Hepatitis A and E and other hepatotropic viruses
Hepatitis E and A are the major cause of acute hepatitis worldwide. Hepatitis E is also one of the major causes of chronic hepatitis in immunocompromised individuals. Both infections were initially attributed to developing countries because of poor sanitation and limited health access. However, it is now apparent that hepatitis E virus is endemic in high-income countries and is largely a zoonotic infection. Furthermore, recent hepatitis A outbreaks in high-risk populations have reinforced the necessity of scaling up the vaccination rates in these groups in developed countries. (Source: Medicine)
Source: Medicine - March 24, 2023 Category: Internal Medicine Authors: Maria Fernanda Guerra Veloz, Kosh Agarwal Tags: Liver infections Source Type: research

Medical liver biopsies: a pattern-based diagnostic approach
Liver biopsy plays an important role in the diagnosis and management of liver diseases. A recent advance in liver histopathology is evidence of the utility of a pattern-based diagnostic approach in daily practice. This enables a systematic, efficient assessment of microscopic findings. In this system, cases are classified into one of six patterns: acute hepatitis, chronic hepatitis, acute cholestasis, chronic cholangiopathy, fatty liver disease and others, based on overall histological changes under a low-power view. (Source: Medicine)
Source: Medicine - March 23, 2023 Category: Internal Medicine Authors: Yoh Zen Tags: Assessment of liver disease Source Type: research

Investigation of jaundice
Jaundice is a clinical sign that reflects an accumulation of bilirubin in the blood. It can result from increased bilirubin production, inability of the liver to conjugate bilirubin or failure to excrete bilirubin into the biliary tree. Appropriate investigation of jaundice starts with a history of associated symptoms and risk factors for liver disease. Clinical examination should look for stigmata of chronic liver disease and signs of specific liver diseases. Initial blood tests should assess liver injury and synthetic function. (Source: Medicine)
Source: Medicine - March 23, 2023 Category: Internal Medicine Authors: Sara Mahgoub, Reenam S. Khan, Diarmaid D. Houlihan, Philip N. Newsome Tags: Assessment of liver disease Source Type: research

Hepatobiliary tumours
Hepatocellular carcinoma (HCC) and cholangiocarcinoma are the two major types of primary liver tumour. Both are increasing in incidence in the UK, for HCC because of the increasing prevalence of chronic liver disease, particularly that caused by alcohol and non-alcoholic fatty liver disease. They have a poor overall prognosis because of late presentation and the presence of underlying liver cirrhosis in patients with HCC. Patients usually present with a liver mass or jaundice. Assessment is primarily radiological by means of computed tomography and/or magnetic resonance imaging. (Source: Medicine)
Source: Medicine - March 23, 2023 Category: Internal Medicine Authors: Stephen D. Ryder Tags: Tumours Source Type: research

Drug-induced liver injury
The lack of substantial advances in pre-clinical testing for hepatotoxicity has meant that drug-induced liver injury (DILI) remains an important issue during both the drug development and post-marketing phases. Several drug-related, genetic and non-genetic host factors influence the risk of DILI in any individual. The demonstration of human leukocyte antigen genotype as a strong risk factor for the development of DILI from a range of drugs has highlighted the role of the adaptive immune system in its pathogenesis; there is accumulating evidence that drug metabolism genes also contribute to some forms of DILI. (Source: Medicine)
Source: Medicine - March 23, 2023 Category: Internal Medicine Authors: Guruprasad P. Aithal, Anand V. Kulkarni Tags: Common european liver disorders Source Type: research

Hepatitis C
virus (HCV) is a major public health problem and a leading cause of chronic liver disease. Over 58 million people worldwide have chronic HCV infection and are at risk of developing its life-threatening complications. Acute infection is usually asymptomatic, with most patients unaware that they have contracted the virus. Some individuals clear the virus spontaneously, but most become chronic carriers. If carriers are identified, they can be treated with antiviral therapy, the main goal being the prevention of cirrhosis, liver failure and hepatocellular carcinoma by eradicating the virus. (Source: Medicine)
Source: Medicine - March 23, 2023 Category: Internal Medicine Authors: Ryan Buchanan, Yun Jung Kim, Kathryn L. Nash Tags: Liver infections Source Type: research

Clinical and laboratory assessment of symptomatic and asymptomatic liver disease
Chronic liver disease is rising in incidence and prevalence in the UK and carries a significant mortality as well as socioeconomic burden for individuals, their families and health services. Although the causes of liver disease are many, the vast majority of liver disease is preventable and related to excess alcohol consumption, being overweight/obese or the acquisition of hepatitis B and or C. However, less common causes of liver disease should not be overlooked, especially as effective specific therapies may be available; this is the case for autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) and haemochromato...
Source: Medicine - March 23, 2023 Category: Internal Medicine Authors: Neil Mistry, Andrew Yeoman Tags: Assessment of liver disease Source Type: research

