Definition: fibrosis and nodular regeneration resulting from hepatocellular injury
|
|
- Marshall Bradford
- 6 years ago
- Views:
Transcription
1 Cirrhosis Understanding the liver: Patterns of LFT Abnormalities - Hepatocellular/Transaminitis: o Ratio of AST: ALT >2:1 ETOH (keep in mind AST is also produced by red cells, heart muscle) o If Aminotransferases >1,000: severe viral hepatitis, toxin, ischemia - Cholestatic: Elev TB/DB, Elev Alk Phos o Intrahepatic: meds, sepsis, PBC, post-op o Extrahepatic: PSC, pancreatic ca, cholangiocarcinoma, choledocholithiasis - Infiltrative: elev AlkPhos/GGT o Malignancy: HCC, Mets, lymphoma o Granulomas: TB, Sarcoid, Histo o Abscess - Isolated Hyperbilirubinemia o Conjugated: Dubin-Johnson, Rotor s o Unconjugated: overproduction, defective conjugation Definition: fibrosis and nodular regeneration resulting from hepatocellular injury Severity of Disease: two scoring systems - Child-Pugh (A-C) - MELD o Combination of TB, INR, Creatinine o MELD predicts short-term mortality post-tips o Used for liver transplant listing Complications of Cirrhosis Portal Hypertension - defined as hepatic venous pressure gradient >10-12 mmhg o wedge catheter from the IJ into the hepatic veins and measure pressure gradient between free hepatic vein and wedged pressure - non-invasively: Doppler US with reversal of flow Ascites
2 SAAG >1.1 <1.1 Portal Hypertension Non-Portal HTN Protein >2.5 Protein <2.5 Pancreatitis Carcinomanosis Post-Sinusoidal (e.g. CHF, Budd-Chiari) Sinusoidal Pre-Siinusoidal Tuberculosis Nephrotic Syndrome Management of Ascites - Sodium Restriction - Diuretics: Lasix/Spironolactone to maintain normokalemia - Serial LVPs Spontaneous Bacterial Peritonitis - Definition: PMN >250 in ascetic fluid, positive culture - Microbiology: E coli, Klebsiella, strep species - Management o ABX: cephalosporin, quinolone o Albumin: on days 1 and 3 to prevent HRS GE Varices - Diagnosis: endoscopy - Management: o Acute Bleed: IV access Serial CBC ABX (GI Bleed with Ascites) Octreotide or Vasopressin Emergent Endoscopic Ligation/Sclerotherapy Balloon Compression TIPS Mental Status Checks o Prevention Non-specific beta blocker (propranolol, nadolol)
3 Hepatic Encephalopathy - Pathophysiology: o Inability to metabolize toxins from the bowel that affect the CNS o Ammonia is the detectable representative neurotoxin but not the sole neurotoxin - Stages of encephalopathy o changes in behavior with changes in sleep wake cycle (stage 1) o comatose (stage 4) - Precipitants: o Increased Nitrogen: GI Bleed, constipation, high protein diet, renal failure o Electrolyte Abnormalities: hypoxemia, hypokalemia, hyponatremia, dehydration o Drugs: opiates, benzos, ETOH o Infection: systemic or SBP - Treatment o Treat precipitant o Lactulose o Rifaximin Hepatorenal Syndrome - Pathophysiology o Decreased circulating volume 2/2 ascites o Increased circulating vasodilators (particularly NO) with resulting splanchnic vasodilation with decreased SVR o Heart compensates with increased CO o Ultimately production of vasodilators overcomes increase in CO and you get activation of RAS, sympathetic nervous system, vasopressin with renal vasoconstriction - Diagnostic Criteria o Cirrhosis with ascites o Serum Cr >1.5 o No improved in Cr after fluid challenge o Absence of shock or intrinsic renal disease o No current or recent use of nephrotoxic agents - Types o Type 1: rapidly progressive o Type 2: indolent - Precipitants o GI Bleeding o Overdiuresis o Infection (SBP) o Paracentesis - Treatment o Albumin o Peripheral Vasoconstriction: midodrine, terlipressin
