Editorial Board
(Source: Medicine)
Source: Medicine - April 27, 2023 Category: Internal Medicine Source Type: research
Gallstones
This article discusses the cause of gallstones, their presentation and their management. (Source: Medicine)
Source: Medicine - April 27, 2023 Category: Internal Medicine Authors: Ian J. Beckingham Tags: Gallstones Source Type: research
Acute liver failure: updates in pathogenesis and management
Acute liver failure is a life-threatening illness precipitated by an acute liver injury in patients with no pre-existing liver disease. Acute viral hepatitis and drug-induced liver injury account for most cases, the clinical course characterized by the development of coagulopathy and hepatic encephalopathy, often progressing to multi-organ disease, which is associated with high fatality rates. The outcomes have improved significantly over time with improving standards of organ system support and access to liver transplantation for very sick individuals. (Source: Medicine)
Source: Medicine - April 27, 2023 Category: Internal Medicine Authors: Ahmed Adel Amin, Banwari Agarwal, Rajiv Jalan Tags: Management problems in liver disease Source Type: research
Complications of cholestasis: symptoms and extrahepatic manifestations
Cholestasis is a state of impaired or reduced bile flow, resulting from intrahepatic disease, cholangiocellular disorders or large bile duct obstruction. Although disease-modifying treatments exist, not all provide the relief that patients seek. Pruritus and fatigue are the most commonly reported symptoms, and chronic cholestatic disorders can be complicated by hepatic osteodystrophy, dyslipidaemia and hypovitaminosis. Mechanistic insights into specific biological pathways have led to a revived interest in developing symptom-specific therapies, with a resurgence of clinical trial activity directed toward improving patients...
Source: Medicine - April 27, 2023 Category: Internal Medicine Authors: Sarah Al-Shakhshir, Palak J. Trivedi Tags: Management problems in liver disease Source Type: research
Diagnosis and management of ascites and hepatorenal syndrome (acute kidney injury) in cirrhosis
Ascites is the most common decompensation-defining complication of cirrhosis and represents a watershed moment, with median survival falling from>12 years for compensated cirrhosis to approximately 2 years. Treatment is based on reducing sodium intake and increasing renal sodium excretion with the aldosterone antagonist spironolactone at a starting dose of 100 mg daily, to which 60% respond. Renal dysfunction affects as many as 20% of hospitalized patients and is a strong predictor of mortalit y. (Source: Medicine)
Source: Medicine - April 27, 2023 Category: Internal Medicine Authors: Dominic Crocombe, Alastair O'Brien Tags: Management problems in liver disease Source Type: research
IgG4-related disease
Immunoglobulin G4-related disease is a rare immune-mediated systemic fibro-inflammatory condition characterised by a mass and/or thickening of the involved organ systems. The diagnosis remains challenging and requires a combination of clinical findings, serology, imaging and histological evaluation with cross-speciality input. Classification criteria have been developed with a high specificity to distinguish IgG4-related disease from disease mimics, which are essential for clinical trial design. (Source: Medicine)
Source: Medicine - April 27, 2023 Category: Internal Medicine Authors: Chinedu Nwaduru, Emma L. Culver Tags: Autoimmune liver disease Source Type: research
Liver transplantation
is a successful therapy for end-stage liver disease, hepatocellular carcinoma and acute liver failure. Early referral is essential to allow time for careful assessment. The patient's needs must be balanced against the predicted outcome after transplantation. The calcineurin inhibitor tacrolimus is the mainstay of immunosuppression in liver transplantation. Outcomes after liver transplantation are excellent but patients do not have a normal quantity or quality of life compared with an age- and sex-matched population. (Source: Medicine)
Source: Medicine - April 26, 2023 Category: Internal Medicine Authors: James W. Ferguson Tags: Transplantation Source Type: research
Management of portal hypertension, Budd – Chiari syndrome and portal vein thrombosis
Portal hypertension is associated with many of the known complications of cirrhosis and has an enormous impact on prognosis. Ascites and hepatic encephalopathy represent the most common complications of cirrhosis; both are associated with a significantly worse prognosis, with 50% survival over 1 –2 years. Acute variceal bleeding remains a life-threatening complication and leading cause of death in individuals with cirrhosis. Advances in variceal bleeding management, including empirical antibiotic use, vasoactive drugs, early endoscopy and therapies such as transjugular intrahepatic portos ystemic shunts (TIPS), have resu...
