Not All Patients With Liver Disease Have HCV Diagnosis and Management of Some Common Non HCV Liver Diseases
|
|
- Ashlynn Short
- 6 years ago
- Views:
Transcription
1
2 Not All Patients With Liver Disease Have HCV Diagnosis and Management of Some Common Non HCV Liver Diseases Lisa Ganjhu, DO, FACG, AGAF Clinical Assistant Professor of Medicine Division of Gastroenterology and Hepatology NYU Langone Medical Center
3 Prevalence of Chronic Liver Disorders in the United States Nonalcoholic Fatty Liver Disorder 1 Nonalcoholic steatohepatitis 2 Chronic Hepatitis C 3 Alcoholic Liver Disease 4 Hemochromatosis 5 Chronic Hepatitis B Percent of Population 1. Hilden M et al. Scand J Gastroenterol. 1977;12: Ground KEU. Aviat Spac Environ Med. 1982;53; Alter MF et al. N Engl J Med. 1999;341: Venkataramani A et al. In: Maddrey WC, Feldman M, eds. Atlas of the Liver. Philadelphia: Current Medicine;1999: Adapted from Accessed 11/01/ McQuillan GM et al. Am J Public Health 1999;89:
4 Chronic Liver Disease Prevalence In New York University Clinical Practice Chronic Hepatitis C Non Alcoholic Fatty Liver Disease Cryptogenic Cirrhosis Alcohol Related Liver Disease Chronic Hepatitis B Primary Biliary Cirrhosis Autoimmune Liver Disease Hemochromatosis (Hepato Celllular Carcinoma)
5 Non Alcoholic Fatty Liver Disease Major risk factors Central obesity Diabetes Hyperlipidemia Metabolic syndrome (insulin resistance, hypertension) Usual age 40s 50s Possible associated conditions Polycystic ovarian syndrome Hypothyroidism Hypogonadism
6 Alternate Causes of Hepatic Steatosis Alcoholic Liver disease Hepatitis C (esp. Genotype 3) Starvation Parenteral Nutrition Abetalipoproteinemia Reye s syndrome AFLPregnancy HELLP Syndrome Wilson s Disease DILI Medications: Methotrexate Amiodarone Tamoxifen Steroids Valproate HIV drugs Various inborn errors of metabolism, lypodystrophy
7 NAFLD and Cirrhosis NAFLD is major cause of cryptogenic cirrhosis Cirrhosis occurs when steatosis progresses to steatohepatitis (inflammation) and fibrosis Major risk factor for progression to cirrhosis is presence of inflammation on liver biopsy Other risk factors: older age, DM, ALT >2X ULN, ballooning degen on liver bx, BMI>28, obesity, alcoholic intake >60g/day Increased risk of HCC with or without cirrhosis
8 Diagnosis of NAFLD/NASH Demonstration of steatosis by imaging or biopsy Exclusion of alcohol etiology & other specific causes Hepatomegaly (only 10-18%) Abnormal enzymes: AST & ALT 2X-5X ULN, AST: ALT ratio <1,(vs ETOH >2) AP 2-3X ULN Normal enzymes do not preclude significant histopathology Increased iron and ferritin may be present
9 Imaging Studies in Diagnosis of NAFLD Ultrasound Transient elastography (Fibroscan ) of limited value to evaluate fibrosis in patients with marked steatosis Liver biopsy to definitively establish level of inflammation 85% sensitivity 94% specificity Sensitivity markedly reduced in morbid obesity (49%) Non Contrast CT Sensitivity 33% Contrast CT Sensitivity 50% MRI Sensitivity 88%
10 NAFLD/NASH Treatment Low carbohydrate weight loss diet Aim for 1-2 lbs/week Exercise Avoid alcohol Screen all NASH cirrhosis for cancer
11 NAFLD/NASH Treatment Vitamin E 800 ug/day Pioglitazone Rosiglitazone Atorvastatin, Pentoxifylline Omega 3 fatty acids Branched Chain Amino Acids SAMe Losarten Metformin & Urso: not proven helpful
12 Alcohol Related Liver Disease
13 Spectrum of ETOH Induced Liver Pathology Fatty liver Alcoholic Hepatitis Liver Fibrosis Cirrhosis Hepatocellular Carcinoma
14
15 Multifactorial Physiology of Alcoholic Liver Disease Metabolic induction of hepatic steatosis Alcohol induced inflammatory cytokine reactions Immunologic reaction stimulation Role of microbiome Role of LPS Effect on the triglyceride circulation pattern Inhibition of adiponectin
16 Alcohol Induced Fatty Liver: Ethanol Inhibits Adiponectin Secretion
17 ETOH Induced Adiponectin Reduction Significantly Affects ALD Development
18 Alcohol Intake Patterns Low Risk: Men <4 drinks/day Maximum 14/week Women: <3 drinks/day Maximum 7/week Moderate: up to 2 drinks/day men 1drink/day women High Risk: Binge drinking Women 5 drinks/2 hours Men 4 drinks/2 hours WHO definition excessive ETOH intake Men > 60gms/day Women > 40 gms/day
19 Alcoholic Fatty Liver 80% of patients drinking >60 g alcohol a day have increased fat in liver Elevated AST, usually normal ALT Ultrasound is a useful diagnostic test Non invasive fibrosis testing Fibroscan may be limited value
20 Alcoholic Hepatitis Symptoms: Physical examination Fever Jaundice Nausea Hepatomegaly Anorexia Splenomegaly Fatigue Evidence of malnutrition Pruritus Ascites (75%) Weakness Right upper quadrant pain Confusion
21 Blood Test Diagnosis of ALD Elevated ALT and AST AST/ALT ratio >2; AST > 300 rarely seen in ALD GGTP: most frequently used marker for early detection of excessive ethanol intake 73% sensitivity classically 4x higher in ALD as compared to other liver diseases loses alcohol specificity in more advanced stages of liver disease Carbohydrate Deficient Transferrin (CDT): 70% sensitivity for detection of ethanol consumption >50 g/day Combined: GGTP, MCV, CDT & AST/ALT ratio 90% spec/ sensitivity
22 Assessment of Alcoholic Hepatitis Discriminant Function Glasgow Alcoholic Hepatitis Score (GHAS) Lille Score
23 Maddrey Discriminant Function 4.6 x (PT-Control PT)+Total Bil (mg/dl) DF > 32, 50% mortality DF > 32, consider treatment
24 Glasgow Alcoholic Hepatitis Score Factors Age WBC BUN PT ratio, Bilirubin GHACS score 28 day survival 84 day survival <9 87% 79% >9 46% 40%
25 Lille Score Dynamic Model Factors: Assess steroid treatment response at day 7 Age Lille Score >0.45: 25% six month survival Bilirubin Day 7 Lille Score <0.45: 85% six month survival Albumin Day 0 Bilirubin Day 0 Creatinine Day 0 Pro Time Day 0
26 Treatment of Acute Alcoholic Hepatitis Alcohol abstinence Address alcohol withdrawal syndrome: Address malnutrition Address renal dysfunction & HRS Address bacterial infection
