Liver Disease 2Complications and their management;Specific signs/symptoms and their managementJaundiceClassificationPrehepatic!ntrahepatic/hepatocellularPost hepaticConse"uences#anagement$reat cause or remove precipitating drugPruritisDeposition of %ile salts in the s&in#anagement'emove any causes of o%structionPharmaceutical management$ransplantation(scitesPooling of fluid in the peritoneal )a%dominal cavity*CausesConse"uences#anagement+ncephalopathySymptomsCause/precipitating factors#anagement,pper -!/.esophageal varices/igh mortality#anagementSupportive measures/fluid replacement$erlipressinProcedural intervention )once sta%ilised*Deranged clottingDefective synthesis of clotting factors0urther reading-reene '1J12 /arris2 31D1 )2445* Pathology and therapeutics for pharmacists: A basis for clinical pharmacy practice1 )6rd ed* London7 Pharmaceutical Press8ennedy P and .9-rady J1 )244:* Liver Disease1 in ;al&er2 '1 and ;hittlesea2 81 )eds1* Clinical Pharmacy & Therapeutics2 ?=5>8umar2 P @ Clar& #1 )244?* Clinical Medicine1 :th ed1 London7 Saunders +lsevierLiver Disease 6(ssessing and monitoring liver function;Drugs and the liver(ssessing @ monitoring liver disease!maging techni"uesAiopsySerologyL0$sBBB1Liver function testsLiver function tests$ransaminasesAiliru%in(l&aline PhosphataseLiver function tests$ransaminasesAiliru%in(l&aline PhosphataseC-lutamyl transpeptidase )--$*(l%uminProthrom%in timeClassification of liver diseaseChildPugh ClassificationChildPugh ( is a score of D/>1 $his indicates a Eell compensated liver/mild impairmentChildPugh A is a score of :?1 $his indicates significant functional compromise/moderate impairmentChildPugh C is a score of =4=D1 $his indicates a decompensated liver/severe impairmentPrescri%ing in Liver DiseaseDrug meta%olism$he liver generally has a high capacity/reserve for drug meta%olism even in severe impairmentPatient varia%ility+nFyme inducers/inhi%itors.ther liver disease mediated factors affecting drug handling(scitesGarices indicating impaired portal circulationLoE al%umin/protein levels.ther liver disease mediated factors affecting drug handling )cont1*'educed %iliary eHcretion'is& of encephalopathy!mpaired coagulationSoBB1(dverse drug reactions$ypes$ype ( vs1 $ype A$ypical eHamplesPresentationPredisposing factorsPreeHisiting hepatic disease(ge-ender-enetic factors+nFyme inductionPolypharmacy.ther conditionsDiagnosisDrug eHposure.nset'esolutionSigns/symptoms/investigations#anagementDiscontinuation/ospitalisation'emovalSupportive therapyPreventionIPharmaceutical careParacetamol overdose0urther readingCurrent A30Cadman A+ and 0eatherstone A1 )244:* (dverse effects of drugs on the liver1 in ;al&er2 '1 and ;hittlesea2 81 )eds1* Clinical Pharmacy & Therapeutics2 ?=5>;ard 0#2 Daly #J and Lee (1 )=??:* (dverse drug reactions7 Druginduced hepatic disorders1 The Pharmaceutical Journal1 2587 pp1 5>65;right2 J1 -ray2 (1/1 and -oodey2 G1 )244>* Clinical Pharmacy1 London7 Pharmaceutical Press;ynne / and +dEards C1 )244:* La%oratory data1 in ;al&er2 '1 and ;hittlesea2 81 )eds1* Clinical Pharmacy & Therapeutics2 ?=5>