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Gastroenterology
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Rare. More common in men. Clinical features: fatigue, pruritus, jaundice, abdominal pain and/or pyrexia. On examination: hepatomegaly and/or splenomegaly +/- features of chronic liver disease. Patients with ulcerative colitis are at increased risk. Investigations: raised ALP, AST, ALT and bilirubin, hypergammaglobulinaemia and positive p-ANCA autoantibodies. ERCP reveals multiple strictures within the biliary tree (giving a beaded appearance). Liver biopsy should be performed. Management: treat symptoms, e.g. pruritis with colestyramine, ursodeoxycholic acid. Consider liver transplantation in end stage disease.
Medical Problems in Alcoholics
Published in Frank Lynn Iber, Alcohol and Drug Abuse as Encountered in Office Practice, 2020
Fatty liver is manifest by hepatomegaly, which is most often tender and may produce the largest livers clinically encountered. There may or may not be liver test abnormalities of the magnitude noted in Section V.A. The larger livers may be associated with splenomegaly and minimal-sized esophageal varices. This lesion also seems to be associated with alcohol consumption and does not require malnutrition for its production. If imaging is performed, the fatty liver has many internal echoes on sonography, irregular uptake on scintography, and may have nodularity on CT scan, but these methods are not required for diagnosis. The liver biopsy is diagnostic. In this diagnosis the liver tests are never severely abnormal, the bilirubin is less than 50 μm/L (3 mg/dl), the ALT and AST are only elevated up to three times normal, and the alkaline phosphatase may be elevated up to five times normal. With abstinence this disease resolves over several months and of itself is not permanent. This lesion occurs in 80 to 90% of drinkers in the 100-g/day range and is often present with other lesions. It is more likely to be present in diabetics or in the obese.
Diseases of the Hepatobiliary Tree and Pancreas Associated with Fever
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Complications of liver biopsy are exceedingly rare. The morbidity is about 0.1 to 0.2%; the mortality is approximately 0.015%,12,13 and zero in one large series of 20,000 biopsies.14 Some complications, indicated by an asterisk (*) may be accompanied by fever. Vascular lesions — (a) Intrahepatic hematoma,* (b) retroperitoneal or intraperitoneal hemorrhage, (c) intrahepatic arteriovenous fistulaInfection* — (a) Liver abscess, (b) septicemiaBiliary — (a) Biliary peritonitis,* (b) biliary pleurisy*, (c) biliary embolism,* (d) hemobilia
Deep learning for assessing liver fibrosis based on acoustic nonlinearity maps: an in vivo study of rabbits
Published in Computer Assisted Surgery, 2022
Jinzhen Song, Hao Yin, Jianbo Huang, Zhenru Wu, Chenchen Wei, Tingting Qiu, Yan Luo
Liver fibrosis, which may be caused by hepatic injury such as virus infection and alcohol abuse, is a stage progressing to cirrhosis [1]. Patients with cirrhosis might suffer from several complications, such as hepatocellular carcinomas, esophageal varices and/or hepatic failure [2]. Staging fibrosis stages is essential for prognosis, surveillance and management of patients with liver fibrosis [3,4]. The golden standard of assessing fibrosis stages is liver biopsy [5,6]. However, liver biopsy is invasive so that it may lead to various potential complications such as bleeding and rupture. Meanwhile, sampling errors also limit the diagnostic accuracy. Biomarkers show suboptimal diagnostic accuracy compared with imaging methods [7,8]. Conventional ultrasound, CT and MRI are not sensitive enough for predicting fibrosis. Ultrasound-based elastography is studied for staging liver fibrosis in recent years with good performance [9,10]. Shear wave speed is measured in ultrasound-based elastography such as Transient Elastography and Shear Wave Elastography. Diagnostic accuracy is high for the detection of significant and advanced fibrosis and cirrhosis (area under curve (AUC) > 0.90) [9]. Nevertheless, the cutoff values among various kinds of elastography machines require further investigation. Breath could also affect the reliability and accuracy [11].
Longitudinal evolution of catheter-related bloodstream infections, kidney function and liver status in a nationwide adult intestinal failure cohort
Published in Scandinavian Journal of Gastroenterology, 2022
Anne K. Pohju, Antti I. Hakkarainen, Mikko P. Pakarinen, Taina M. Sipponen
A subgroup of patients (n = 12) monitored in the gastroenterology clinic of Helsinki University Hospital had undergone more detailed imaging tests of the liver. Abdominal ultrasound revealed liver steatosis in eight patients, and gallstones in one patient. Transient elastography (TE; Fibroscan®; Echosens, Paris, France) suggested advanced fibrosis or cirrhosis (F3–F4) in five patients. Liver fat content (LFC) according to magnetic resonance spectroscopy (MRS) was increased (≥5.56%) in three patients. Liver biopsy was clinically indicated in three patients. Advanced fibrosis (Metavir classification F3 or F4) was present in two patients, and of these two, one had also moderate steatohepatitis. The third patient was diagnosed with mild steatohepatitis. Both patients with histologically confirmed advanced fibrosis had a TE result exceeding 10.3 kPa, suggestive of cirrhosis. The patient with moderate steatohepatitis had, according to MRS, an abnormal LFC, while LFC was normal in the patient with mild steatohepatitis.
Non-invasive diagnosis of nonalcoholic fatty liver disease: impact of age and other risk factors
Published in The Aging Male, 2020
Although abdominal ultrasonography is a useful and readily available tool in the diagnosis of hepatic steatosis, a definitive diagnosis of early fibrosis and NASH still requires liver biopsy [6]. However, liver biopsy is an invasive procedure with attending risk of complications [7]. Therefore, intensive efforts have been exerted to develop noninvasive biomarkers for the detection of the degree of fibrosis in patients with NAFLD. These biomarkers include clinical and biochemical parameters such as body mass index (BMI), presence of diabetes, alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST/ALT ratio, and HOMA-IR, among others. Some scoring systems derived from aforementioned and some other parameters have been validated to reflect the degree of liver fibrosis noninvasively. The NAFLD, FIB4, BARD, and NIPPON scores are some examples of these scoring systems [8–10].