Handbook of liver disease

Cover \r......Page 1
Handbook of Liver Disease......Page 2
Copyright......Page 3
Contributors......Page 4
Foreword......Page 10
Dedication......Page 13
Preface......Page 14
Acknowledgments......Page 15
Serum bilirubin......Page 16
Serum aminotransferases (Table 1.1)......Page 18
Serum alkaline phosphatase......Page 19
Serum proteins......Page 23
Assessment of Hepatic Metabolic Capacity......Page 24
Galactose elimination capacity......Page 25
Bromsulphalein (BSP)......Page 26
Contraindications......Page 27
Technique......Page 28
Plain abdominal x-ray studies and barium studies......Page 29
Ultrasonography......Page 30
Magnetic resonance imaging (MRI)......Page 31
Radioisotope scanning......Page 32
Transient Elastography......Page 33
Fulminant hepatic failure (FHF)......Page 35
Epidemiology......Page 36
Pathophysiology......Page 37
Drug or toxin-induced ALF......Page 38
Viral hepatitis (see also Chapter 3)......Page 40
Wilson disease (see Chapter 17)......Page 41
Pregnancy-related acute liver failure (see Chapter 21)......Page 42
Metabolic disorders......Page 43
Treatment......Page 44
Liver transplantation (see also Chapter 31)......Page 45
Future therapies......Page 48
Importance......Page 49
Enterically transmitted agents......Page 50
Blood-borne agents......Page 51
HAV......Page 52
HBV......Page 53
HCV......Page 54
Self-limited disease......Page 55
Self-limited disease......Page 56
Self-limited disease......Page 57
Serologic diagnosis......Page 58
Blood-borne infections......Page 62
Relapsing hepatitis......Page 63
HAV......Page 64
HBV......Page 65
Combined HAV and HBV Vaccine......Page 66
Clinical features and natural history......Page 68
Pathology and pathogenesis......Page 70
Treatment......Page 71
Liver transplantation (see Chapter 31)......Page 74
Serologic and molecular tests (see Chapter 3)......Page 76
Pathogenesis, liver biopsy, and noninvasive tests......Page 77
Treatment......Page 78
Clinical features and natural history......Page 82
Treatment......Page 83
Chronic Hepatitis E......Page 84
Nomenclature......Page 85
Diagnosis......Page 86
Principal hypotheses......Page 87
Ancillary hypotheses......Page 90
Types......Page 91
Variants......Page 92
Severity of inflammation......Page 94
Genetic status......Page 95
Clinical Features......Page 96
Promising New Autoantibodies......Page 97
Treatment regimens (Table 5.6)......Page 98
Drug actions......Page 99
Treatment end points (Table 5.7)......Page 101
Treatment results......Page 103
Promising alternative drugs (Table 5.10)......Page 105
Potential site-specific investigational therapies......Page 107
Epidemiology......Page 110
Risk Factors for Alcoholic Liver Disease......Page 111
History......Page 112
Laboratory Abnormalities (Table 6.1)......Page 113
Fatty Liver (Steatosis)......Page 114
Cirrhosis......Page 115
General Measures......Page 116
Specific TherapY for Alcoholic HEPATITIS......Page 118
Specific TherapY for Decompensated Alcoholic CIRRHOSIS......Page 119
Terminology......Page 121
Impaired Synthesis of Triglyceride and its Secretion as Very-Low-Density Lipoproteins from the Liver......Page 122
Risk Factors......Page 123
History......Page 125
Imaging......Page 126
Liver Biopsy......Page 127
Medications......Page 128
Overview......Page 130
Idiosyncratic Hepatotoxicity......Page 131
Biotransformation......Page 133
Phase 1 Reactions......Page 134
Acetaminophen (Paracetamol, Tylenol)......Page 135
Treatment......Page 137
Nonsteroidal Anti-Inflammatory drugs......Page 138
Antimicrobial Agents......Page 139
Antituberculous Agents......Page 140
Hormonal Agents......Page 141
Halothane......Page 142
Cardiovascular Agents and Glycemic Agents......Page 143
Lipid-Lowering Agents......Page 144
Immunosuppressive Medications Used for Treatment of Inflammatory Bowel Disease......Page 145
Environmental Hepatotoxins......Page 146
Definition......Page 151
Pathology......Page 152
Clinical Features......Page 153
Diagnosis......Page 156
Prognosis......Page 158
Measurement of Portal Pressure......Page 159
Evaluation......Page 162
Pathophysiology......Page 165
Epidemiology of Esophagogastric Variceal Hemorrhage......Page 166
Pharmacologic......Page 167
Initial......Page 168
Pharmacologic......Page 169
Treatment for Failures of Medical Therapy......Page 170
Pharmacologic (Table 10.2)......Page 171
Gastric Varices......Page 172
Portal Hypertensive Gastropathy......Page 173
Epidemiology and Natural History......Page 174
History......Page 175
Grade and Type of Ascites......Page 176
Ascitic Fluid TESTs......Page 177
General Principles......Page 178
Stepwise Diuretic Approach......Page 180