27 Specific Therapeutic Measures In Severe Acute Alcoholic Hepatitis Corticosteroids: 5 recent RCTs clearly demonstrate increased 28 day survival in steroid treated patients Maddrey Discriminant Function >32 Stopping rule: Lille score 0.56 at 7 days defines non-response Infection is not contraindication but must be treated aggressively
28 Therapeutic Measures for Acute Severe Alcoholic Hepatitis Pentoxifylline: anti-oxidant and weak anti- TNF agent/anticytokine therapy Patients with DF>32 treated with Pentoxifylline had higher 6 month survival Decreased incidence HRS Early switch to PTX in steroid non-responders does not seem effective rescue RX Value of combination therapy not established
29 Glucocorticoids Plus NAC In Severe Alcoholic Hepatitis Nguyen-Khac etal NEJM Nov 10, 2011 Maddrey DF >50 40 mg prednisolone/day x28 days IV NAC days 1-5: 300mg/kg day 1 and 100mg/kg days 2-5 Total 174 patients-11 hospitals
30 N-Acetylcysteine NAC replenishes glutathione NAC alone is inferior to steroids Combination of NAC & steroids Lower incidence of HRS and infection Increased survival
31 Prednisone + NAC in Severe Alcoholic Hepatitis Prednisone 1 month mortality 3 month mortality 6 month mortality Hepatorenal deaths 24% 34% 38% 22% 22% 27% 9% Prednisone/ 8% NAC Deaths, variceal hemorrhage greater in NAC group Septic shock greater in prednisone group Nguyen-Khac etal NEJM Nov 10, 2011
32 Liver Transplantation for Acute Alcoholic Hepatitis
33 Early Liver Transplantation for Severe ETOH Hepatitis 26 patients Lille scores > month survival 2 year survival Transplant 77% 72% Control 23% 24% MELD at OLTX 34 5/6 post transplant deaths secondary to infection 3/26 ultimately resumed some alcohol intake but this did not adversely affect graft function NEJM Mathurin et al Nov 10, 2011
34 Chronic Hepatitis B
35 Hepatitis B Virus (HBV) Hepatitis B Virus Lipid Bilayer Envelope Capsid (œ) (+) HBV DNA pol Transmission electron micrograph of HBV from blood of patient with hepatitis B
36 Hepatitis B Epidemiology About 2 billion persons world wide are infected with HBV About 800 million people have chronic hepatitis B Over 2 million persons in US have chronic hepatitis B Highest incidence in US is in Asian population with estimates of 8 to 12% Patients infected with HBV at birth have 95% chance developing chronic disease Those infected in adulthood 5% CHB
37 Presentations of Hepatitis B Asymptomatic carrier of hepatitis B virus with normal liver enzymes Asymptomatic carrier of hepatitis B virus with ongoing hepatitis HBV infected patient with cirrhosis, stable or decompensated HBV infected patient with HCC HBV patient with acute liver failure Acute HBV flare resulting from non prophylaxis prior to chemotherapy or immunosuppression
38 Evaluation for HBV Liver Disease Asian population is high risk group and must be screened, whether or not they have evidence of ongoing hepatitis Majority of virus carriers are unaware they have disease Panel of HBV serologic tests should be performed Patients with any serologic positivity should have HBV DNA determination Imaging studies need to be done to r/o occult cirrhosis and HCC
39 ALT as Measure of HBV Elevation of ALT indicates liver injury New surveys indicate normal as 19 for woman and 30 for men Initial normal levels of ALT may fluctuate and should be assessed every three months Poor correlation between normal ALT and the extent of liver injury Up to 40% of CHB individuals with normal ALT may have significant fibrosis on liver biopsy
40 Serological Markers of HBV HBsAg: marker of HBV infection HBsAB: marker of HBV immunity / recovery HBeAg clinical marker of infectivity and replication Anti Hbe: antibody to HBeAg, may indicate recovery from infection Anti HBc: IGM (current acute infection or flare)or IGG (current, non acute or past infection)
41 Hepatitis B and Hepatocellular Carcinoma Hepatitis B patients develop carcinoma without developing cirrhosis 70% of HBV deaths are due to HCC Asian Americans are almost 3X as likely to develop HCC as other Americans Persons with highest viral counts are most likely to develop HCC
42 The Reveal Study Almost 4000 chronic hepatitis B patients in Taiwan Risk of cirrhosis increased directly with viral HBV DNA load Starting with viral loads as low as 300 c/ml (1.4X) up to viral loads of 1 million (9.8X) Risk of hepatocellular carcinoma also increases directly with viral load Highest risk when HBVDNA >1 million
43 Progression of HBV Disease Up to half of chronically infected patients will develop progressive liver disease with ongoing liver injury and increasing fibrosis Ultimate progression to cirrhosis and HCC Viral suppression prevents progression
44 HBV: Who Should Be Treated? Multiple guidelines from various professional societies differ in recommendations Essentially all HBV patients with elevated ALT are candidates for treatment All HBV patients with viral counts above 10K are potential candidates for treatment All HBV cirrhotics are candidates for treatment
45 Comparison of Initiation Thresholds Among Existing CHB Treatment Guidelines/Algorithms Guidelines/ Algorithm AASLD US Treatment Algorithm EASL APASL HBeAg+ HBV DNA ALT (IU/mL) (U/L) >20,000 >2x ULNb or (+) biopsy 20,000 >ULNb or (+) biopsy > ,000 >ULNa or (+) biopsy >2x ULNaor (+) biopsy HBeAgHBV DNA ALT (IU/mL) (U/L) >20,000 or >2000 if (+) biopsy 2x ULNb or (+) biopsy 2000 >ULNb or (+) biopsy >2000 >ULNa or (+) biopsy 2000 >2x ULNa or (+) biopsy auln for EASL (2009) and APASL (2008) is the local reference lab; buln for US Algorithm (2008) and AASLD (2009): 30 IU/mL (men) and 19 IU/mL (women). AASLD, American Association for the Study of Liver Diseases; APASL, Asian Pacific Association for the Study of the Liver; EASL, European Association for the Study of the Liver; ULN, upper limit of normal. 1Lok ASF, McMahon BJ. Hepatology. 2009;50: Keeffe EB, et al. Clin Gastroenterol Hepatol. 2008;6: J Hepatol. 2009;50: Liaw Y-F, et al. Hepatol Int. 2008;2: EASL.