4 o Splanchnic Vasoconstriction: octreotide Hepatopulmonary - Pathophysiology: pulmonary vascular dilations with intrapulmonary shunting - Clinical Manifestations: orthodeoxia, platypnea - Diagnosis: TTE with late bubbles Portopulmonary Hypertension - Clinical Manifestations: sx of RH failure - Diagnosis: PAP > 35 mmhg on RHC - Management: use same therapies as in portal HTN, no improvement posttransplant Hepatic Hydrothorax - Pathophys: microperforations in diaphragm with movement of ascitic fluid into pleural space - Clinical Manifestations o Effusion on CXR (R>L) - Management o Reaccumulates rapidly post-thora or chest tubes o Difficult to treat diuretics or TIPS Lab and Exam Findings Labs: - ALT >AST - Elevated Bilis - Elevated Coags - Low Albumin - Cell Line Deficiencies: 2/2 marrow suppression, hypersplenism, iron/folate deficiency, decreased TPO production o Anemia o Thrombocytopenia Physical Exam Cirrhosis - Decreased hepatocellular mass: o Jaundice: frenular jaundice, scleral icterus o Ecchymosis - Decreased Hepatic Metabolism of Androstenedione Increased Estrogen o Spider Angioma: arteriole with surrounding small radiating vessels, blanching, most frequently found in distribution of SVC o Palmar Erythema o Gynecomastia o Testicular Atrophy - Portal Hypertension
5 o Splenomegaly o Ascites o Caput Medusae o Encephalopathy and asterixis - Dupuytren s contracture - Terry s Nails: white lines on proximal nail beds - Fevor hepaticus - Hypertrophic Osteoarthropathy References Udell et al. Does this patient with liver disease have cirrhosis? Journal of the American Medical Association, 2012; 307(8):
Management of Chronic Liver Failure/Cirrhosis Complications in Hospitals. By: Dr. Kevin Dolehide
Management of Chronic Liver Failure/Cirrhosis Complications in Hospitals By: Dr. Kevin Dolehide Overview DX Cirrhosis and Prognosis Compensated Decompensated Complications Of Cirrhosis Management Of Complications
More informationConflict of interest disclosures. Complications of end stage liver disease. None. The many complications of Cirrhosis. Portal Hypertension.
Complications of end stage liver disease Conflict of interest disclosures None Amir Qamar, MD Instructor of Medicine Brigham and Women s s Hospital Harvard Medical School Boston, MA 02115 The many complications
More informationMANAGEMENT OF LIVER CIRRHOSIS: PRACTICE ESSENTIALS AND PATIENT SELF-MANAGEMENT
MANAGEMENT OF LIVER CIRRHOSIS: PRACTICE ESSENTIALS AND PATIENT SELF-MANAGEMENT Sherona Bau, ACNP The Pfleger Liver Institute 200 UCLA Medical Plaza, Suite 214 Los Angeles, CA 90095 September 30, 2017 I
More informationManagement of Cirrhosis Related Complications
Management of Cirrhosis Related Complications Ke-Qin Hu, MD, FAASLD Professor of Clinical Medicine Director of Hepatology University of California, Irvine Disclosure I have no disclosure related to this
More informationWEEK. MPharm Programme. Liver Biochemistry. Slide 1 of 49 MPHM14 Liver Biochemistry
MPharm Programme Liver Biochemistry Slide 1 of 49 MPHM Liver Biochemistry Learning Outcomes Assess and evaluate the signs and symptoms of illness Assess and critically appraise a patients medication regimen,
More informationDecompensated chronic liver disease
Decompensated chronic liver disease Definition of decompensated chronic liver disease Patients with chronic liver disease can present with acute decompensation due to various causes. The decompensation
More informationEtiology of liver cirrhosis
Liver cirrhosis 1 Liver cirrhosis Liver cirrhosis is the progressive replacement of normal hepatic cells by fibrous scar tissue, This scarring is accompanied by the loss of viable hepatocytes, which are
More informationAscites. Matthew Johnson M.D.