Overview......Page 181
Pathogenesis......Page 182
Classification (See Table 11.7)......Page 183
Treatment......Page 184
Antibiotic Regimens......Page 185
Concerns......Page 186
Pathogenesis......Page 188
Facts that Sustain Support for the Vasodilatation Theory......Page 191
Glomerular Disease......Page 192
Treatment......Page 193
Type 1 (Fig. 12.3)......Page 194
Prevention......Page 195
Pathophysiology......Page 198
Clinical Features......Page 199
Diagnosis......Page 200
Covert Hepatic Encephalopathy......Page 201
Overt Hepatic Encephalopathy......Page 202
Laboratory Tests......Page 203
Treatment......Page 204
Epidemiology......Page 208
Immunologic Abnormalities......Page 209
Pathogenesis......Page 210
Hepatic Histology......Page 212
Symptoms......Page 214
Physical Examination......Page 215
Natural History and Prognosis......Page 216
Imaging Tests......Page 217
Symptoms of Chronic Cholestasis......Page 218
Underlying Disease (Table 14.2)......Page 220
Liver Transplantation......Page 221
Terminology and Diagnostic Criteria......Page 223
Clinical Features......Page 224
Diseases Associated with Primary Sclerosing Cholangitis......Page 226
Epidemiology......Page 227
Etiology and Pathogenesis......Page 228
Natural History......Page 229
Treatment......Page 230
Complications and Their Treatment......Page 231
Acknowledgment......Page 233
Genetics......Page 234
HFC Hemochromatosis (type 1)......Page 235
Parenchymal Iron Deposition in Types 1 to 3......Page 236
Clinical Features......Page 237
Joint Disease......Page 238
Clinical Suspicion and Laboratory Tests......Page 239
Other Tests......Page 241
Treatment......Page 242
Population Screening......Page 243
Copper Metabolism (Figs 17.1 and 17.2)......Page 245
Genetics......Page 246
Hepatic......Page 248
Neurologic......Page 249
Skeletal......Page 250
Diagnostic tests......Page 251
drugs......Page 253
preferred Regimens......Page 256
Future Therapies......Page 257
Menkes Disease......Page 258
Overview......Page 260
Clinical Features......Page 261
Pathogenesis and Diagnosis......Page 262
Clinical Features......Page 263
Treatment and Screening......Page 264
Treatment and Screening......Page 265
Clinical Features......Page 266
Genetics......Page 267
Treatment and Screening......Page 268
Clinical Features......Page 269
Treatment and Screening......Page 270
Disorders Causing Damage to Other Organs (see also Chapter 23)......Page 271
Classification and etiology......Page 274
Clinical and laboratory features......Page 275
Diagnosis......Page 276
Treatment......Page 277
Classification......Page 278
Diagnosis......Page 279
Definition and etiology......Page 280
Pathogenesis......Page 281
Treatment......Page 282
Hepatic blood supply......Page 283
Liver Architecture......Page 284
Decreased hepatic blood flow......Page 285
Macroscopic......Page 286
Microscopic......Page 287
Etiology (Table 20.1)......Page 289
Congestive Hepatopathy......Page 290
Ischemic hepatitis......Page 291
1. Bilirubin......Page 292
4. International normalized ratio (INR)......Page 293
Radiologic Features......Page 294
Prognosis......Page 295
Overview......Page 297
History......Page 298
Physical examination......Page 299
Hyperemesis gravidarum......Page 300
Acute fatty liver of pregnancy......Page 302
Pre-eclampsia/eclampsia......Page 303
Hellp syndrome......Page 304
Hepatic rupture......Page 305
Cirrhosis (see also Chapters 9 and 10)......Page 306
Primary biliary cirrhosis (see also Chapter 14)......Page 307
Hepatitis C......Page 308
Hepatitis E......Page 309
Cholelithiasis and Cholecystitis in Pregnant Women (see also Chapter 32)......Page 310
Heart failure......Page 312
Polymyalgia rheumatica and giant cell arteritis......Page 314
Systemic sclerosis (scleroderma)......Page 315
Granulomatous Disease and Sarcoidosis (see Chapter 26)......Page 316
Malignant hematologic conditions......Page 317
Systemic infection, sepsis, and the critically ill patient......Page 318
Liver abnormalities......Page 319
Biliary abnormalities......Page 320
Amyloidosis......Page 321
Consequences of Physiologic Immaturity of the Liver......Page 323
Pathophysiologic Mechanisms......Page 324
Causes......Page 327
Accumulation of metabolic substances......Page 328
Tumor infiltration......Page 330
Acute Liver Disease......Page 331
Systemic Diseases Affecting the Liver (see Chapter 22)......Page 332
Cellular and biochemical changes in the aging liver......Page 335
Changes in drug metabolism......Page 336
Acute viral hepatitis (see Chapter 3)......Page 337
Chronic viral hepatitis (see Chapter 4)......Page 338
Drug-induced hepatotoxicity (see Chapter 8)......Page 339
