient of serum
hepatitis B virus DNA level. This patient is most likely grade 3 of hepatic encephalopathy (due to
being disoriented to. Systematic review with meta-analysis: non-invasive assessment of non-alcoholic
fatty liver disease - the role of transient elastography and plasma cytokeratin-18 fragments. Due to
the patient's history of alcoholism, his intestinal mucosa is most likely severely damaged.
Postgraduate Diploma in Hospital Management and Operational Excellence - Broc. Elsebaie EM,
Abdel-Fattah AN, Bakr NA, Attalah KM, Aweas A-HA. GERIATRIC PHARMACOLOGY
Geriatric pharmacology is a specialized field focusing. Fruits and vegetables are rich in fibre,
antioxidants such as polyphenols, which help prevent the occurrence of NAFLD. First, because the
overall number of studies included was small, subgroup and sensitivity analyses were limited to four
of the eleven food groups (red meat, soft drinks, fruits and vegetables). Treatme nt for this st age
requires Brown and LC Balancer to nurture Liver Yin to increase the blood flow to the liver to
control the ROS generation, increase the production of the glutathione and repair liver damage.
Selective intestinal decontamination (SID) reduced the rate of positive cultures to that of non-
cirrhotic patients. 4.3. Impaired Host Defense System Conversely, the host defense system also plays
an important role in SBP pathogenesis. The AST:ALT ratio may be helpful in determining both the
aetiology and the stage of liver disease (see main text). The cause of the patient's weight gain is most
likely due to edema, which is from water retention. Therefore, a number of dietary strategies, such as
the low-fat diet (LFD), low-carbohydrate diet (LCD), ketogenic diet (KD), Dietary Approaches to
Stop Hypertension (DASH) dietary pattern, and the Mediterranean dietary pattern (MedDiet) have
been evaluated in the NAFLD setting as alternatives to reducing overall energy intake. Delayed
initiation of iron chelation and poor compliance are major factors that leave thalassemic patients,
especially TI who are nontransfusion-dependent at higher risk for developing HCC even in the
absence of hepatitis infection or cirrhosis.
ISPRS International Journal of Geo-Information (IJGI). Patients with end-stage liver failure are
advised to take multivitamin supplements, with thiamine being a special recommendation. Physical
activity is decreased and practically nonexistent in people with decompensated cirrhosis. Physical
examination findings are often normal in patients with LFT derangement; the presence of abnormal
findings should increase suspicion of more advanced or severe liver disease. 8 For example: 8, 14. As
of now, there is not enough information about the pre-transplant period to provide precise advice.
Potential clinical features include abdominal pain, ascites, pleural effusions, acute pancreatitis and
sometimes renal failure. Treatme nt for this st age requires Brown and LC Balancer to nurture Liver
Yin to increase the blood flow to the liver to control the ROS generation, increase the production of
the glutathione and repair liver damage. ES, effect size. Further, subgroup analyses were conducted
by risk of bias, geographic location, number of cases and dietary assessment. Or too low levels of
lipids: hypocholesterolemia: low total. It has also been thoroughly investigated whether frequent
feeding can assist the prevention of increased hunger and the associated proteolysis. Check weight to
see if the amount of intake is accurate, ask for a food recall and look to see that. The cause of weight
gain is most likely due to the overconsumption of alcohol in the diet. In the updated Italian registry in
2014, of the available AFP data of 45 thalassemic patients with HCC, 20 had normal AFP at
diagnosis. Hepatology (epublication ahead of print version 25 September 2019). Due to the high link
between bodyweight reduction and improvements in intrahepatic fat among other measures, the
primary goal of lifestyle interventions in NAFLD is to lower bodyweight. Levels are higher in
childhood due to bone turnover. Meanwhile, it has been found that gastroenterologists in private
practice treat mainly patients with newly diagnosed hepatitis C, while highly prevalent conditions
such as non-alcoholic or alcoholic fatty liver disease account for only 8% to 9% of their caseload
(Figure 5). There remain lacking data on HCC treatment outcomes in patients who have thalassemia.
