MKSAP: 57-year-old man with chronic hepatitis C infection

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man is evaluated during a routine examination. His medical history is notable for chronic hepatitis C infection with cirrhosis, which was diagnosed 3 years ago. He undergoes surveillance ultrasound for hepatocellular carcinoma every 6 months. On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 110/82 mm Hg, pulse rate is 65/min, and respiration rate is 18/min; BMI is 22. Muscle wasting and scleral icterus are noted. There is no flank dullness and no asterixis. Ultrasound demonstrates three new liver masses. A four-phase CT demonstrates three lesions (1.8 cm, 2.5 cm, and 2.9 cm in size) that show arterial enhancement with venous washout. Splenomegaly and esophageal varices are also noted. Which of the following is the most appropriate next step in management? A. Liver biopsy B. Liver transplantation evaluation C. Sorafenib D. Surgical resection E. Transarterial chemoembolization Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Gastroenterology Oncology/Hematology Source Type: blogs

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Opinion statementChronic hepatitis C (HCV) is a hepatotropic virus which, when untreated, can lead to progressive inflammation and fibrosis resulting in cirrhosis, hepatocellular carcinoma (HCC), and decompensations related to end-stage liver disease. The relatively recent introduction of all oral, interferon-free, direct-acting antiviral medications against HCV has transformed the management of these patients. Previous treatment regimens were prolonged, poorly tolerated, and frequently did not result in cure. Current therapies achieve sustained viral response (SVR) in the vast majority of patients including those with dec...
Source: Current Treatment Options in Gastroenterology - Category: Gastroenterology Source Type: research
Abstract Statins are a class of molecules that inhibit HMG CoA reductase. They are usually prescribed as a lipid lowering medication. However, there is accumulating evidence that statins have multiple secondary effects both related and unrelated to their lipid-lowering effect. This narrative review of the literature aims to provide the reader with information from clinical studies related to the effect of statin and statins' potential use in patients with liver diseases. In patients with advanced liver disease due to any etiology, statins exhibit an antifibrotic effect possibly through the prevention of hepatic si...
Source: World Journal of Gastroenterology - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
Getting ready for the United States Medical Licensing Examination® (USMLE®) Step 2 is no easy feat, but we’re sharing expert insights to help give you a leg up. Take a look at the exclusive scoop on this month’s most-missed USMLE Step 2 test prep question. Think you have what it takes to rise above your peers? Test your USMLE knowledge, and view an expert video explanation of the answer from Kaplan Medical. Once you’ve got this question under your belt, be sure to test your knowledge with other posts in this series. Ready. Set. Go. This month’s question that stumped most students:...
Source: AMA Wire - Category: Journals (General) Authors: Source Type: news
ConclusionsIn patients with compensated HCV‐related cirrhosis with or without OVs at baseline, SVR is associated with reduced disease progression and liver‐related mortality.This article is protected by copyright. All rights reserved.
Source: Liver International - Category: Gastroenterology Authors: Tags: Original Article Source Type: research
ConclusionsIn patients with compensated HCV‐related cirrhosis with or without OVs at baseline, SVR is associated with reduced disease progression and liver‐related mortality.This article is protected by copyright. All rights reserved.
Source: Liver International - Category: Gastroenterology Authors: Tags: Original Article Source Type: research
Authors: Basaranoglu M, Najjar SM, Demirbag AE, Senturk H Abstract AIM: To characterize non-alcoholic fatty liver disease (NAFLD) presentation with esophageal varices. METHODS: We carried out a retrospective cohort study on 258 patients with esophageal varices at a single tertiary referral center. These patients underwent diagnosis of several liver diseases, including: NAFLD-associated cirrhosis, hepatitis B, hepatitis C, Wilson disease, autoimune liver diseases, and others. RESULTS: Of the 258 patients, 39% of patients exhibited esophageal varices due to NAFLD-associated cirrhosis. Of the 38 (14.7%) patien...
Source: World Journal of Hepatology - Category: Gastroenterology Tags: World J Hepatol Source Type: research
Authors: Gentile I, Buonomo AR, Zappulo E, Borgia G Abstract It is estimated that hepatitis C virus (HCV) infects chronically about 160 million people worldwide. Between 15 and 56% of these chronic carriers will evolve towards liver cirrhosis during their lifetimes. In managing subjects with HCV chronic infection, it is crucial to perform accurate staging of the disease and specifically to ascertain whether or not they have liver cirrhosis for at least three reasons: 1) the presence of cirrhosis has prognostic relevance as it entails a relatively high risk of developing decompensation (e.g., ascites, encephalopathy...
Source: Infezioni in Medicina - Category: Infectious Diseases Tags: Infez Med Source Type: research
Authors: Nakayama H, Takayama T Abstract The global distribution of hepatocellular carcinoma (HCC) varies markedly among regions, and patients in East Asia and Central Africa account for about 80% of all cases. The risk factors are hepatitis B, hepatitis C, alcohol, and etc. The risk of carcinogenesis further increases with progression to hepatic cirrhosis in all liver disorders. Radical treatment of HCC by liver resection without causing liver failure has been established as a safe approach through selection of an appropriate range of resection of the damaged liver. This background indicates that both evaluation o...
Source: World Journal of Hepatology - Category: Gastroenterology Tags: World J Hepatol Source Type: research
Conclusion: An increasing number of reliable noninvasive methods are now available that are widely used in clinical practice, mostly in viral hepatitis, resulting in a significant decrease in the need for liver biopsy.Dig Dis 2015;33:498-503
Source: Digestive Diseases - Category: Gastroenterology Source Type: research
Conclusions: SVR represents the fundamental goal of antiviral treatment for patients infected with chronic HCV, so as to reduce risk of liver disease progression. Achievement of SVR has implications beyond those of clearing viral infection; it is associated with improved long-term clinical outcomes, economic benefits and improved health-related quality of life.
Source: BMC Infectious Diseases - Category: Infectious Diseases Authors: Source Type: research
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