Ascites Matthew Johnson M.D. The most common complication of portal hypertension 50% of patients who have compensated cirrhosis develop ascites by 10 years Survival after ascites develops: 1-year: 85%
More informationCirrhosis and Portal Hypertension Gastroenterology Teaching Project American Gastroenterological Association
CIRRHOSIS AND PORTAL HYPERTENSION Cirrhosis and Portal Hypertension Gastroenterology Teaching Project American Gastroenterological Association WHAT IS CIRRHOSIS? What is Cirrhosis? DEFINITION OF CIRRHOSIS
More informationPORTAL HYPERTENSION An Introduction to the Culprit of Many Liver Failure Complications
PORTAL HYPERTENSION An Introduction to the Culprit of Many Liver Failure Complications Edy G. Trujillo, RN, MSN, ACNP-BC Liver Transplant RRUCLA Medical Center July 31, 2018 What Do We All Look Forward
More informationThe Continuum of Care for Advanced Liver Disease: Partnering with the Liver Specialist. K V Speeg, MD, PhD UT Health San Antonio
The Continuum of Care for Advanced Liver Disease: Partnering with the Liver Specialist K V Speeg, MD, PhD UT Health San Antonio Objectives Review staging of liver disease Review consequences of end-stage
More informationApproach to the Patient with Liver Disease
Approach to the Patient with Liver Disease Diagnosis of liver disease Careful history taking Physical examination Laboratory tests Radiologic examination and imaging studies Liver biopsy Liver diseases
More informationComplications of Cirrhosis
Complications of Cirrhosis Causes of Cirrhosis Alcohol Chronic Viral Hepatitis (B/C) Haemochromatosis Autoimmune Hepatitis NAFLD/NASH Primary Biliary Cirrhosis Primary Sclerosing Cholangitis 1-AT deficiency
More informationJaundice. Agnieszka Dobrowolska- Zachwieja, MD, PhD
Jaundice Agnieszka Dobrowolska- Zachwieja, MD, PhD Jaundice definition Jaundice, as in the French jaune, refers to the yellow discoloration of the skin. It arises from the abnormal accumulation of bilirubin
More informationEnd-Stage Liver Disease (ESLD): A Guide for HIV Physicians
Slide 1 of 32 End-Stage Liver Disease (ESLD): A Guide for HIV Physicians Marion G. Peters, MD John V. Carbone, MD, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California
More informationLiver Failure. The most severe clinical consequence of liver disease is liver failure:
Liver diseases I The major primary diseases of the liver are: - Viral hepatitis, - Nonalcoholic fatty liver disease (NAFLD), - Alcoholic liver disease, - Hepatocellular carcinoma (HCC) Hepatic damage also
More informationComplications of Cirrhosis
What is Cirrhosis? Complications of Cirrhosis Paul J. Gaglio, MD Center for Liver Disease and Transplantation Columbia University College of Physicians and Surgeons NAFLD 1 PHYSICAL EXAM FINDINGS Decreased
More informationAscites Management. Atif Zaman, MD MPH Oregon Health & Science University Professor of Medicine Division of Gastroenterology and Hepatology
Ascites Management Atif Zaman, MD MPH Oregon Health & Science University Professor of Medicine Division of Gastroenterology and Hepatology Disclosure 1. The speaker Atif Zaman, MD MPH have no relevant
More informationInitial approach to ascites
Ascites: Filling and Draining the Water Balloon Common Pathogenesis in Refractory Ascites, Hyponatremia, and Cirrhosis intrahepatic resistance sinusoidal portal hypertension Splanchnic vasodilation (effective
More informationLiver failure &portal hypertension
Liver failure &portal hypertension Objectives: by the end of this lecture each student should be able to : Diagnose liver failure (acute or chronic) List the causes of acute liver failure Diagnose and
More informationSteps in Assessing Fibrosis 4/30/2015. Overview of Liver Disease Associated With HCV
Overview of Liver Disease Associated With HCV Marion G. Peters, MD John V. Carbone, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California San Francisco San Francisco,
More informationESLD a Guide for HIV Physicians. Marion Peters University of California San Francisco June 2015
ESLD a Guide for HIV Physicians Marion Peters University of California San Francisco June 2015 Disclosures Honararia from Johnson and Johnson Roche Merck Gilead Spouse employee of Hoffman La Roche Natural
More informationDenver Shunts vs TIPS for Ascites
Denver Shunts vs TIPS for Ascites Hooman Yarmohammadi MD Assistant Professor of Radiology Interventional Radiology & Image Guided Therapies Memorial Sloan-Kettering Cancer Center, New York, USA Hooman
More informationTreating patients with end-stage liver disease: Are we ready? Dr. Mino R. Mitri, M.D., C.M., M.Ed., FRCPC
Treating patients with end-stage liver disease: Are we ready? Dr. Mino R. Mitri, M.D., C.M., M.Ed., FRCPC mino.mitri@ubc.ca No Conflict of Interest 157 patients 157 patients 6 transplanted Criteria Liver
More informationDISEASE LEVEL MEDICAL EVIDENCE PROTOCOL
DISEASE LEVEL MEDICAL EVIDENCE PROTOCOL 1. This Protocol sets out the medical evidence that must be delivered to the Administrator for proof of Disease Level. It is subject to such further and other Protocols
More informationChronic Hepatic Disease
Chronic Hepatic Disease 10 th Leading Cause of Death Liver Functions Energy Metabolism Protein Synthesis Solubilization, Transport, and Storage Protects and Clears drugs, damaged cells Causes of Liver
More informationThe Yellow Patient. Dr Chiradeep Raychaudhuri, Consultant Hepatologist, Hull University Teaching Hospitals NHS Trust
The Yellow Patient Dr Chiradeep Raychaudhuri, Consultant Hepatologist, Hull University Teaching Hospitals NHS Trust there s a yellow patient in bed 40. It s one of yours. Liver Cirrhosis Why.When.What.etc.