Thus, cirrhosis need no longer be regarded as the irreversible end stage of chronic liver disease, but
rather as one stage in a dynamic process whose further course (progression or reversion of fibrosis)
depends on the provision of appropriate treatment and the avoidance of further harmful influences.
Waleed Al-hamoudi Gastroentrology and hepatology unit. Case. The main characteristics of the
included studies are illustrated in online Supplementary Tables S1 and S2. Fig. 1. Flow diagram of
literature search and study selection. Population: adults with NAFLD; intervention: food groups
(refined grains, whole grains, red meat, fish, vegetables, fruits, dairy products, legumes, eggs, nuts
and soft drinks); comparison: adults without NAFLD; outcome: the occurrence of NAFLD. This is
given to patients with hepatic encephalopathy and cirrhosis. Polymorphisms in this gene are
associated both with susceptibility to fatty liver diseases and with the risk of progression, including
progression to HCC ( 22, 23 ). Because malnutrition has a significant negative impact on morbidity,
mortality, and quality of life, it is crucial to evaluate all cirrhosis patients, regardless of etiology or
severity. Clams and oysters, for example, that have been harvested from the coastline are especially
likely to be pathogenic. ISPRS International Journal of Geo-Information (IJGI). Besides monitoring
the iron load in patients with thalassemia, liver imaging and serum tumor markers also have a role in
the early detection of HCC. End Stage Liver Disease with GERD and Bleeding Esophageal Varices.
Synthetic liver failure can be either acute or chronic liver failure.
Diabetes: Having diabetes increases the risk of liver disease by 50 percent. The practitioner, the
patient, their careers, and the healthcare system all face considerable challenges when trying to
improve the nutritional condition of patients with decompensated cirrhosis. In fact, different
approaches exist, and the best choice of treatment remains controversial, mainly due to the fact that
the evidence behind it is only based on a series of case reports. Screening with serial liver ultrasound
biyearly for patients with risk factors, along with the less-sensitive AFP, continue to be the main
modalities used nowadays until more sensitive modalities, like liver MRI, find their way into the
guidelines. However, more significant changes in individual markers or a progressive increase from
previous results may prompt more immediate investigation. Patients with cirrhosis are more likely to
experience micronutrient deficiencies, patients with hepatocellular disease are more likely to
experience calorie and protein deficiencies, and patients with cholestasis liver disease are more likely
to experience calorie deficits and an increased risk of fat-soluble vitamin deficits. This presents a
challenge for primary care clinicians, particularly given that elevated liver enzyme levels are
estimated to occur in up to 9% of asymptomatic people. 7. AF in secondary peritonitis usually meets
at least two of the following criteria (sometimes referred to as Runyon’s criteria). Tropical Medicine
and Infectious Disease (TropicalMed). Recent studies support a “two-hit” model to explain the
progression of NAFLD. All articles published by MDPI are made immediately available worldwide
under an open access license. No special. Also ask about use of any over-the-counter (OTC)
medicines or herbal or dietary supplements. 1, 17 See: “ Always consider a possible pharmacological
cause ”. Also, achieving weight loss and maintaining it is often difficult for the most obese patients (
Reference Dixon, Bhathal and Hughes 10 ). We use cookies on our website to ensure you get the
best experience. Nutritional assessment in various stages of liver cirrhosis. Cirrhosis instances linked
to non-alcoholic steatohepatitis have increased in recent years as a result of the rising incidence of
obesity. H2 blockers simultaneously which may cause decreased appetite along with other
medications. Data extraction and risk of bias Two investigators (K. H. and Y. L.) independently
extracted and summarised data from each study. Journal of Theoretical and Applied Electronic
Commerce Research (JTAER). It has also been thoroughly investigated whether frequent feeding can
assist the prevention of increased hunger and the associated proteolysis. The liver is one of the major
organs to synthesize triglycerides as the body's energy supply and cholesterol which function for
bile, Vitamin D, horm ones production and cell membrane support. Anorexia, zinc deficiency-related
dysgeusia, unappealing meals as a result of sodium restriction, and incorrect protein restriction for
patients with hepatic encephalopathy or chronic renal insufficiency are just a few causes of
decreased oral intake. As such, learning to recognise certain biochemical signatures in the context of
specific patient types becomes an important skill that general practitioners develop over time. Similar
to what is described for HBV above, HCV-mediated carcinogenesis is either directly related to the
virus or to complications of HCV hepatic infection like fibrosis and cirrhosis. Feature papers
represent the most advanced research with significant potential for high impact in the field. A
Feature. Patient disoriented to time and place (grade 2-3). Mild. Paracentesis is the drawing of fluid
from the abdominal cavity to reduce ascites. It was. Hepatomegaly may also be caused by liver
congestion (e.g. due to heart failure or hepatic venous obstruction) or malignant infiltration
(particularly lymphoma and hepatocellular carcinoma). Several epidemiological studies attempted to
assess the relationship between food groups and the likelihood of NAFLD, but these results were
conflicting. Patient has a medical history of alcoholism and cholecystectomy, and a family history of
CHF.