Alcoholic liver disease (see Chapter 6)......Page 340
Liver abscess (see Chapter 28)......Page 341
Gallstones (see Chapter 32)......Page 342
Acute liver failure (see Chapter 2)......Page 343
Liver transplantation (see Chapter 31)......Page 344
Hepatitis A virus......Page 347
Hepatitis B and D viruses......Page 348
Hepatitis C virus......Page 349
Other viruses......Page 350
Fungal and Protozoal Infections......Page 351
Lymphoma (see also Chapter 22)......Page 352
Antiretroviral-Induced Hepatotoxicity......Page 353
Aids cholangiopathy......Page 354
Acalculous cholecystitis......Page 355
Morphologic types......Page 357
Symptoms and signs......Page 358
Liver biochemical tests......Page 359
Other laboratory tests......Page 360
Sarcoidosis (see also Chapter 22)......Page 361
Schistosomiasis (see also Chapter 29)......Page 362
Lipogranulomas......Page 363
Fibrin-ring (“doughnut”) granulomas......Page 364
Miscellaneous granulomatous conditions......Page 365
Therapy......Page 366
Hepatic adenoma......Page 367
Tumor-like lesions of hepatocytes......Page 368
Benign hepatic tumors of mesenchymal origin......Page 369
Hepatocellular carcinoma......Page 370
Cholangiocarcinoma (see also Chapter 34)......Page 373
Other tumors of the liver......Page 374
Diagnostic Approach to Liver Masses or Tumors......Page 375
Parasitology......Page 378
Pathogenesis......Page 379
Diagnosis......Page 380
Treatment and prognosis......Page 382
Pathogenesis......Page 384
Diagnosis......Page 385
Treatment and prognosis......Page 386
Overview......Page 387
Parasitology......Page 388
Pathogenesis......Page 389
Diagnosis......Page 390
Treatment and prognosis......Page 391
Serologic tests and blood cultures......Page 392
Aspiration......Page 393
Staphylococcus aureus (toxic shock syndrome)......Page 395
Neisseria gonorrhoeae......Page 396
Coxiella burnetii (Q fever)......Page 397
Brucella spp. (brucellosis)......Page 398
Treponema pallidum (syphilis)......Page 399
Protozoal infections......Page 400
Helminthic infections: roundworms (nematodes) (see Table 29.1)......Page 407
Helminthic infections: flatworms (trematodes) (see Table 29.1)......Page 410
Candidiasis......Page 415
Histoplasmosis......Page 416
Effects of anesthetic agents on the cirrhotic liver......Page 418
Other agents in liver disease......Page 419
Problems in estimating operative risk......Page 420
Chronic hepatitis (see Chapters 4 and 5)......Page 421
Cirrhosis (see Chapter 9)......Page 422
Use of the Child-Pugh Classification to Assess Surgical Risk (Table 30.2)......Page 423
Use of the Model for End-stage Liver Disease Score to Assess Surgical Risk......Page 424
Perioperative complications in patients with obstructive jaundice......Page 426
Hepatic Resection (see Chapter 27)......Page 427
Treatment of coagulopathy......Page 428
Treatment of ascites (see Chapter 11)......Page 429
Treatment of hepatic encephalopathy (see Chapter 13)......Page 430
Postoperative Jaundice......Page 431
Overview......Page 435
Assessment of liver disease severity......Page 436
Benefit of liver transplantation......Page 437
Liver transplant evaluation......Page 438
Clinical management while patient is on waitlist......Page 439
Extended-criteria donors......Page 440
Viral hepatitis (see Chapters 3 and 4)......Page 441
Hepatocellular carcinoma (see Chapter 27)......Page 442
Exceptional Conditions in Transplant Listing......Page 443
Hepatopulmonary syndrome (see Chapter 9)......Page 444
Mycophenolate mofetil and mycophenolic acid......Page 445
Allograft rejection......Page 446
Post-transplant metabolic syndrome......Page 447
Cholesterol stones......Page 449
Cholesterol stones......Page 450
Asymptomatic gallstones......Page 451
Biliary pain......Page 452
Bile salts (ursodeoxycholic acid, or ursodiol)......Page 453
Acute Cholecystitis......Page 454
Acute Acalculous Cholecystitis......Page 456
Definition......Page 457
Other Less Common Syndromes Associated with Gallstones......Page 458
Composition......Page 460
Imaging studies......Page 461
Treatment......Page 463
Gallstone pancreatitis......Page 465
Definition......Page 466
Overview......Page 467
Diagnosis......Page 468
Pathogenesis......Page 469
Overview......Page 470
Etiology: proposed theories......Page 471
Clinical features......Page 472
Treatment......Page 473
Adenomyosis......Page 475
Incidence......Page 476
Etiology......Page 477
Pathology and staging......Page 478
Diagnosis and preoperative staging......Page 479
Treatment......Page 480
Incidence......Page 481
Clinical features......Page 483
Diagnosis and preoperative evaluation......Page 484
Treatment......Page 485
Prognosis......Page 486
INDEX\r......Page 489