Medical Nutrition Therapy in Ischemic Hepatitis and Acute Kidney Injury Due to Congestive Heart Failure NYHA III

Objectives Congestive Heart Failure is a major public health problem with an estimated prevalence of 1–2% of the adult population in developed countries, rising to ≥ 10% among persons > 70 years of age. The incidence of impaired liver function in the form of congestive hepatopathy and ischemic hepatitis ranges from 15% to 65% of patients with significant heart failure. Methods Mr.T, Male, 63 years old was suffered from ischemic hepatitis due to congestive heart failure NYHA III. He had history of hipertension since 2011 and a history of heart disease since 2011. The patient has reduced oral intake since 2 weeks ago and worsening 5 days ago due to decreased appetite and shortness of breath. Anthropometric examination found body length was 166 cm, ideal body weight was 59.4 Kg, Mid Upper Arm Circumference (MUAC) was 19 cm and Handgrips strength 8,6 kg. Laboratory assessments found leukocytosis (13,100 103 /ml), impaired kidney function (Ureum was 206 mg/dL and Creatinine was 3.51 mg/dl), increased transminase enzymes (SGOT 4113 U/L and SGPT 4721 U/L) and increased levels of bilirubin (Total Bilirubin 9.79 mg/dL and Bilirubin Direk 7.79 mg/dL). Results Medical Nutritional Therapy was determined with a calorie target of 1700 kcal; protein 1,4 gr/Kg ideal body weight/day; 50% carbohydrates and 30% fat, respectively. We provided oral suplementation in the form of zinc, vitamin B Complex and curcuma. The Patient was discharged after being treated for 11 days and recovered from shortness of breath and jaundice, with adequate nutritional intake (according to calorie targets), increased anthropometric parameters (MUAC was little increased 19,3 cm but handgrips strength was significantly increased to 28,3 kg), improved laboratory result including leukocytes decreased to normal (9.940 103/ml), ureum and creatinine were also turned to normal (47 mg/dL and 1,1 mg/dL, respectively), liver function was markedly decreased (SGOT 71 U/L, SGPT 468 U/L) as well as total bilirubin (2,90 mg/dL) and direct bilirubin (1,20 mg/dL). Conclusions Optimal treatment of the underlying disease (CHF) and adequate nutritional therapy could improve nutritional status and quality of life patients with CHF NYHA III with complications of ischemic hepatitis and acute kidney injury. Funding Sources The author(s) received no financial support for research, authorship, and/or publication of this article.

Case report of severe constrictive perimyocarditis and ischemic hepatitis in a Crohn’s disease patient upon infliximab-induced lupus-like syndrome

Anti-tumor necrosis factor (TNF) antibodies have become an indispensable part in the therapeutic landscape of treating inflammatory bowel disease (IBD) patients. Nevertheless, they can be associated with the occurrence of severe systemic side effects. Here, we report the case of a 23-year-old patient with ileocolonic Crohn’s disease in endoscopic remission under ongoing anti-TNF infliximab therapy with occurrence of novel generalized arthralgia, pleuritic chest pain, and dyspnea. Clinical, laboratory, and imaging diagnostic workup in an extended clinical routine setting at the University Hospital of Erlangen, Germany, was used by a multidisciplinary team consisting of gastroenterologists, radiologists, cardiologists, and rheumatologists to investigate the underlying cause of the clinical symptoms in the patient. The results received using the aforementioned diagnostic setup led to the diagnosis of severe constrictive perimyocarditis due to infliximab-induced lupus-like syndrome with distinct ANA reactivity and elevated anti-dsDNA levels. Furthermore, pronounced ischemic hepatitis was diagnosed. Infliximab treatment was immediately stopped, and initiated corticosteroid pulse therapy only led to partial response as it had to be reduced due to pronounced psychiatric side effects. Persistent signs of pericarditis required additional ibuprofen therapy, which led to subsequent resolution of cardial symptoms. Formerly elevated liver enzymes returned to normal, and there were no clinical signs of recurrence of Crohn’s disease activity over 18 months of follow-up. The patient was subsequently switched to ustekinumab therapy for further treatment of underlying Crohn’s disease. This case report describes for the first time severe infliximab-induced lupus-like syndrome in an IBD patient, concurrently mimicking ST-elevation myocardial infarction with MRI visualization of pericarditis, occurrence of ischemic hepatitis, and pronounced signs of systemic inflammation.

Reversal of Ischemic Hepatitis after Cardiac Surgery under Cardiopulmonary Bypass: A Case Report

Acute hepatic failure due to ischemic hepatitis is associated with high mortality. The safety of cardiopulmonary bypass in this setting is not fully described. Here we report a case of a 21-year-old female who developed an acute fulminant hepatic failure due to ischemic hepatitis following a cardiogenic shock. She underwent subsequent successful mitral valve replacement under cardiopulmonary bypass, thus providing an evidence of its safety in acute fulminant hepatic failure.

A study in early neonatal period for the outcome based on the hepatic involvement following severe birth asphyxia in full term neonates

Background: The current study is focused on assessing the liver involvement of severely birth asphyxiated newborns, by measuring liver enzymes like Serum glutamic oxaloacetic transaminase (SGOT) and Serum glutamic pyruvic transaminase (SGPT) to predict the outcome of those babies. Methods: Total 111 severely birth asphyxiated newborns were assessed in a hospital based prospective analytical study. Liver enzymes were measured for all babies included in the study. Study subject details were obtained through a pre-structured questionnaire and also morbidity and mortality were noted. Analysis of the research data was done through appropriate statistical methods using SPSS version 20.Results: It was observed that incidence of hypoxic ischemic hepatitis, among entire study population was 34.2% (38 cases) based on SGPT (>100 U/l) values. Current study findings indicated that incidence of hypoxic ischemic hepatitis had a positive correlation with hypoxic ischemic encephalopathy (HIE) staging. Mean SGOT, SGPT values were observed to increase as the HIE staging progressed. Based on Spearman’s correlation coefficient evaluation, it was determined that the elevated SGOT and SGPT values had moderate positive correlation with HIE, seizure, ventilator support and death in the study population. It was found from the present study findings that statistically significant mortality (77.4%) was observed among the HIE stage III babies, with elevated SGPT values.Conclusions: Current study findings revealed that elevated SGOT and SGPT values (more than twice the normal) has high sensitivity to predict the outcome in severely birth asphyxiated newborns. The stated parameters can prove to be effective in counselling parents regarding morbidity and mortality of neonates due to birth asphyxia.