More informationManagement of Cirrhotic Complications Uncontrolled Ascites. Siwaporn Chainuvati, MD Siriraj Hospital Mahidol University
Management of Cirrhotic Complications Uncontrolled Ascites Siwaporn Chainuvati, MD Siriraj Hospital Mahidol University Topic Definition, pathogenesis Current therapeutic options Experimental treatments
More informationA Review of Liver Function Tests. James Gray Gastroenterology Vancouver
A Review of Liver Function Tests James Gray Gastroenterology Vancouver Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted
More informationPORTAL HYPERTENSION. Tianjin Medical University LIU JIAN
PORTAL HYPERTENSION Tianjin Medical University LIU JIAN DEFINITION Portal hypertension is present if portal venous pressure exceeds 10mmHg (1.3kPa). Normal portal venous pressure is 5 10mmHg (0.7 1.3kPa),
More informationCOMPLICATIONS OF CIRRHOSIS: ASCITES & HEPATIC ENCEPHALOPATHY
COMPLICATIONS OF CIRRHOSIS: ASCITES & HEPATIC ENCEPHALOPATHY DR. ESTER YAGUDAYEVA CLINICAL PHARMACIST HOSPICE PHARMACY SOLUTIONS OBJECTIVES Understand the prognosis of End Stage Liver Disease (ESLD) Identify
More informationCHAPTER 7. End Stage Liver Disease in the ICU: Walking a Tightrope. Lynn A. Kelso, MSN, APRN, FCCM, FAANP University of Kentucky College of Nursing
CHAPTER 7 End Stage Liver Disease in the ICU: Walking a Tightrope Lynn A. Kelso, MSN, APRN, FCCM, FAANP University of Kentucky College of Nursing Besey Oren, Assistant Professor Istanbul University Health
More informationLiver Transplantation Evaluation: Objectives
Liver Transplantation Evaluation: Essential Work-Up Curtis K. Argo, MD, MS VGS/ACG Regional Postgraduate Course Williamsburg, VA September 13, 2015 Objectives Discuss determining readiness for transplantation
More informationManagement of the Cirrhotic Patient in the ICU
Management of the Cirrhotic Patient in the ICU Peter E. Morris, MD Professor & Chief, Pulmonary, Critical Care and Sleep Medicine University of Kentucky Conflict of Interest Funding US National Institutes
More informationDefinition: HPS is a disease process with a triad of: 1- Liver disease. 2- Widespread intrapulmonary vasodilatation. 3- Gas exchange abnormality prese
Hepatopulmonary syndrome (HPS) By Alaa Haseeb, MS.c Definition: HPS is a disease process with a triad of: 1- Liver disease. 2- Widespread intrapulmonary vasodilatation. 3- Gas exchange abnormality presenting
More informationfollowing the last documented transfusion; thereafter, evaluate the residual impairment(s).
Adult Listings 5.01 Category of Impairments, Digestive System 5.02 Gastrointestinal hemorrhaging from any cause, requiring blood transfusion (with or without hospitalization) of at least 2 units of blood
More informationCrackCast Episode 28 Jaundice
CrackCast Episode 28 Jaundice Episode overview: 1) Describe heme metabolism 2) List common pre-hepatic/hepatic/post-hepatic causes of jaundice Wisecracks: 1) What are clinical signs of liver disease? 2)
More informationEDUCATION PRACTICE. Management of Refractory Ascites. Clinical Scenario. The Problem
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2005;3:1187 1191 EDUCATION PRACTICE Management of Refractory Ascites ANDRÉS CÁRDENAS and PERE GINÈS Liver Unit, Institute of Digestive Diseases, Hospital Clínic,
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Accelerated intravascular coagulation and fibrinolysis (AICF) in liver disease, 390 391 Acid suppression in liver disease, 403 404 ACLF.
