HPB Surgery
Tjun Tang, Elizabeth O'Riordan, Stewart Walsh in Cracking the Intercollegiate General Surgery FRCS Viva, 2020
A 65-year-old male, with history of non-alcoholic steatohepatitis (NASH), presents with weight loss, loss of appetite and vague discomfort over the right upper quadrant. On examination, he is mildly jaundiced and has hepatomegaly. How would you investigate this patient?This patient is at risk for liver dysfunction and also development of hepatocellular carcinoma (HCC). A thorough history looking at other possible causes of liver disease needs to be elucidated and this includes alcohol intake, and also of hepatitis B and/or C exposure including at-risk behaviour.The important blood investigations here would be the liver function panel to determine his current status and also alphafoetoprotein (AFP) for possible HCC. As a good number of patients with HCC have normal AFP levels, I would also request for imaging to look for tumour in the liver and the ultrasound (US) is a simple, quick and cost-effective initial modality for this purpose. Any suspicious findings on US would lead me to proceed on to either a triphasic CT or an MRI of the liver depending on availability and cost considerations.
Diagnosis of IBD
Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Hepatobiliary manifestations are common in IBD patients with elevation of liver function tests affecting up to a half of patients during the course of their disease.14 Some are associated with IBD, whereas others are secondary to metabolic changes induced by the IBD or due to adverse effect of the medications. In most cases, the condition will be detected by abnormal liver function tests on routine screening rather than symptoms or signs of liver disease. Primary sclerosing cholangitis constitutes the most important condition relatively specific to the underlying IBD. Other hepatobiliary manifestations in patients with IBD include fatty liver disease, autoimmune hepatitis, pericholangitis, cirrhosis, cholestasis, gallstone formation, drug induced liver disease, reactivation of viral hepatitis in patients receiving immunosuppression, secondary amyloidosis, granulomatous hepatitis, liver abscesses and portal vein thrombosis.136
Intestinal transplantation
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
It is our practice to carry out cross-sectional abdominal imaging, as well as appropriate gastrointestinal contrast radiographs if there appear to be opportunities for intestinal rehabilitation. Based on the clinical examination and biochemical tests of liver function, a liver biopsy may be required for accurate staging of the extent of liver disease. Recently, ultrasound elastography to measure liver stiffness has shown meaningful correlation with the results of liver biopsy, and, if validated, it provides a non-invasive method to monitor liver disease in this group of the patients. It is also important to evaluate the status of the central veins to ensure that central venous access can be securely maintained in the post-transplant period, at least in the short to medium term.
Response to fumaric acid esters for plaque type psoriasis in real-world practice is largely independent of patient characteristics at baseline – a multivariable regression analysis from the German Psoriasis Registry PsoBest
Published in Journal of Dermatological Treatment, 2022
Kristian Reich, Ulrich Mrowietz, Christina Sorbe, Ralph von Kiedrowski, Sebastian Diemert, Lisa Schaeffer, Natalia Kirsten, Nesrine Ben-Anaya, Matthias Augustin
Data on comorbidity are collected in PsoBest using prelisted diseases or disease clusters. Additional comorbidities may be recorded using free text. Cardiovascular disease (prelisted in the CRF) captures peripheral artery occlusive disease, heart failure, coronary heart disease, thrombosis, hypertension and cerebrovascular disease. Metabolic disease includes diabetes mellitus type I and type II, disorders of lipid metabolism and hyperuricemia. Psychiatric or addictive disease includes depression, sleep apnea syndrome (following the classification of system organ class of Medical Dictionary for Regulatory Activities (MedDRA) at time of CRF development) and alcohol abuse. Liver disease encompasses liver cirrhosis, hepatic steatosis and chronic liver damage. Further details on the registry have been published before (25). The evaluation was carried out according to the Declaration of Helsinki, the EU directive on data protection and the guidelines of good clinical practice.
Gastrodin ameliorates Concanavalin A-induced acute hepatitis via the IL6/JAK2/STAT3 pathway
Published in Immunopharmacology and Immunotoxicology, 2022
Yingqun Zhou, Jiaojiao Chen, Zhilu Yao, Xuezhen Gu
Liver diseases are a serious human health problem worldwide and include alcoholic liver disease, nonalcoholic fatty liver disease, viral hepatitis, cholestatic, autoimmune, and inherited liver disorders [1]. Liver injury can be triggered by a diverse range of stimuli, ranging from drug or alcohol abuse to infection and autoimmunity. The immune‑mediated liver injury is one of the most clinically troublesome diseases [2]. Autoimmune hepatitis (AIH) is a well-known chronic liver autoimmune disease characterized by elevated circulating autoantibodies, hypergammaglobulinemia, and histological evidence of interface hepatitis [3,4]. There is no effective treatment for AIH except for steroid hormones, and liver transplantation is the only effective treatment for end-stage liver disease [5]. Therefore, finding effective agents to ameliorate immune-mediated liver injury remains an urgent issue.
How successful has targeted RNA interference for hepatic fibrosis been?
Published in Expert Opinion on Biological Therapy, 2018
Mohube Betty Maepa, Abdullah Ely, Patrick Arbuthnot
Broadly, treatment for hepatic fibrosis includes eliminating the primary causes, suppressing inflammation, inducing fibrinolysis and inhibiting HSC activation [1] (Figure 1). Animal models that simulate the causes of hepatic fibrosis have improved understanding of liver injury and fibrogenesis, which in turn have been used to develop promising treatments of hepatic fibrosis. A major problem of managing hepatic fibrosis is the dearth of non-invasive clinical tests that may be used to diagnose the condition [3]. Histological analysis of patients’ liver biopsy samples, the best currently available diagnostic test, is imperfect and dependent on an invasive procedure that is contraindicated in some patients with liver disease. Identification of biomarkers that reliably correlate with progression of hepatic fibrosis has been challenging. Early detection and monitoring of the disease process in response to treatment is thus difficult.
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