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  • Elevated creatinine gnc store viagra occurs in less than 40% of patients. The typical presentation of right upper quadrant pain and weight gain 1 to 5 weeks after chemotherapy or bone marrow transplantation may be subtle. The most common lab abnormality is a conjugated hyperbilirubinemia, although thrombocytopenia and elevated prothrombin time may also occur from spleen and liver congestion. Physical examination may reveal jaundice, tender hepatomegaly, and/or ascites. 10. What are the clinical features of VOD?.

    Mildmoderate elevations in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) suggest hepatocyte necrosis. A serum AST greater than 780 or rapidly rising bilirubin portends a poor prognosis. Alternatively, patients can develop rapidly progressive jaundice.

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    It is not accompanied by hypotension and frequently previous blood cultures failed to gnc store viagra document fungemia prior to the patient manifesting signs and symptoms of infection. As marrow function recovers and neutropenia resolves, radiological manifestations of chronic infection are seen in the liver and spleen on ultrasound, CT, or most reliably on magnetic resonance imaging (MRI). The patient may have presented with persistent or new fevers, but may also have had minimal temperature elevations with anorexia, weight loss, or failure to thrive along with an isolated increase in alkaline phosphatase.

    This clinical presentation warrants further evaluation to rule out chronic disseminated fungal infection. Although frequently referred to as “hepatosplenic candidiasis” because of the radiological manifestations in the liver and spleen, this infection may be widely disseminated involving many other organs. Confirmation of the diagnosis of fungal infection with biopsy and culture of liver and/or other accessible lesions should be attempted in order to direct appropriate therapy.

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