46 Recommendations from the Asian American Treatment Algorithm Order HBeAg, HBV DNA, and ALT tests for all patients with CHB Clinical Stage HBeAg HBV DNA ALTb Immune Tolerant + >2000 IU/mL ULN Monitor Chronic Hepatitisa,b + >2000 IU/mL >ULN Treat Chronic Hepatitisa,b - >2000 IU/mL >ULN Treat Chronic Hepatitisb - >2000 IU/mL ULN Assess gray zone considerations Chronic Hepatitisb +/ IU/mL >ULN Assess gray zone considerations Cirrhosisc +/- Detectable NA Treat Cirrhosisc +/- Undetectable NA Monitor Decompensated Cirrhosisc +/- NA NA Treat Inactive Carrier IU/mL ULN aor Recommendation Monitor liver biopsy stage 1-3 and/or grade 1-3; balt normal range is based on local laboratory reference range; cpatients with signs and symptoms suggestive of advanced liver disease or indicative of cirrhosis should be evaluated by a specialist. These patients frequently require ongoing evaluation and management of liver-related complications. Tong MJ, et al. Dig Dis Sci. 2011;56(11):
47 Current Guideline Recommendations for First-line Therapy Peginterferon alfa-2a Exceptions: pregnancy, chemotherapy prophylaxis, decompensated cirrhosis, acute infection Entecavir Tenofovir EASL. J Hepatol. 2009;50: Liaw YF, et al. Hepatol Int. 2008;2: Lok AS, et al. Hepatology. 2009;50:
48 Cumulative Resistance Rate (%) 5-Yr Rates of Resistance With Oral Agents in Nucleos(t)ide-Naive Patients Lamivudine[1] Adefovir[1] Telbivudine*[1] Entecavir[1] Tenofovir[2] *Telbivudine rate determined at Yr EASL. J Hepatol. 2009;50: Marcellin P, et al. AASLD Abstract 1375.
49 Duration of Treatment Treatment is long term Usually indefinite with no established stopping guidelines HBeAg positive patients are generally treated until they turn HBeAg negative plus 1-2 years HBeAg negative patients are treated until they develop a positive HBsAB Some give medication discontinuation trial to those HBeAg negative patients who are HBV DNA negative for five years Restart treatment if they become positive again
50 Primary Biliary Cirrhosis
51 Primary Biliary Cirrhosis A chronic autoimmune liver disease caused by T-Lymphocyte mediated destruction of small intralobular bile ducts 90-95% women Onset typically between years of age > 60% of patients are asymptomatic at diagnosis Fatigue is most common complaint Pruritus may present in pregnancy and be mistaken for cholestasis of pregnancy (but doesn t resolve post partum)
52 PBC: Symptoms and Physical Findings Physical Findings Symptoms Pruritus Fatigue Jaundice 50-60% 66% 16% Asymptomatic >60% Usually normal Hepatomegaly 50-70% Excoriations of the skin Kayser-Fleischer rings Late findings: Splenomegaly Xanthoma Jaundice
53 PBC: Autoimmune Markers High IgM Anti-mitochondrial antibody (AMA) 95% positive M-2, M-4, M-8, M-9 antibodies Directed at pyruvate dehydrogenase E-2
54 PBC: Diagnosis Middle aged women with cholestasis Alkaline phosphatase 3-4X normal or more Mild transaminase elevations Up to 5X normal Positive AMA (95% of cases) Positive ANA (70%) Elevated IgM Elevated serum bile acids Liver biopsy confirms and stages
55 Histopathologic Classification of PBC Stage zero: normal liver Stage One: inflammation confined to portal areas including florid duct lesions and granulomas Stage Two: inflammation with fibrosis in peri-portal areas Stage Three: bridging fibrosis Stage Four: cirrhosis
56 PBC Associated Conditions Sjogrens syndrome: keratoconjunctivitis (dry eyes) and xerostomia (dry mouth) in 40-70% Classic rheumatoid arthritis 5-10% Scleroderma and CREST syndrome (calcinosis cutis, raynauds, esophageal dysmotility, sclerodactyly, telangiectasia) up to 15% patients Right upper quadrant discomfort Osteoporosis & osteomalacia Hyperpigmentation (not jaundice) and xanthoma
57 Treatment of PBC Ursodeoxycholic Acid 13-15mg/kg is first line treatment suppressing in inflammatory bile ductule destruction Stage 1 & 2 patients treated with UDCA generally have normal life expectancy 20-25% of PBC patients do not respond adequately to UDCA Combination therapy with UDCA and budesonide may be promising Triple therapy with UDCA, budesonide, and micophenolate mofetil under study Fibrates (fenofibrate) added to UDCA has been shown to improve biochemical resonse Obeticholic Acid (farnesoid X receptor agonist) positive trials in UDCA non responders Use of methotrexate and colchicine is questionable and discouraged Liver Transplantation is relatively uncommon in era of UDCA treatment
58 Monitoring of PBC Patients Liver biochemistry every 3-6 months Annual thyroid evaluation (autoimmune hypothyroidism in 20% patients) Vitamin D 1000u/day, calcium 1500mg Bone densitomitry every 2 years Monitor levels of vitamins A, D, K RX vitamin A units per day Increased incidence of noniron deficiency anemia Imaging studies every 12 months in non cirrhotics, every six months in cirrhotics Endoscopy yearly if cirrhosis suspected Hypercholesterolemia: common but does not require treatment Treatment of pruritus
59 Primary Sclerosing Cholangitis Chronic cholestasis associated with chronic inflammation of the biliary epithelium Multifocal bile duct strictures that can affect the entire biliary tree. Progression can lead to fibrosis and eventually cirrhosis as well as cholangiocarcinoma Median age onset 40 years > 90% male Survival: Asymptomatic patients: median 12-18yrs Symptomatic patients median 9 yrs
60 PSC: Presentation Asymptomatic Fatigue Pruritus Cholangitis Jaundice
61 Diagnosis of PSC Increased serum alkaline phosphatase is hallmark of disease Aminotransferase frequently normal but may be up to 2X-3X ULN Higher values indicated acute obstruction or overlap (AIH) syndrome MRCP can identify changes in biliary system (partiuclarly in IBD subjects) No specific serologic tests available IGG4 disease should be ruled out-especially in those with pancreatitis
62 Imaging Studies in PSC MRCP best imaging Multifocal annular stricturing within intrahepatic and /or extrahepatic bile ducts with alternating normal or dilated segments. ERCP is necessary only in equivocal cases or indications for biliary dilatation ERCP indicated for duct biopsy or brushings Liver biopsy is usually not required Fibroscan may be used to determine extent of fibrosis
63 Immunoglobulin Associated G4 Cholangitis 23% of liver explants from PSC patients have infiltration with IgG4 positive cells These patients have a more aggressive disease course 40% of subjects with increased IgG4 levels did not have IgG4 positive tissue IgG4 disease is usually accompanied by pancreatitis IgG4 disease responds to steroids PSC does not
64 IBD and PSC All patients with PSC should undergo colonoscopy and biopsy for IBD even when asymptomatic Recent studies suggest more patients are being diagnosed with PSC before IBD PSC increases the colon cancer risk of IBD Surveillance colonoscopy indicated in all PSC patients PSC can be diagnosed after colectomy IBD can develop after liver transplant
65 PSC Subtypes Small duct PSC: chronic cholestasis & normal cholangiogram-liver biopsy diagnosis Overlap syndrome : AIH and PSC
66 PSC: Therapy and Role of Liver Transplant Ursodiol is treatment of choice Proof that it affects natural history of disease in most patients is lacking 5th most common cause of liver transplantation (in U.S.) Survival 1/5 years = 90%/80% Exception points for recurrent cholangitis 25% of OLTX recipients suffer recurrent PSC within ten years.