More informationOntario s Adult Referral and Listing Criteria for Liver Transplantation
Ontario s Adult Referral and Listing Criteria for Liver Transplantation Version 3.0 Trillium Gift of Life Network Ontario s Adult Referral & Listing Criteria for Liver Transplantation PATIENT REFERRAL
More informationInitial Evaluation for HCV Therapy. Hope McGratty PA-C, MPH
Initial Evaluation for HCV Therapy Hope McGratty PA-C, MPH Conflict of Interest Disclosure Statement None Who are we talking about today? Treatment naïve Chronic infection This patient seems complicated
More informationRISK STRATIFICATION IN CIRRHOSIS: FOCUS ON UMBILICAL HERNIA Sam Hawkins MD PGY5
RISK STRATIFICATION IN CIRRHOSIS: FOCUS ON UMBILICAL HERNIA Sam Hawkins MD PGY5 PATIENT PRESENTATION 73M w/ Hep B Cirrhosis, HTN, DM II Liver disease followed at OSH x2 years (when moved from China), on
More informationResident Teaching Conference:
Resident Teaching Conference: Evaluation of the Dreaded Liver Mass May 6, 2011 Sunil Geevarghese, MD, HS 00 Matt Landman, MD Anatomy Overview Couinaud anatomy Resection nomenclature Functional Assessment
More information5/8/2018. Update on Liver Disease. Learning Objectives. Abnormal Liver Tests
Update on Liver Disease Heather Patton, MD, AGAF, FAASLD Transplant Hepatology San Diego Learning Objectives Categorize liver test abnormality as hepatocellular, cholestatic, or mixed and based on pattern,
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A ACLF. See Acute-on-chronic liver failure (ACLF) Acute kidney injury (AKI) in ACLF patients, 967 Acute liver failure (ALF), 957 964 causes
More informationUnderstanding this condition will help you provide optimal care for patients and their families.
Cirrhosis A complex cascade of care ILLUSTRATION BY STEVE OH/PHOTOTAKE Understanding this condition will help you provide optimal care for patients and their families. By Ann Crawford, PhD, RN, CNS, CEN,
More informationContraindications. Indications. Complications. Currently TIPS is considered second or third line therapy for:
Contraindications Absolute Relative Primary prevention variceal bleeding HCC if centrally located Active congestive heart failure Obstruction all hepatic veins Thomas D. Boyer, M.D. University of Arizona
More informationLiver Diseases. Yasmine Lashine MD, PhD
Liver Diseases Yasmine Lashine MD, PhD ILOs Recognize different causes of Live failure Recall and understand clinical picture and complication of Liver failure Discuss causes and clinical picture of hepatic
More informationHow to manage your patient with cirrhosis. HUGO E. VARGAS, M.D, FAASLD, FACG, AGAF, FACP Professor of Medicine MAYO CLINIC, ARIZONA
How to manage your patient with cirrhosis HUGO E. VARGAS, M.D, FAASLD, FACG, AGAF, FACP Professor of Medicine MAYO CLINIC, ARIZONA Objectives What we will review: Diagnosis of cirrhosis What do I do
More informationNorepinephrine versus Terlipressin for the Treatment of Hepatorenal Syndrome
Norepinephrine versus Terlipressin for the Treatment of Hepatorenal Syndrome Disclosure I have no conflicts of interest to disclose Name: Margarita Taburyanskaya Title: PharmD, PGY1 Pharmacy Practice Resident
More informationNursing Care & Management of the Pre-Liver Transplant Population. Christine Kiamzon, RN, MSN, PCCN 8 North Educator
Nursing Care & Management of the Pre-Liver Transplant Population Christine Kiamzon, RN, MSN, PCCN 8 North Educator Objectives 1. Identify key nursing interventions in caring for pre-transplant ESLD patients.
More informationNursing Care & Management of the Pre-Liver Transplant Population
Nursing Care & Management of the Pre-Liver Transplant Population Christine Kiamzon, RN, MSN, PCCN 8 North Educator Objectives 1. Identify key nursing interventions in caring for pre-transplant ESLD patients.
More informationCauses of Liver Disease in US
Learning Objectives Updates in Outpatient Cirrhosis Management Jennifer Guy, MD MAS Director, Liver Cancer Program California Pacific Medical Center guyj@sutterhealth.org Review cirrhosis epidemiology,
More informationGastrointestinal System: Accessory Organ Disorders
Gastrointestinal System: Accessory Organ Disorders Mary DeLetter, PhD, RN Associate Professor Dept. of Baccalaureate and Graduate Nursing Eastern Kentucky University Disorders of Accessory Organs Portal
More informationTranjugular Intrahepatic Portosystemic Shunt
Tranjugular Intrahepatic Portosystemic Shunt Christopher Selhorst July 25, 2005 BIDMC Radiology Overview Portal Hypertension Indications, Contraindications The Procedure Case Review Complications Outcomes
More informationPortal hypertension and ascites
Portal hypertension and ascites Muhammad S Mirza Guruprasad P Aithal Abstract Portal pressure is the product of portal blood flow and resistance; an increase in either leads to increased portal pressure.
