Academic literature on the topic 'Bilirubin/diagnostic use'

This paper presents an assessment of liver function using novel neuro-fuzzy model of blood albumin level (BA). The developed model that is used to predict the BA consists of four inputs: Asparate Aminotransferace (AST), Alkaline Phosphate (ALP), Total Bilirubin (T. Bil.) and Total Protein (T. Prot.), which are measured in any routine liver function test. The proposed BA model was trained using 211 measured data and a root-mean square error (RMSE) of 0.29 for 100 epochs was achieved. The performance of the developed BA model was validated using 57 testing data sets and RMSE of 0.34 for 100 epochs was achieved. The correlation coefficient (CC) between the predicted and measured values of blood albumin is statistically significant (CC=0.83), which ensures the efficiency and accuracy of developed fuzzy model for predicting BA. The main clinical benefit of this model is that it improves the assessment capabilities of liver diseases and can be used as an integral part of any medical expert system denoted for assessment and diagnosis of liver disorders.

Sepsis is defined as life- threatening organ dysfunction caused by a detrimental host response to infection. Septic shock is a subset of sepsis in which underlying circulatory and cellular abnormalities are profound enough to substantially increase mortality. Septic shock is characterized by: ● The need for vasopressors to maintain mean arterial pressure (MAP) > 65mmHg despite adequate volume resuscitation. ● A serum lactate > 2mmol/L In lay terms, it is hypoperfusion with evidence of metabolic derangement. The mortality for both criteria is ~40%, compared to 20–30% for a single item. Please also refer to: https:// www.nice.org.uk/ guidance/indevelopment/gid-cgwave0686 The old definitions of sepsis described a heterogeneous group of patients and did not discriminate between infectious and non- infectious causes such as pancreatitis and trauma. The new definitions also allow easier recognition, based on a combination of symptoms and signs. Key parameters include: decreased level of consciousness, rigors, severe myalgia, high or low temperature, pulse > 130/min, systolic blood pressure < 90mmHg, respiratory rate (RR) > 25/ min, creatinine > 170μmol/ L, platelets < 100 x 109/l and bilirubin > 33μmol/ L. The Clinical Quality Commission recommend that NHS trusts use the national early warning score (NEWS), and a score > 5 is an indication to consider moving a patient to critical care. SIRS is defined as any of the two following criteria: acutely altered mental state, temperature < 36°C or > 38°C, pulse > 90/ min, RR > 20/ min, WCC > 12 or < 4 x 109/L and hyperglycaemia in the absence of diabetes mellitus. In the former definitions (1991 and 2001), sepsis was defined as infection plus SIRS. SIRS, however, was not good at separating infected patients who died from those who recovered from infection. SIRS was often an appropriate reaction to infection and many hospitalized patients meet the SIRS criteria. Also, as many as one in eight patients admitted to critical care units with infection and new organ failure did not have two SIRS criteria required to fulfil the sepsis definition. SIRS is no longer part of the new definitions.

Diseases of the gallbladder and bile ducts are common, with gallstones and their complications being most frequent. Less common are biliary strictures, usually malignant, which are caused by adenocarcinomas of the pancreas, bile ducts, ampulla of Vater, and gallbladder. Rarely encountered are sclerosing cholangitis and a variety of congenital disorders. Disorders of the biliary system include gallstones, which cause biliary colic and cholecystitis by obstruction of the cystic duct, and bile duct obstruction (cholestasis), with jaundice, dark urine, and pale stools, itching, and sometimes constant right hypochondrial pain. Fevers and rigors may indicate bacterial infection of the biliary tract (cholangitis), which frequently accompanies partial obstruction. Weight loss may be due to fat malabsorption but can also be caused by malignancy. Prolonged biliary obstruction leads to skin changes of increased pigmentation (due to melanin) and cholesterol deposition (xanthelasma and xanthoma). Biliary cirrhosis can cause portal venous hypertension and liver cell failure. Disorders of the biliary system generally give rise to the biochemical picture of cholestasis: the serum (conjugated) bilirubin concentration may be normal or raised; serum alkaline phosphatase, γ‎-glutamyl transferase, and bile acids are elevated; serum transaminases show only modest elevation. Bilirubinuria is present, with the disappearance of urobilinogen from the urine indicating complete biliary obstruction. Imaging is critical in the diagnosis of biliary disease, initially by ultrasonography, with CT and MRI in more complicated cases. However, these investigations sometimes provide insufficient anatomical detail for diagnosis or planning of treatment, and further imaging with the cholangiographic techniques of magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) are required. ERCP and PTC can be used to place biliary stents.

Elastography, a non-invasive imaging modality, utilizes mechanical properties of tissue as markers for disease diagnosis or staging. In the case of liver, there have been a number of studies focusing on the relationship between elastic mechanical properties and underlying disease, i.e. fibrosis and cirrhosis. In summary, these studies indicate the feasibility of elastographic tools in detecting liver diseases such as fibrosis and steatosis. There have not been any studies looking at the mechanical properties of the preterm neonate liver to date, which is important, because preterm neonates are