67 PSC and Cholangiocarcinoma PSC life time risk of cholangiocarcinoma is up to 10% Not found in conjunction with cirrhosis Monitoring with levels of CA 19-9 Cut off of Ca 19-9 of 130 U/ml, in absence of bacterial cholangitis detects CCA with 79% sensitivity and 98% specificity Brush cytology with FISH may be useful Transplant survival after dx of CCA is very poor unless cancer has been totally eradicated preop (Mayo Clinic protocol) Increased risk of GB neoplasia
68 Autoimmune Hepatitis Chronic inflammation of the liver of unknown cause T cell mediated immune attack upon liver antigens leads to progressive necroinflammatory /fibrotic process with progression to cirrhosis May present asymptomatically or with severe liver failure 40% present asymptomatically 70% of asymptomatic patients become symptomatic in their life time
69 AIH Diagnostic Criteria Elevated ALT/AST Elevated gamma globulin (IgG) Positive smooth muscle antibody / and ANA, or LKM1 (in children)/sometimes AMA Negative viral markers Negative DILI history Coexistent immune diseases Histology: plasma cell infiltrate, interface hepatitis Other autoimmune serologies: soluble liver antigen (SLA), anti liver cytosol (anti LC1), p-anca
70 Type 1 AIH 70% women Bimodal incidence Presentation Insidious Acute hepatitis Adapted from Czaja DDS 1995 Antibodies 33% ANA 100% ASMA 2% AMA 43% cirrhosis in 3 yrs
71 Type 2 Children 2-14 yo Extrahepatic associations Europe > USA Vitiligo + LKM IDDM >80% cirrhosis in 3 yrs 30% anti-parietal cell Ab Homberg Hepatology 1987 AIHA Thyroiditis ITP
72 Treatment of AIH Untreated asymptomatic patients have marked impairment of survival Patients with AST/ALT >5X ULN, elevated gamma globulin, and histologic disease activity must be treated Initial treatment regimen 40-60mg prednisone or 30 mg prednisone plus 50mg azathioprine After response prednisone is tapered Azathioprine can be increased up to 2 mg/kg Budesonide (9mg) has been used for induction and maintenance in milder cases Goal of therapy is normalization of enzymes Liver biopsy assessment prior to termination of treatment is the only way to ensure full resolution. Histologic resolution lags up to 8 months behind enzyme resolution Patients should be treated 1-2 years post enzyme resolution Post treatment patients should be carefully monitored regularly for recurrence
73 AIH Treatment Failure Treatment failures should be managed with high dose prednisone (60mg/day) or prednisone of varying dose combined with 150mg azothioprine Alternate therapies of cyclosporine, mycophenolate mofetil or tacrolimus may be considered Liver Transplantation for those presenting with acute liver failure or developing decompensated cirrhosis Recurrent autoimmune disease (30%) following transplantation remains a significant problem Immunosuppressive therapy does not help in burned out cirrhosis patient HCC Cancer risk in AIH is 3% within 10 years and related to development of cirrhosis
Not All Patients With Liver Disease Have HCV Diagnosis and Management of Some Common Non HCV Liver Diseases
Not All Patients With Liver Disease Have HCV Diagnosis and Management of Some Common Non HCV Liver Diseases Prevalence of Chronic Liver Disorders in the United States Nonalcoholic Fatty Liver Disorder
More informationAutoimmune Hepatobiliary Diseases PROF. DR. SABEHA ALBAYATI CABM,FRCP
Autoimmune Hepatobiliary Diseases PROF. DR. SABEHA ALBAYATI CABM,FRCP Autoimmune hepatobiliary diseases The liver is an important target for immunemediated injury. Three disease phenotypes are recognized:
More informationI have no disclosures relevant to this presentation LIVER TESTS: WHAT IS INCLUDED? LIVER TESTS: HOW TO UTILIZE THEM OBJECTIVES
LIVER TESTS: HOW TO UTILIZE THEM I have no disclosures relevant to this presentation José Franco, MD Professor of Medicine, Surgery and Pediatrics Medical College of Wisconsin OBJECTIVES Differentiate
More informationOverview of PSC Jayant A. Talwalkar, MD, MPH Associate Professor of Medicine Mayo Clinic Rochester, MN
Overview of PSC Jayant A. Talwalkar, MD, MPH Associate Professor of Medicine Mayo Clinic Rochester, MN 2012 Annual Conference PSC Partners Seeking a Cure May 5, 2012 Primary Sclerosing Cholangitis Multifocal
More informationSerologic Markers CONVENTIONAL ANTIBODIES ANTIBODIES UNCONVENTIONAL. AIH Type I
Autoimmune Hepatitis By Thomas Frazier Objective What we need to know about AIH Diagnosis Treatment Difficulties in both Liver transplantation concerns AASLD Guidelines: Hepatology. 2010 Jun;51(6):2193-213.