More informationPodcast (Video Recorded Lecture Series): Portal HTN and Derivatives for the USMLE Step One Exam. Ultrasound (w/ doppler) Reversal of flow Portal Vein
Podcast (Video Recorded Lecture Series): Portal HTN and Derivatives for the USMLE Step One Exam Hepatic Vein (Budd Chiari) Ultrasound (w/ doppler) Reversal of flow Portal Vein Howard J. Sachs, MD www.12daysinmarch.com
More informationEndovascular Techniques for Symptomatic Portal Hypertension. Michael Meuse, M.D. Vascular and Interventional Radiology
Endovascular Techniques for Symptomatic Portal Hypertension Michael Meuse, M.D. Vascular and Interventional Radiology Objectives Review indications and contraindications for TIPS Define a treatment algorithm
More informationThe Management of Ascites & Hepatorenal Syndrome. Florence Wong University of Toronto. Falk Symposium March 14, 2008
The Management of Ascites & Hepatorenal Syndrome Florence Wong University of Toronto Falk Symposium March 14, 2008 Management of Ascites Sodium Restriction Mandatory at all stages of ascites in order to
More informationManagement of Ascites and Hepatorenal Syndrome. Florence Wong University of Toronto. June 4, /16/ Gore & Associates: Consultancy
Management of Ascites and Hepatorenal Syndrome Florence Wong University of Toronto June 4, 2016 6/16/2016 1 Disclosures Gore & Associates: Consultancy Sequana Medical: Research Funding Mallinckrodt Pharmaceutical:
More informationEvaluating HIV Patient for Liver Transplantation. Marion G. Peters, MD Professor of Medicine University of California San Francisco USA
Evaluating HIV Patient for Liver Transplantation Marion G. Peters, MD Professor of Medicine University of California San Francisco USA Slide 2 ESLD and HIV Liver disease has become a major cause of death
More informationCLINICAL How Should a Hospitalized Patient with Newly Diagnosed Cirrhosis Be Evaluated and Managed?
CLINICAL How Should a Hospitalized Patient with Newly Diagnosed Cirrhosis Be Evaluated and Managed? The Hospitalist. 2016 August;2016(8) Author(s): Raj Sehgal, MD; Joshua Hanson, MD, MPH; Division OF The
More informationHEPATOrenal Syndrome Type I: Correct Diagnosis = Correct Management
HEPATOrenal Syndrome Type I: Correct Diagnosis = Correct Management Stephen G. M. Wong BSc, BSc(Med), MD, MHSc, FRCPC Associate Professor of Medicine Director, Hepatology Education Section of Hepatology
More informationCIRRHOSIS Definition
Cirrhosis Update Robert S. Brown, Jr., MD, MPH Vice Chair, Transitions of Care Interim Chief, Division of Gastroenterology & Hepatology Weill Cornell Medical College CIRRHOSIS Definition Irreversible fibrous
More informationInterpreting Liver Function Tests
PSH Clinical Guidelines Statement 2017 Interpreting Liver Function Tests Dr. Asad A Chaudhry Consultant Hepatologist, Chaudhry Hospital, Gujranwala, Pakistan. Liver function tests (LFTs) generally refer
More information4/3/2014. Elizabeth Thompson, PharmD April Understand the importance of the liver and basic physiology.
