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Liver, Biliary Tract and Pancreatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
In assessing and managing the patient with chronic liver disease, it is important to consider several aspects: Cause of the liver disease: Specific treatment may be indicated and family screening may be required.Presence of portal hypertension: This may lead to ascites and the development of varices that require screening and, where present, treatment to reduce bleeding.Possibility of developing liver cancer: Surveillance is therefore needed.Effect on management of the patient: Consider lifestyle, drug treatment and nutrition.
Musculoskeletal system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Secondary causes of osteoporosis including: Rheumatoid arthritis.Amenorrhea.Untreated hypogonadism in men.Organ transplantation.Type 1 diabetes.Malabsorptive conditions such as Crohn’s.Hyperthyroidism.Chronic liver disease.Chronic obstructive pulmonary disease.Certain conditions such as anorexia nervosa.Prolonged immobility.Anticonvulsants.Aromatase inhibitors.Falls.
Dermatology
Published in Shibley Rahman, Avinash Sharma, A Complete MRCP(UK) Parts 1 and 2 Written Examination Revision Guide, 2018
Shibley Rahman, Avinash Sharma
One should examine palate for petechial haemorrhages, gums for ulceration and haemorrhage (suggests neutropaenia and thrombocytopaenia), conjunctivae and fundi for haemorrhages (fundal haemorrhages only in severe thrombocytopaenia); also look for evidence of cause ?Cushingoid (steroid), ?rheumatoid disease, SLE, infective endocarditis, ?chronic liver disease, ?Ehlers-Danlos syndrome.
The role of hepatic microenvironment in hepatic fibrosis development
Published in Annals of Medicine, 2022
Ying Meng, Tong Zhao, Zhengyi Zhang, Dekui Zhang
Chronic liver disease is a global public health problem. It is estimated that currently, 844 million people suffer from chronic liver disease worldwide, with an annual death rate of about two million [1]. This is mainly because most chronic liver injuries, such as toxic liver disease, alcoholic liver disease, non-alcoholic fatty liver disease, chronic viral hepatitis, and cholestatic liver disease, can develop into liver fibrosis [2,3]. This is a pathological change resulting in increased extracellular matrix (ECM) and decreased parenchymal cells in the liver. Although mild fibrosis is mostly asymptomatic, it eventually progresses to cirrhosis and is often accompanied by serious structural disorders and vascular distortion, which is the leading cause of liver-related morbidity and mortality [4]. Since most patients had already developed obvious liver fibrosis or cirrhosis when they were first clinically identified, anti-fibrosis drugs that can prevent the progression of liver fibrosis or induce cirrhosis regression are urgently needed [5].
Serum ceruloplasmin monitoring in a case of silver intoxication due to intravenous silver infusion
Published in Clinical Toxicology, 2022
Chun-yiu Law, Siu-chung Leung, Florence Loong, Tsz-ki Ling, Ka-chung Wong, Nike Kwai-cheung Lau, Sik-hon Tsui, Ching-lung Lai, Ching-wan Lam
The pathomechanism of silver-induced damage is believed to be reactive oxygen species (ROS)-related [12]. The lack of ferrous oxidase activity in Ag-Cp could partly explain the ROS stress in multiple organs, for example, liver and brain. This oxidase is physiologically vital which oxidize intracellular ferrous (Fe2+) to ferric (Fe3+) ions and allows subsequent Fe3+ exocytosis with incorporation to circulating transferrin. Indeed, a low circulating iron and transferrin and high ferritin was presented in our case. The pattern is similar to hereditary aceruloplasminemia; our patient, likewise also complained of cognitive decline [13]. Nevertheless, ferritin is a positive acute phase reactant and hyperferritinemia could also be secondary to an inflammatory process. Yet, non-transferrin-bound Fe2+ could cause oxidative stress with damages via Fenton reaction. The liver biochemistry and histology are suggestive of chronic liver disease in this patient. Since this patient is neither an alcoholic nor a viral hepatitis carrier, and his liver function improved after silver cessation, it is likely that silver has contributed to his liver derangement. However, we cannot ascertain the causal effect here since we do not have his baseline liver function status before silver use.
Propranolol-induced hallucinations mimicking encephalopathy in a patient with liver cirrhosis
Published in Scandinavian Journal of Gastroenterology, 2021
Samer Al-Dury, Antonio Molinaro, Per Hedenström
HE is usually dominated by mental slowing, but psychotic symptoms dominated by hallucinations, aggression and manic behavior may sometimes also be present. In patients with chronic liver disease, such symptoms are often attributed to gradual worsening in liver function and may lead to frequent contact with the outpatient clinic as well as repetitive hospital admissions, which may result in patient evaluation for a possible liver transplantation to alleviate those symptoms. In this case report we discuss a patient with liver cirrhosis and a history of HE, who presented to the outpatient clinic repeatedly with hallucinations. Diagnostic workup led to the conclusion that her hallucinations were induced by treatment with low dose of the non-selective β-blocker Propranolol for primary prophylaxis of variceal bleeding. Switching the drug to Carvedilol resulted in immediate resolution of hallucinations and the patient was therefore removed from the liver transplantation evaluation list. This case highlights the importance of thorough clinical investigation of unusual neuropsychiatric symptoms in patients with chronic liver disease to avoid misdiagnosis and unnecessary medical costs of liver transplantation evaluation.