Clinical Case Database / Category: Case Based Discussion

Prescribing in liver disease

Publication details

Dr Ankur Srivastava MBChB, Dr Robert Przemioslo MBBS MD FRCP
Foundation Years Journal, volume 1, issue 3, p.106 (123Doc Education, London, June 2007)


You are asked to see a 56-year-old gentleman with confirmed alcoholic liver cirrhosis who is complaining of increasing abdominal discomfort and bloating.

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Dr Ankur Srivastava MBChB

Foundation One Doctor
Department of Gastroenterology
Frenchay Hospital, North Bristol Trust

Dr Robert Przemioslo MBBS MD FRCP

Consultant Hepatologist
Department of Gastroenterology
Frenchay Hospital, North Bristol Trust


1.  Howden CW, Birnie GG, Brodie MJ. Drug Metabolism in Liver Disease. Pharmacol Ther 1989; 40: 439

2.  Schoene B, Fleischmann RA, Remmer H et al. Determination of drug metabolizing enzymes in needle biopsies of human liver. Eur J Clin Pharmacol 1972. 4; 65

3.  Colli A, Buccini G, Cocciolo M et al. Disposition of a flow limited drug (lidocaine and a metabolic capacity limited drug (theophylline) in Liver Cirrhosis. Clin Pharmacol Ther 1988; 44: 642-9

4.  Farrell GC, Cooksley WGE, Powell LW. Drug Metabolism in Liver Disease: activity of hepatic microsomal metabolizing enzymes. Clin Pharmacol Ther 1979; 26: 483

5.  Clark JM, Brancati FL, Diehl AM. Non alcoholic fatty liver disease. Gasterenterology 2002; 122: 1649

6.  Westphal JF & Brogard JM. Drug Administration in chronic liver disease. Drug Safety 1997; 17: 47-73

7.  Russo MW & Jacobson IM. How to use statins in patients with chronic liver disease. Cleveland Clinic Journal of Medicine 2004; 71: 58-63

8.  Simonson SG, Martin PD, Mitchell P et al. Pharmacokinetics and Pharmacodynamics of Rusovastatin in Subjects with Hepatic Impairment. Eur J Clin Pharmacol 2003; 58: 669-675

9.  Reverter JC. Abnormal haemostasis tests and bleeding in chronic liver disease: are they related? Yes. J Thromb Haemost 2006; 4: 717-20

10.  Orozco H, Takahashi T, Garcia-Tsao G. A comparative clinical study of idiopathic portal hypertension, extrahepatic portal vein throbosis and cirrhosis. J Clin Gastroenterology. 1994; 19: 217-303

11.  Condat B, Pessione F, Hillaire S et al. Current outcome of Portal Vein Thrombosis in Adults: risk and benefis of anticoagulant therapy. Gastroenterology 2001; 120: 490-7

12.  Riley TR & Bhatti AM. Preventative Strategies in Chronic Liver Disease. American Family Physician 2001; 64

13.  Speeg KV, Bay MK. Prevention and treatment of Drug induced liver disease. Hepatology 1998; 27: 881-6

14.  Zimmerman HJ & Maddrey WC. Acetaminophen hepatotoxicity with regular intake of alcohol: anaylsis of instances of thereupeutic misadventure. Hepatology 1995; 22: 767-73

15.  Riley TR & Smith JP. Ibuprofen induced hepatotoxicity in those with chronic hepatitis C; a case series. Am J Gastroenterol 1998; 93: 1563-5

16.  Aithal PG & Day CP. The natural history of histologically proved drug induced liver disease. GUT 1999; 44:731-5

17.  Australian Government: Department of Health and Ageing Therapeutic Goods Administration. Australian Adverse Drug Reactions Bulletin. 1996; 15


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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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