Liver Disease Elizabeth Thompson, PharmD thompse@sarmc.org April 2014 Objectives Understand the importance of the liver and basic physiology. Review hepatic disorders Recognize liver function scoring systems
More informationHepatorenal Syndrome
Necker Seminars in Nephrology Institut Pasteur Paris, April 22, 2013 Hepatorenal Syndrome Dr. Richard Moreau 1 INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, 2 Université Paris Diderot
More informationDiagnostic Procedures. Measurement of Hepatic venous pressure in management of cirrhosis. Clinician s opinion
5 th AISF Post-Meeting Course Diagnostic and Therapeutic Invasive Procedures in Hepatology Rome, February 25 th Diagnostic Procedures Measurement of Hepatic venous pressure in management of cirrhosis Clinician
More informationHepatocytes produce. Proteins Clotting factors Hormones. Bile Flow
R.J.Bailey MD Hepatocytes produce Proteins Clotting factors Hormones Bile Flow Trouble.. for the liver! Trouble for the Liver Liver Gall Bladder Common Alcohol Hep C Fatty Liver Cancer Drugs Viruses Uncommon
More informationLIVER DISEASES. Anatomy
LIVER DISEASES Anatomy PHYSIOLOGY Bilirubin metabolism: 250-300 mg/d SER Bile UDPG-A B. diglucuronide Unc. B B. monoglucuronide Albumin Glucuronyltransferase 100-200 mg/d Bacteria 4mg In urine urobilinogen
More informationLife After SVR for Cirrhotic HCV
Life After SVR for Cirrhotic HCV KIM NEWNHAM MN, NP CIRRHOSIS CARE CLINIC UNIVERSITY OF ALBERTA Objectives To review the benefits of HCV clearance in cirrhotic patients To review some of the emerging data
More informationCONTROLLED DOCUMENT. Cirrhosis Care Bundle CATEGORY: Clinical Guidelines. CLASSIFICATION: Clinical. Controlled Document CG201 Number:
Cirrhosis Care Bundle CONTROLLED DOCUMENT CATEGORY: Clinical Guidelines CLASSIFICATION: Clinical Controlled Document CG201 Number: Version Number: 1 Controlled Document Clinical Guidelines Group Sponsor:
More informationLearning Objectives. After attending this presentation, participants will be able to:
Learning Objectives After attending this presentation, participants will be able to: Describe HCV in 2015 Describe how to diagnose advanced liver disease and cirrhosis Identify the clinical presentation
More informationHepatic Encephalopathy
Hepatic Encephalopathy John Barber UMassMedical Student, Class of 2019 www.12daysinmarch.com Outline Overview Normal Physiology Pathology Symptoms Diagnosis Treatment Overview Ammonia (NH 3 ) is a byproduct
More informationHepatic dysfunction: Can we recognize it sooner? And intervene earlier
Hepatic dysfunction: Can we recognize it sooner? And intervene earlier Juliet M.Lopez, M.D. Chief, General Surgery Division Raymond G Murphy Veterans Administration Medical Center, ABQ, NM Prometheus Hepatic
More informationEvidence-Base Management of Esophageal and Gastric Varices
Evidence-Base Management of Esophageal and Gastric Varices Rino Alvani Gani Hepatobiliary Division Department of Internal Medicine Faculty of Medicine Universitas Indonesia Cipto Mangunkusumo National
More informationElevated Creatinine in a Patient With Cirrhosis
REVIEW Elevated Creatinine in a Patient With Cirrhosis Heather L. Klavan, M.D., and Brett E. Fortune, M.D., M.S. Elevation in serum creatinine is a common laboratory finding for patients with cirrhosis
More informationDISCLOSURES. This activity is jointly provided by Northwest Portland Area Indian Health Board and Cardea
DISCLOSURES This activity is jointly provided by Northwest Portland Area Indian Health Board and Cardea Cardea Services is approved as a provider of continuing nursing education by Montana Nurses Association,
More informationBeta-blockers in cirrhosis: Cons
Beta-blockers in cirrhosis: Cons Eric Trépo MD, PhD Dept. of Gastroenterology. Hepatopancreatology and Digestive Oncology. C.U.B. Hôpital Erasme. Université Libre de Bruxelles. Bruxelles. Belgium Laboratory
More informationCLINICAL APPROACH TO ASCITES. Dr Lui Hock Foong FRCP, FAMS (Gastroenterology)
CLINICAL APPROACH TO ASCITES Dr Lui Hock Foong FRCP, FAMS (Gastroenterology) CLINICAL PRESENTATION De Novo OR during follow-up of chronic disease Presentation: Increased abdominal girth, abdominal distension
More informationD. Debray, Hépatologie pédiatrique Hôpital Bicêtre
D. Debray, Hépatologie pédiatrique Hôpital Bicêtre LUNG LIVER GUT AND PORTAL SYSTEM Hepatopulmonary syndrome (HPS) Portopulmonary hypertension (PPH) HEPATOPULMONARY SYNDROME Defect in arterial oxygenation
More informationManagement in Cirrhosis