More informationManagement of Chronic Hepatitis B in Asian Americans
Management of Chronic Hepatitis B in Asian Americans Myron J Tong; UCLA, CA Calvin Q. Pan; Mount Sinai, NY Hie-Won Hann; Thomas Jefferson, PA Kris V. Kowdley; Virginia Mason, WA Steven Huy B Han; UCLA,
More informationNoncalculous Biliary Disease Dean Abramson, M.D. Gastroenterologists, P.C. Cedar Rapids. Cholestasis
Noncalculous Biliary Disease Dean Abramson, M.D. Gastroenterologists, P.C. Cedar Rapids Cholestasis Biochemical hallmark Impaired bile flow from liver to small intestine Alkaline phosphatase is primary
More informationHépatopathies auto-immunes
16 ème Journée d'automne Lausanne, le 19 octobre 2017 Hépatopathies auto-immunes Nurullah Aslan et Darius Moradpour Service de Gastroentérologie et d'hépatologie Centre Hospitalier Universitaire Vaudois
More informationChronic Hepatitis B: management update.
Chronic Hepatitis B: management update. E.O.Ogutu Department of clinical medicine & therapeutics, University of Nairobi. Physicians meeting,kisumu 2011. Background epidemiology Chronic hepatitis B (CHB)
More informationSarah Landes October 23, 2014
Sarah Landes October 23, 2014 A T-cell mediated inflammatory destruction of intralobular bile ducts progressively leading to cholestasis and cirrhosis 9:1 F to M ratio Mostly diagnosed between 30-60 years
More informationEVALUATION OF ABNORMAL LIVER TESTS
EVALUATION OF ABNORMAL LIVER TESTS MIA MANABAT DO PGY6 MOA 119 TH ANNUAL SPRING SCIENTIFIC CONVENTION MAY 19, 2018 EVALUATION OF ABNORMAL LIVER TESTS Review of liver enzymes vs liver function tests Clinical
More informationChronic Hepatitis B Infection
Chronic Hepatitis B Infection Mohssen Nassiri Toosi, MD Imam Khomeinin Hospital Tehran University of Medical Sciences Chronic Hepatitis B Infection Virus : HBs Ag Positive Host Liver Health Chronic Hepatitis
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 informationManagement of Hepatitis B - Information for primary care providers
Management of Hepatitis B - Information for primary care providers July 2018 Chronic hepatitis B (CHB) is often a lifelong condition. Not everyone infected needs anti-viral therapy. This document outlines
More informationPrimary Sclerosing Cholangitis and Cholestatic liver diseases. Ahsan M Bhatti MD, FACP Bhatti Gastroenterology Consultants
Primary Sclerosing Cholangitis and Cholestatic liver diseases Ahsan M Bhatti MD, FACP Bhatti Gastroenterology Consultants I have nothing to disclose Educational Objectives What is PSC? Understand the cholestatic
More informationKey Points: Autoimmune Liver Disease: Update for Pathologists from the Hepatologist s Perspective. Jenny Heathcote, MD. University of Toronto
Autoimmune Liver Disease: Update for Pathologists from the Hepatologist s Perspective Jenny Heathcote, MD University of Toronto Key Points: AILD comprise autoimmune hepatitis, primary biliary cirrhosis
More informationPediatric PSC A children s tale
Pediatric PSC A children s tale September 8 th PSC Partners seeking a cure Tamir Miloh Assistant Professor Pediatric Hepatology Mount Sinai Hospital, NY Incidence Primary Sclerosing Cholangitis (PSC) ;
More informationPatterns of abnormal LFTs and their differential diagnosis
Patterns of abnormal LFTs and their differential diagnosis Professor Matthew Cramp South West Liver Unit and Peninsula Schools of Medicine and Dentistry, Plymouth Outline liver function tests / tests of
More informationPrimary Sclerosing Cholangitis Medical Management
Primary Sclerosing Cholangitis Medical Management Kapil Chopra M.D. Assistant Professor of Medicine Division of Transplant Medicine Mayo Clinic Arizona PSC Primary sclerosing cholangitis is a progressive
More informationFat, ballooning, plasma cells and a +ANA. Yikes! USCAP 2016 Evening Specialty Conference Cynthia Guy
Fat, ballooning, plasma cells and a +ANA. Yikes! USCAP 2016 Evening Specialty Conference Cynthia Guy Goals Share an interesting case Important because it highlights a common problem that we re likely to
More informationACCME/Disclosures. The Overlap Syndromes: Do They Exist? Key Points and Questions 4/6/2016. Hans Popper Hepatopathology Society
ACCME/Disclosures The USCAP requires that anyone in a position to influence or control the content of CME disclose any relevant financial relationship WITH COMMERCIAL INTERESTS which they or their spouse/partner
More informationPatterns of abnormal LFTs and their differential diagnosis
Patterns of abnormal LFTs and their differential diagnosis Professor Matthew Cramp South West Liver Unit and Peninsula Schools of Medicine and Dentistry, Plymouth Outline liver function / liver function
More informationPatologia sistematica V Gastroenterologia Prof. Stefano Fiorucci Autoimmune liver diseases
Patologia sistematica V Gastroenterologia Prof. Stefano Fiorucci Autoimmune liver diseases Harrison s Principles of Internal Medicine 18-19 Ed. 2012 e seguenti Chronic hepatitis classification by cause
More informationIN THE NAME OF GOD. D r. MANIJE DEZFULI AZAD UNIVERCITY OF TEHRAN BOOALI HOSPITAL INFECTIOUS DISEASES SPECIALIST
IN THE NAME OF GOD AZAD UNIVERCITY OF TEHRAN BOOALI HOSPITAL D r. MANIJE DEZFULI INFECTIOUS DISEASES SPECIALIST Acute Viral Hepatitis The Anatomy of the Liver Hepatic Physiology Liver: Largest solid organ
More informationHepatitis B Treatment Pearls. Agenda
Hepatitis B Treatment Pearls Fredric D. Gordon, MD Vice Chair Dept. of Transplantation and Hepatobiliary Diseases Lahey Hospital & Medical Center Associate Professor of Medicine Tufts Medical School Boston,
More informationCurrent Concepts in the Management and Treatment of PBC & PSC
Current Concepts in the Management and Treatment of PBC & PSC Michael A Heneghan, MD, MMedSc, FRCPI. Institute of Liver Studies, King s College Hospital, London A family affair? Central vein Hepatocytes
More informationAutoimmune Hepatitis in Clinical Practice