Comorbidities and nonalcoholic fatty liver disease: the chicken, the egg, or both. Patients who
engage in behavior that puts them at risk for chronic liver disease are often not aware of the fact, and
subtle clinical manifestations are easily overlooked by physicians as well. First, because the overall
number of studies included was small, subgroup and sensitivity analyses were limited to four of the
eleven food groups (red meat, soft drinks, fruits and vegetables). Applied nutrition 3 rd presentation
- diseases of liver, gall bladder, and. We use cookies on our website to ensure you get the best
experience. As such, learning to recognise certain biochemical signatures in the context of specific
patient types becomes an important skill that general practitioners develop over time. Severe liver
heat toxin can cause genital inflamma tion, formication and Skin Crawling. It contains seven
domains that rank the studies as low, moderate, serious or critical serious. The quality of included
studies ranged from low to moderate risk of bias as shown in online Supplementary Table S3.
Lifestyle changes can prevent at least 60% of all Cancers - By Dr Sanjiv Hari. Gastroscopic
Examination showed bleeding esophageal varices. Medications: Lactulose, Octreotide, Vitamin K,
Compazine, Morphine, albumin iv, furosamide iv. ES, effect size. He et al. supplementary material
Tables S1-S7. Chemotherapy: People undergoing chemotherapy for cancer treatment have a risk of
damaging. Inversely, nut consumption was negatively associated with NAFLD. West Africa Scene
Setting African Continental Master Plan (CMP) for electrici. The AST:ALT ratio may be helpful in
determining both the aetiology and the stage of liver disease (see main text). See our Other
Publications MDedge: Keeping You Informed. Malnutrition is more common in cirrhotic individuals,
with prevalence rates ranging from 50% to 90%, according to the Pathophysiology of Malnutrition in
Chronic Liver Disease. Besides monitoring the iron load in patients with thalassemia, liver imaging
and serum tumor markers also have a role in the early detection of HCC. Table 1 outlines the most
common markers used in LFTs in New Zealand and their biological significance. Taken together, the
above findings suggest that higher consumption of fish, legumes, fruits and vegetables appeared to
have a protective trend against NAFLD likelihood, while intake of more milk may be an adverse
effect on the likelihood of NAFLD. Moreover, most cases of hepatocellular carcinoma (HCC) arise
in a cirrhotic liver, so cirrhosis prevention is, in fact, also HCC prevention (Figure 1). Intestinal
infections caused by the yeast Candida interferes with the detoxification function of the. Although
weight loss is an important approach for the management of NAFLD, extreme dietary intervention
for the purposes of weight loss, such as very low-carbohydrate diet, may increase insulin resistance
and exacerbate NAFLD even if it can reduce body weight ( Reference Asrih and Jornayvaz 9 ).
Liver Disease. Approach to abnormal labs AST ALT Alkaline phosphatase Bilirubin. The main
characteristics of the included studies are illustrated in online Supplementary Tables S1 and S2. Fig.
1. Flow diagram of literature search and study selection. There remain lacking data on HCC treatment
outcomes in patients who have thalassemia. Diets with a range of normal to high protein content are
secure and do not raise the danger of encephalopathy in alcoholic hepatitis. Patients with cirrhosis
experience an altered metabolism due to a decreased hepatocyte bulk, which causes a switch from
glycogenolysis to gluconeogenesis as an energy source in addition to decreased oral intake and
malabsorption, following which gluconeogenesis, lipopenia, and sarcopenia occur.