Management in Cirrhosis Outline Introduction Cause of cirrhosis and management General management in cirrhosis Management complication and surveillance Clue of Chronic Liver Disease and Cirrhosis Risk
More informationAssessment of Liver Function: Implications for HCC Treatment
Assessment of Liver Function: Implications for HCC Treatment A/P Dan Yock Young MBBS, PhD, MRCP, MMed. FAMS Chair, University Medicine Cluster. NUHS Head, Department of Medicine, National University of
More informationSign up to receive ATOTW weekly -
HEPATORENAL SYNDROME ANAESTHESIA TUTORIAL OF THE WEEK 240 10 TH SEPTEMBER 2011 Gerry Lynch Rotherham General Hospital Correspondence to gerry.lynch@rothgen.nhs.uk QUESTIONS Before continuing, try to answer
More informationRenal Care and Liver Disease: Disease Trajectory and Hospice Eligibility
Renal Care and Liver Disease: Disease Trajectory and Hospice Eligibility Terri L. Maxwell PhD, APRN VP, Strategic Initiatives Weatherbee Resources/HEN Course Materials & Disclosure Course materials including
More informationComplications of Portal Hypertension A Practical Management Approach
Complications of Portal Hypertension A Practical Management Approach Advances in Liver Disease 2018: A Year in Review 12/8/18 Richard Kalman, MD Assistant Professor of Medicine SKCM Einstein Healthcare
More informationManagement of Acute Decompensation of Cirrhosis JOHN O GRADY KING S COLLEGE HOSPITAL
Management of Acute Decompensation of Cirrhosis JOHN O GRADY KING S COLLEGE HOSPITAL Terminology Acute decompensation of cirrhosis - stable patient with sudden deterioration Acute-on-chronic liver failure
More informationHepatorenal syndrome. Jan T. Kielstein Departent of Nephrology Medical School Hannover
Hepatorenal syndrome Jan T. Kielstein Departent of Nephrology Medical School Hannover Hepatorenal Syndrome 1) History of HRS 2) Pathophysiology of HRS 3) Definition of HRS 4) Clinical presentation of HRS
More informationThe Liver for the Nonhepatologist
The Liver for the Nonhepatologist Michael R. Charlton, MBBS, FRCP Professor of Medicine University of Chicago Chicago, Illinois Overview Initial assessment of liver disease How do you diagnose cirrhosis?
More informationProf. Mohammad Umar. MBBS, MCPS, FCPS, FACG (USA), FRCP (London), FRCP (Glasgow), FAGA
Prof. Mohammad Umar MBBS, MCPS, FCPS, FACG (USA), FRCP (London), FRCP (Glasgow), FAGA Chairman and Head Department of Medicine Rawalpindi Medical College, Rawalpindi. Consultant Gastroenterologist / Hepatologist
More informationApproach to Abnormal Liver Tests
Approach to Abnormal Liver Tests Scott W. Biggins, MD, MAS Assistant Professor Division of Gastroenterology UCSF Scott.Biggins@ucsf.edu (Thanks to Hal Yee, MD) This Morning s Presentation Clinical vignettes
More informationR1 orientation 蘇哲萱 2014/10/21
R1 orientation 蘇哲萱 2014/10/21 I. Decompensated liver cirrhosis & associated complications II. GI Bleeding Liver cirrhosis Compensate liver cirrhosis Decompensate liver cirrhosis Prognosis of Liver cirrhosis
More informationCHAPTER 1. Alcoholic Liver Disease
CHAPTER 1 Alcoholic Liver Disease Major Lesions of Alcoholic Liver Disease Alcoholic fatty liver - >90% of binge and chronic drinkers Alcoholic hepatitis precursor of cirrhosis Alcoholic cirrhosis end
More informationInterpreting Your Tests
Interpreting Your Tests Lisa M. Forman, MD, MSCE Associate Professor of Medicine Section Hepatology and Liver Transplantation University of Colorado Denver Outline Bile Duct Anatomy Lab Tests LFTs Tumor
More informationBETA-BLOCKERS IN CIRRHOSIS.PRO.
BETA-BLOCKERS IN CIRRHOSIS.PRO. Angela Puente Sánchez. MD PhD Hepatology Unit. Gastroenterology department Marques de Valdecilla University Hospital. Santander INTRODUCTION. Natural history of cirrhosis
More informationVARICEAL BLEEDING. Ram Subramanian MD Hepatology & Critical Care Medical Director of Liver Transplant Emory University, Atlanta.
VARICEAL BLEEDING Ram Subramanian MD Hepatology & Critical Care Medical Director of Liver Transplant Emory University, Atlanta Disclosures: None OUTLINE Pathophysiology of portal hypertension Splanchnic
More informationTransplant Hepatology
Transplant Hepatology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified
More informationCIRRHOTIC MANAGEMENT
DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care
More informationSupplemental Tables. Parasitic Schistosomiasis increase < 1. Genetic Hemochromatosis increase < 1. autoimmune Autoimmune hepatitis (AIH) increase < 1
Supplemental Tables Supplemental Table 1 Various etiologies of liver cirrhosis and their association with liver stiffness and AST/ALT ratio Disease category Cause Example LS AST/ALT Inflammatory liver
More information