1 Autoimmune Hepatitis in Clinical Practice Atif Zaman, MD MPH Professor of Medicine Senior Associate Dean for Clinical and Faculty Affairs School of Medicine Oregon Health & Science University Disclosure
More informationCURRENT TREATMENT. Mitchell L Shiffman, MD Director Liver Institute of Virginia Bon Secours Health System Richmond and Newport News, Virginia
CURRENT TREATMENT OF HBV Mitchell L Shiffman, MD Director Liver Institute of Virginia Bon Secours Health System Richmond and Newport News, Virginia CHRONIC HBV INFECTION DEMOGRAPHICS IN THE USA Estimated
More informationEnd Stage Liver Disease & Disease Specific Indications for Liver Transplant. Susan Kang, RN, MSN, ANP-BC
End Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP-BC Introduction (https://www.srtr.org) What does the liver do? STORAGE METABOLIC DETOXIFICATION SYNTHETIC
More informationEnd Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP BC
End Stage Liver Disease & Disease Specific Indications for Liver Transplant Susan Kang, RN, MSN, ANP BC Introduction (https://www.srtr.org) 1 What does the liver do? STORAGE METABOLIC DETOXIFICATION SYNTHETIC
More informationAlcoholic Hepatitis: Management Options
Alcoholic Hepatitis: Management Options Paul J. Thuluvath, MD. FRCP Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore Professor of Surgery & Medicine, Georgetown University,
More informationUpdate on Nonalcoholic Fatty Liver Disease. Kathleen E Corey, MD, MPH, MMSc Director, Mass General Fatty Liver Clinic
Update on Nonalcoholic Fatty Liver Disease Kathleen E Corey, MD, MPH, MMSc Director, Mass General Fatty Liver Clinic Outline Defining the phenotypes of nonalcoholic fatty liver disease NAFLD Diagnostics
More informationFatty Liver Disease A growing epidemic
Fatty Liver Disease A growing epidemic Updates in GIM for Primary Care Don C. Rockey March 9 th, 2018 Disclosures 2018 Research Funding (all to MUSC) NIH/NIDDK Actelion Pharmaceuticals Gilead Sciences
More informationDiagnosis and Management of PBC
Diagnosis and Management of PBC Cynthia Levy, MD, FAASLD University of Miami Miller School of Medicine Miami, Florida 1 Primary Biliary Cholangitis (PBC) Chronic cholestatic liver disease Autoimmune in
More informationCornerstones of Hepatitis B: Past, Present and Future
Cornerstones of Hepatitis B: Past, Present and Future Professor Man-Fung Yuen Queen Mary Hospital The University of Hong Kong Hong Kong 1 Outline Past Natural history studies Development of HBV-related
More informationPBC/AIH variant/ overlap syndrome vs PBC with hepatitic features?
22 November 2018 BD-IAP UK-LPG Liver Update PBC/AIH variant/ overlap syndrome vs PBC with hepatitic features? in a UDCA non-responder Dina G. Tiniakos Institute of Cellular Medicine, Faculty of Medical
More informationMorning Report Presentation. Sarah Hughes, MD January 11, 2005
Morning Report Presentation Sarah Hughes, MD January 11, 2005 Primary Biliary Cirrhosis! PBC is a chronic, progressive, cholestatic liver disease of unknown cause that usually affects middle-aged women
More informationAutoimmune Liver Diseases
2nd Pannonia Congress of pathology Hepato-biliary pathology Autoimmune Liver Diseases Vera Ferlan Marolt Institute of pathology, Medical faculty, University of Ljubljana Slovenia Siofok, Hungary, May 2012
More informationChronic Cholestatic Liver Diseases
Chronic Cholestatic Liver Diseases - EASL Clinical Practice Guidelines - Rome, 8 October 2010 Ulrich Beuers Department of Gastroenterology and Hepatology Tytgat Institute of Liver and Intestinal Research
More informationABNORMAL LIVER FUNCTION TESTS. Dr Uthayanan Chelvaratnam Hepatology Consultant North Bristol NHS Trust
ABNORMAL LIVER FUNCTION TESTS Dr Uthayanan Chelvaratnam Hepatology Consultant North Bristol NHS Trust INTRODUCTION Liver function tests Cases Non invasive fibrosis measurement Questions UK MORTALITY RATE
More informationAutoimmune Hepatitis. Dr. Stefania Casu Hepatology, UVCM, Inselspital Bern. November 14th, 2018
Autoimmune Hepatitis Dr. Stefania Casu Hepatology, UVCM, Inselspital Bern November 14th, 2018 AIH - Definition Manns MP J Hepatol 2015, vol 62, P 100-111 AIH - Definition Autoimmune hepatitis (AIH) is
More informationPaul Martin, MD, FACG. University of Miami. 30,000 deaths from cirrhosis per annum, alcohol implicated in 48%
Paul Martin, MD, FACG University of Miami 30,000 deaths from cirrhosis per annum, alcohol implicated in 48% Second commonest indication for liver transplant NIAA 2007 Page 1 of 26 Risk Factors Medical
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Ocaliva (obeticholic acid) Page 1 of 6 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Ocaliva (obeticholic acid) Prime Therapeutics will review Prior Authorization
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 informationThe Impact of HBV Therapy on Fibrosis and Cirrhosis
The Impact of HBV Therapy on Fibrosis and Cirrhosis Jordan J. Feld, MD, MPH Associate Professor of Medicine University of Toronto Hepatologist Toronto Centre for Liver Disease Sandra Rotman Centre for
More informationTREATMENT OF PRIMARY BILIARY CIRRHOSIS (PBC)
TREATMENT OF PRIMARY BILIARY CIRRHOSIS (PBC) URSO not indicated Therapy for PBC Difficulties Etiology is uncertain Therapies are based on ideas regarding pathogenesis Present medical therapies have a limited
More informationHepatitis B Update. Jorge L. Herrera, M.D. University of South Alabama Mobile, AL. Gastroenterology
Hepatitis B Update Jorge L. Herrera, M.D. University of South Alabama Mobile, AL Deciding Who to Treat Is hepatitis B a viral disease or a liver disease? Importance of HBV-DNA Levels in the Natural History
More informationCholestatic Liver Diseases: Update on Diagnosis and Management. Cholestatic Liver Diseases: Location of Injury Determines Phenotype
Cholestatic Liver Diseases: Update on Diagnosis and Management R. Todd Stravitz, M.D. Hume-Lee Transplant Center Section of Hepatology Virginia Commonwealth University Cholestatic Liver Diseases: Location
More informationWho to Treat? Consider biopsy Treat. > 2 ULN Treat Treat Treat Treat CIRRHOTIC PATIENTS Compensated Treat HBV DNA detectable treat