But herbal remedies, too, can be harmful to the liver in excess amounts. Ultrasound (sonography): It
is a diagnostic imaging technique which uses. The metabolic switch from glucose to fatty acids as the
predominant fuel is what causes the respiratory quotient to decrease. Principles of Nutritional
Management in Patients with Liver Dysfunction—A Narrative Review. Livers. 2023; 3(2):190-218.
Malnutrition is present but frequently goes unnoticed in up to 50% of patients with CTP class A
cirrhosis, despite the fact that it is readily apparent in chronically ill patients with CTP class C
cirrhosis. The AST:ALT ratio may be helpful in determining both the aetiology and the stage of liver
disease (see main text). Mathematical models reveal that screening followed by treatment with highly
potent HBV polymerase inhibitors (entecavir or tenofovir) is cost-effective, even in countries with a
low prevalence of hepatitis B (0.3%-0.4%, as in Germany) ( 38 ). Patients with end-stage liver
failure are advised to take multivitamin supplements, with thiamine being a special recommendation.
Methods: This article is a literature review and appraisal of guidelines, randomized controlled trials,
meta-analyses, and other review articles found on PubMed from between 1977 and 2022. Feature
papers represent the most advanced research with significant potential for high impact in the field. A
Feature. We can summarize the information about all mentioned diseases in Table 1, which describes
the nutrition dysregulated and the nutrition management required for each disease. 4. Conclusions
Patients with chronic liver dysfunction (CLD) should have as their nutritional goals the restoration
of liver function, prevention of related comorbidities, and overcoming malnutrition brought on by
nutritional inadequacies. In contrast, alpha fetoprotein (AFP), which is the main tumor marker that
arises in presence of HCC, is inadequate to be used in the screening process due to its low sensitivity
and specificity. A potential source of error in PMN count is hemorrhage into the ascitic fluid, such as
with traumatic paracentesis, which can cause both red and white blood cells to enter the ascites. The
two established risk factors for the development of HCC in thalassemia include iron overload and
viral hepatitis with or without cirrhosis. In addition to the antioxidant effect, polyphenols also have
beneficial effects on metabolic homoeostasis in vivo and in vitro NAFLD model, with anti-
inflammatory and anti-fibrosis effects. Journal of Experimental and Theoretical Analyses (JETA).
Elsebaie EM, Abdel-Fattah AN, Bakr NA, Attalah KM, Aweas A-HA. The results were broadly
consistent with the current dietary recommendation for the management of NAFLD. Paper should
be a substantial original Article that involves several techniques or approaches, provides an outlook
for. I would prescribe Nutrihep at a total volume of 1500 ml since fluid should be restricted to.
Further development of non-antibiotic strategies based on pathogenic mechanisms are also urgently
needed. It should also be borne in mind that the diagnostic threshold values vary depending on the
underlying etiology of liver disease ( 20 ). Despite the crucial role that nutrition plays in the
prognosis of those with cirrhosis, the ability to properly manage the patient’s nutrient needs presents
an additional set of challenges due to the catabolic nature of the disease process and the common
occurrence of anorexia and other symptoms that lead to a poor oral intake. Avoiding iron
supplements and foods strong in iron is also important, as patients’ hepatitis C progresses as a result
of faster hepatic iron intake and the oxidative stress brought on by free radical generation stimulated
by iron. Conflicts of Interest The authors declare no conflict of interest. Systematic review with
meta-analysis: non-invasive assessment of non-alcoholic fatty liver disease - the role of transient
elastography and plasma cytokeratin-18 fragments. Liver disease (also called hepatic disease) is a
type of damage to or disease of the liver. Several randomized, controlled trials (RCTs) have shown
an increase in albumin synthesis, a decrease in the risk of hepatic decompensating, and an increase in
protein synthesis in skeletal muscle. Previous Article in Journal Non-Coding RNAs in Hepatocellular
Carcinoma. GERIATRIC PHARMACOLOGY Geriatric pharmacology is a specialized field
focusing.