Tropical liver disease
This article describes some hepatic and biliary problems that are seen in the tropics or can be imported from resource-poor settings. The epidemiology of hepatitis A is changing in many areas and hepatitis E is now recognized in a wide range of tropical and non-tropical settings. (Source: Medicine)
Source: Medicine - March 23, 2023 Category: Internal Medicine Authors: Nick Beeching, Anuradha Dassanayake Tags: LIVER INFECTIONS Source Type: research

Prescribing in liver disease
Patients with liver disease often require drug therapy. As the liver is the main site of drug detoxification and elimination, each person's need for therapy must be carefully assessed; the choice of the drug, its dose and the duration of therapy must be carefully considered to avoid adverse effects. Ideally, the chosen drug should have a high therapeutic index, be largely devoid of pharmacokinetic and pharmacodynamic interactions and hepatotoxic effects, and be renally eliminated. However, the ideal drug with these properties is often not available, so the dose and drug should be individualized to the patient, who should t...
Source: Medicine - March 23, 2023 Category: Internal Medicine Authors: Munir Pirmohamed Tags: Assessment of liver disease Source Type: research

Self-assessment/CPD answers
Question 1 (Source: Medicine)
Source: Medicine - March 23, 2023 Category: Internal Medicine Tags: Self-assessment/CPD answers Source Type: research

Renal disease in pregnancy
The diagnosis of acute kidney injury (AKI) in pregnancy is complicated by haemodynamic and urinary tract changes in pregnancy, and non-pregnant references intervals for serum creatinine should not be used. Pre-eclampsia is the most common cause of AKI in pregnancy. Although pregnancy-associated haemolytic microangiopathies are rare, it is useful for physicians and nephrologists to be aware of potential clinical discriminators as different, timely management is required. Pregnancy is successful for most women and pregnant individuals with chronic kidney disease (CKD). (Source: Medicine)
Source: Medicine - March 10, 2023 Category: Internal Medicine Authors: Kate Wiles, Laura Skinner, Priscilla Smith Tags: Pregnancy Source Type: research

Lupus nephropathy and vasculitis
Multisystem autoimmune diseases, including systemic lupus erythematosus (SLE) and vasculitis, are inflammatory conditions of unknown cause. Renal involvement occurs in a variety of forms and usually represents a severe disease manifestation. SLE is complicated by renal involvement (lupus nephritis) in over one-third of individuals. Small vessel vasculitides, including antineutrophil cytoplasmic antibody-associated vasculitis, also frequently affect the kidneys, causing a rapidly progressive glomerulonephritis. (Source: Medicine)
Source: Medicine - March 8, 2023 Category: Internal Medicine Authors: Dominic McGovern, Lisa Willcocks, Rachel Jones Tags: Systemic disease and the kidney Source Type: research

Urinary tract infection
is one of the most common infections affecting humans. Uncomplicated infections most commonly occur in otherwise healthy women when uropathogenic bacteria, usually Escherichia coli, enter the bladder and overcome the host's innate immunity. Complicated infections occur in individuals with an anatomical or functional abnormality of the urinary tract. Diagnosis is made on the basis of symptoms, and diagnostic precision is improved by urinalysis. Urine culture is important in individuals with severe, recurrent or complicated infection and when the diagnosis is uncertain, for example in children and elderly people. (Source: Medicine)
Source: Medicine - March 7, 2023 Category: Internal Medicine Authors: Emily K. Glover, Neil S. Sheerin Tags: Obstruction and infection Source Type: research

Secondary glomerular disease
s are those with an identifiable underlying or systemic cause, in contrast to primary diseases, where a localized or intrinsic renal pathology is present. Diabetic and hypertensive glomerulopathies are the most common forms of secondary glomerular disease, although a kidney biopsy is not usually required for their diagnosis or management. Biopsy is more commonly required in cases of suspected glomerulonephritis, where a variety of histological lesions can be seen, all of which – including podocytopathy, membranous nephropathy and various forms of proliferative glomerulonephritis – have established secondary causes or a...
Source: Medicine - March 7, 2023 Category: Internal Medicine Authors: Mukunthan Srikantharajah, Stephen McAdoo Tags: Glomerular disease Source Type: research

Primary glomerular disease
This is a review of the clinical features, pathogenesis, investigation and management of glomerulonephritis (GN). GN can occur as a primary isolated renal disease, as a manifestation of systemic diseases such as vasculitis or lupus, or secondary to drugs, infections or tumours. It is an important cause of morbidity and mortality and a potentially preventable cause of end-stage renal disease; early diagnosis is vital to allow timely referral to specialist units where renal biopsy can be performed. (Source: Medicine)
Source: Medicine - March 3, 2023 Category: Internal Medicine Authors: Peter Mathieson Tags: Glomerular disease Source Type: research