Who to Treat? Parameter AASLD US Algorithm EASL APASL HBV DNA CRITERIA HBeAg+ >, IU/mL > 2, IU/mL > 2, IU/mL >, IU/mL HBeAg- > 2, IU/mL > 2, IU/mL > 2, IU/mL > 2, IU/mL ALT CRITERIA PNALT 1-2 ULN Monitor
More informationPediatric Primary Sclerosing Cholangitis and Potential Therapies
Pediatric Primary Sclerosing Cholangitis and Potential Therapies Philip Rosenthal, M.D. Professor of Pediatrics & Surgery University of California, San Francisco DISCLOSURE I have the following financial
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 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 informationAAIM: GI Workshop Follow Up to Case Studies. Non-alcoholic Fatty Liver Disease Ulcerative Colitis Crohn s Disease
AAIM: GI Workshop Follow Up to Case Studies Non-alcoholic Fatty Liver Disease Ulcerative Colitis Crohn s Disease Daniel Zimmerman, MD VP and Medical Director, RGA Global October 2015 Non-alcoholic Fatty
More informationMarch 29, :15 PM 1:15 PM San Diego, CA Convention Center Ballroom 20D
March 29, 2017 12:15 PM 1:15 PM San Diego, CA Convention Center Ballroom 20D Provided by #IM2017 This lunch symposium is not part of the official Internal Medicine Meeting 2017 Education Program. #IM2017
More informationHBV Diagnosis and Treatment
HBV Diagnosis and Treatment Anna S. F. Lok, MD Alice Lohrman Andrews Professor in Hepatology Director of Clinical Hepatology Assistant Dean for Clinical Research University of Michigan Ann Arbor, MI, USA
More informationNovel Therapies in Autoimmune Hepatitis
Novel Therapies in Autoimmune Hepatitis Paul W. Rassam,MD Ass. Clinical Professor of Medicine Div. of Gastroenterology and Hepatology St George Hospital University Medical Center University of Balamand
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 informationOverview of PSC Making the Diagnosis
Overview of PSC Making the Diagnosis Tamar Taddei, MD Assistant Professor of Medicine Yale University School of Medicine Overview Definition Epidemiology Diagnosis Modes of presentation Associated diseases
More informationHepatitis B Prior Authorization Policy
Hepatitis B Prior Authorization Policy Line of Business: Medi-Cal P&T Approval Date: November 15, 2017 Effective Date: January 1, 2018 This policy has been developed through review of medical literature,
More informationLaboratory Tests and Diagnostic Procedures in Liver Disease: Adventures in Liverland
Laboratory Tests and Diagnostic Procedures in Liver Disease: Adventures in Liverland Sanjiv Chopra, MD, MACP Professor of Medicine Harvard Medical School Editor In Chief Hepatology Section Up To Date Serum
More informationHangzhou, 15 March Ulrich Beuers Department of Gastroenterology and Hepatology Academic Medical Center University of Amsterdam
Clinical Aspects of Primary Biliary Cirrhosis Hangzhou, 15 March 2008 Ulrich Beuers Department of Gastroenterology and Hepatology Academic Medical Center University of Amsterdam Epidemiology of Primary
More informationClinical Case Maria Butí, MD, PhD
Clinical Case Maria Butí, MD, PhD Liver Unit, Internal Medicine Department Vall d Hebron Hospital 1 Clinical Case 70 year-old male Smoker, no alcohol intake No risk factors Diabetes Mellitus treated with
More informationDrug Class Monograph
Drug Class Monograph Class: Chronic Hepatitis B Drug: Baraclude (entecavir), Epivir (lamivudine), Hepsera (adefovir), Intron A (interferon alfa- 2b), Pegasys (peginterferon alfa-2a), Tyzeka (telbivudine),
More informationDhanpat Jain Yale University School of Medicine, New Haven, CT
Dhanpat Jain Yale University School of Medicine, New Haven, CT Case history 15 years old female presented with fatigue. Found to have features suggestive of cirrhosis with esophageal varices, splenomegaly
More informationEmerging Challenges In Primary Care: Chronic Hepatitis B: Guidelines for Screening, Clinical Management, Whether to Follow or Treat, and How
Emerging Challenges In Primary Care: 2015 Chronic Hepatitis B: Guidelines for Screening, Clinical Management, Whether to Follow or Treat, and How 1 Faculty Christopher O'Brien, MD, AGAF, FRCMI Professor
More informationLIVER SPECIALTY CONFERENCE USCAP Maha Guindi, M.D. Clinical Professor of Pathology Cedars-Sinai Medical Center Los Angeles, CA
LIVER SPECIALTY CONFERENCE USCAP 2016 Maha Guindi, M.D. Clinical Professor of Pathology Cedars-Sinai Medical Center Los Angeles, CA Nothing to disclose Case History 47-year-old male, long standing ileal
More informationHepatitis B screening and surveillance in primary care
Hepatitis B screening and surveillance in primary care Catherine Stedman Associate Professor of Medicine, University of Otago, Christchurch Gastroenterology Department, Christchurch Hospital Disclosures
More informationACG Clinical Guideline: Primary Sclerosing Cholangitis
ACG Clinical Guideline: Primary Sclerosing Cholangitis Keith D. Lindor, MD, FACG 1, Kris V. Kowdley, MD, FACG 2, and M. Edwyn Harrison, MD 3 1 College of Health Solutions, Arizona State University, Phoenix,
More informationHepatitis B Virus. Taylor Page PharmD Candidate 2019 February 1, 2019
Hepatitis B Virus Taylor Page PharmD Candidate 2019 February 1, 2019 Epidemiology 3218 cases of acute HBV reported in 2016 847,000 non-institutionalized persons living with chronic HBV in 2011-2012 Viral
More informationPrimary Biliary Cholangitis
Primary Biliary Cholangitis PBC Foundation (UK) Ltd 6 Hill Street Edinburgh EH2 3JZ Tel: +44 (0) 131 556 6811 info@pbcfoundation.org.uk www.pbcfoundation.org.uk PBC for Healthcare Practitioners Introduction
More informationWhy to biopsy? Indications for liver biopsy in common medical liver diseases- how are they changing?
Why to biopsy? Indications for liver biopsy in common medical liver diseases- how are they changing? Stephen D Ryder Nottingham University Hospitals NHS Trust and Biomedical research Unit What are we currently
More informationTratamiento endoscópico de la CEP. En quien como y cuando?