Source: Medicine - April 26, 2023 Category: Internal Medicine Authors: Marcus Robertson, Peter Hayes Tags: Management problems in liver disease Source Type: research
Self-assessment/CPD answers
Question 1 (Source: Medicine)
Source: Medicine - April 26, 2023 Category: Internal Medicine Tags: Self-assessment/CPD answers Source Type: research
Liver and biliary disease in infancy
Liver disease in infancy is a relatively rare but serious cause of morbidity and mortality. Since jaundice is a common finding in the neonatal period, the immediate priority is to differentiate between unconjugated hyperbilirubinaemia, which is generally a benign developmental phenomenon, and conjugated hyperbilirubinaemia (conjugated fraction>20%), which is always pathological. Conjugated hyperbilirubinaemia, suggested by yellow urine and stools that are not yellow or green in an infant of any age, is pathognomonic of liver parenchymal or bile duct disease. (Source: Medicine)
Source: Medicine - April 25, 2023 Category: Internal Medicine Authors: Marianne Samyn, Giorgina Mieli-Vergani Tags: Mothers, babies and children Source Type: research
Haemochromatosis
is an inherited disorder of iron loading associated with significant morbidity and mortality if recognized late. Diagnosis, via HFE genotyping and confirmation of iron overload, followed by treatment with venesection, is simple to enact. Clinicians are now more attuned to thinking about haemochromatosis, with earlier presentations the norm. However, the diagnosis is still missed and irreversible joint disease in particular affects quality of life. Furthermore, men with haemochromatosis are 10 times more likely to develop primary liver cancer, highlighting the need to diagnose and treat early. (Source: Medicine)
Source: Medicine - April 25, 2023 Category: Internal Medicine Authors: William JH. Griffiths Tags: Metabolic liver disease Source Type: research
Non-alcoholic fatty liver disease
(NAFLD) is a global health problem. It has an estimated prevalence of 25% among adults worldwide; predicted to increase significantly over the coming decade. It is closely related to metabolic syndrome – associated with obesity and type 2 diabetes mellitus (T2DM). NAFLD is defined histologically, ranging from simple steatosis to steatohepatitis, fibrosis and cirrhosis. Triglyceride droplet accumulation in hepatocytes is the first feature in the natural history, leading in some patients to oxidat ive stress, inflammation and the development of fibrosis. (Source: Medicine)
Source: Medicine - March 29, 2023 Category: Internal Medicine Authors: Anthony George, Jeremy Cobbold Tags: Common European liver disorders Source Type: research
Hepatitis B and D: an overview of the diagnosis and management
Chronic hepatitis B (CHB) represents a major global healthcare challenge with increasing morbidity and mortality because of the progression to cirrhosis and hepatocellular carcinoma (HCC). Hepatitis delta virus (HDV) is a defective virus that can propagate only in the presence of hepatitis B virus (HBV); it is the most aggressive form of viral hepatitis CHB is a dynamic disease that can be broadly categorized into four phases. HDV infection can develop after synchronous infection with HBV (co-infection) or alternatively after exposure to HDV from a patient with pre-existing CHB (superinfection). (Source: Medicine)
Source: Medicine - March 29, 2023 Category: Internal Medicine Authors: Apostolos Koffas, Upkar S. Gill Tags: Liver infections Source Type: research
Imaging of the liver and biliary tract
Radiology is a rapidly evolving specialty that parallels the advances and achievements of the modern era, including state-of-the-art imaging systems, adaptive artificial intelligence and novel interventional procedures. This is particularly reflected in the imaging of the liver and biliary tract in which the full set of implements available in the radiologist's imaging toolbox (ultrasonography, computed tomography, magnetic resonance imaging, nuclear medicine imaging, image-guided interventional procedures) are fully used and essential in both the investigative diagnostic process and image-guided treatment. (Source: Medicine)
Source: Medicine - March 26, 2023 Category: Internal Medicine Authors: Stephen M. Gregory, Natasha Davendralingam Tags: Assessment of liver disease Source Type: research
Contents
(Source: Medicine)
Source: Medicine - March 25, 2023 Category: Internal Medicine Source Type: research