Tratamiento endoscópico de la CEP. En quien como y cuando? Andrés Cárdenas, MD, MMSc, PhD, AGAF, FAASLD GI / Liver Unit, Hospital Clinic Institut de Malalties Digestives i Metaboliques University of Barcelona
More informationEmerging Challenges In Primary Care: 2015
Emerging Challenges In Primary Care: 2015 Chronic Hepatitis B: Guidelines for Screening, Clinical Management, Whether to Follow or Treat, 1 Faculty Christopher O'Brien, MD, AGAF, FRCMI Professor of Clinical
More informationAASLD Immune tolerant phase HBV NAFLD diagnostic HCC
AASLD 2016 Immune tolerant phase HBV NAFLD diagnostic HCC Immune tolerant 3 Modified from Chan HLY and Wong VWS. Hepatitis B. In Zakim and Boyers s Hepatology 2012 2015 AMERICAN ASSOCIATION FOR THE S1T6UDY
More informationUpdate on HBV Treatment
Update on HBV Treatment Calvin Q. Pan MD, FAASLD, FACG, MACP Professor of Medicine Division of Gastroenterology and Hepatology Department of Medicine, NYU Langone Health New York University School of Medicine,
More informationColangitis Esclerosante Primaria: Manejo Clínico y Endoscópico
Colangitis Esclerosante Primaria: Manejo Clínico y Endoscópico Andrés Cárdenas, MD, MMSc, PhD, AGAF, FAASLD GI / Liver Unit, Hospital Clinic Institut de Malalties Digestives i Metaboliques Associate Professor
More informationEmerging Challenges In Primary Care: 2015
Emerging Challenges In Primary Care: 2015 Chronic Hepatitis B: Guidelines for Screening, Clinical Management, Whether to Follow or Treat, 1 Faculty Christopher O'Brien, MD, AGAF, FRCMI Professor of Clinical
More informationWhat you need to know about liver disease
What you need to know about liver disease Bob Grover Consultant Gastroenterologist and Hepatologist The Hillingdon Hospitals NHS Foundation Trust Overview Liver disease in the UK Alcohol Fatty liver Hepatitis
More informationAt Least 1 in 5 Patients in Your Practice Have Fatty Liver
At Least 1 in 5 Patients in Your Practice Have Fatty Liver What Can You Tell Your Patients Magnus McLeod MD FRCPC Assistant Professor Dalhousie University 30-NOV-2017 NAFLD Non-Alcoholic Fatty Liver Disease
More informationDiseases of liver. Dr. Mohamed. A. Mahdi 4/2/2019. Mob:
Diseases of liver Dr. Mohamed. A. Mahdi Mob: 0123002800 4/2/2019 Cirrhosis Cirrhosis is a complication of many liver disease. Permanent scarring of the liver. A late-stage liver disease. The inflammation
More information29th Viral Hepatitis Prevention Board Meeting
29th Viral Hepatitis Prevention Board Meeting Madrid, November 2006 Treatment of chronic hepatitis B José M. Sánchez-Tapias Liver Unit Hospital Clínic University of Barcelona Spain CHRONIC HBV INFECTION
More informationManagement of autoimmune hepatitis. Pierre-Emmanuel RAUTOU Inserm U970, Paris Service d hépatologie, Hôpital Beaujon, Clichy, France
Management of autoimmune hepatitis Pierre-Emmanuel RAUTOU Inserm U970, PARCC@HEGP, Paris Service d hépatologie, Hôpital Beaujon, Clichy, France Case 1 52 year-old woman, referred for liver blood tests
More informationHepatitis B Virus therapy. Maria Buti Hospital Universitario Valle Hebron Barcelona Spain
Hepatitis B Virus therapy Maria Buti Hospital Universitario Valle Hebron Barcelona Spain Disclosures Advisor: AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck Sharp &
More informationCASE 1 Plasma Cell Infiltrates: Significance in post liver transplantation and in chronic liver disease
CASE 1 Plasma Cell Infiltrates: Significance in post liver transplantation and in chronic liver disease Maria Isabel Fiel, M.D. The Mount Sinai Medical Center New York, New York Case A 57 yo man, 7 months
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 informationABIM Review Hepatobiliary
ABIM Review Hepatobiliary Danielle Brandman, MD, MAS Assistant Professor of Medicine University of California San Francisco ABIM Certification Exam ABIM Certification Exam Hepatobiliary Review Diagnostic
More informationManagement of chronic hepatitis B : recent advance in the treatment of antiviral resistance
anagement of chronic hepatitis B : recent advance in the treatment of antiviral resistance / 김강모 연수강좌 anagement of chronic hepatitis B : recent advance in the treatment of antiviral resistance 김강모 울산대학교의과대학서울아산병원소화기내과
More informationChoice of Oral Drug for Hepatitis B: Status Asokananda Konar
Choice of Oral Drug for Hepatitis B: Status 2011 Asokananda Konar Chronic hepatitis B (CHB) is a global public health challenge with an estimated 350 to 400 million people with chronic HBV infection, despite
More informationHepatitis B. ECHO November 29, Joseph Ahn, MD, MS Associate Professor of Medicine Director of Hepatology Oregon Health & Science University
Hepatitis B ECHO November 29, 2017 Joseph Ahn, MD, MS Associate Professor of Medicine Director of Hepatology Oregon Health & Science University Disclosures Advisory board Gilead Comments The speaker Joseph
More informationLIVER TRANSPLANTATION FOR OVERLAP SYNDROMES OF AUTOIMMUNE LIVER DISEASES
LIVER TRANSPLANTATION FOR OVERLAP SYNDROMES OF AUTOIMMUNE LIVER DISEASES No conflict of interest Objectives Introduction Methods Results Conclusions Objectives Introduction Methods Results Conclusions
More informationBasic patterns of liver damage what information can a liver biopsy provide and what clinical information does the pathologist need?
Basic patterns of liver damage what information can a liver biopsy provide and what clinical information does the pathologist need? Rob Goldin r.goldin@imperial.ac.uk Fatty liver disease Is there fatty
More informationOutline. Updates in the Clinical Management of Hepatitis B and C. Who should be screened for HBV? Chronic Hepatitis B 10/7/2018
Outline Updates in the Clinical Management of Hepatitis B and C Jennifer C. Lai, MD, MBA Transplant Hepatologist Associate Professor of Medicine In Residence University of California, San Francisco Initial
More information2/12/2018. David M. Fettig, M.D. Birmingham Gastroenterology Associates. Outline basics of Hepatitis B. Phases of Chronic Hepatitis B
David M. Fettig, M.D. Birmingham Gastroenterology Associates Outline basics of Hepatitis B Phases of Chronic Hepatitis B Evaluation of Chronic Hepatitis B Treatment of Chronic Hepatitis B Special Populations
More informationAlcoholic Hepatitis: Routine Screening for Early Recognition and Management. Juan Guerrero, MD
Alcoholic Hepatitis: Routine Screening for Early Recognition and Management Juan Guerrero, MD Global Problem 1% of GNP of medium/high income countries Additional societal costs Disproportionately affects
More informationExtrahepatic Biliary Obstruction. Ductal Diseases: Stones Tumors. Acute Injury: Viral Hepatitis Toxin (APAP/Etoh) Reye s Shock.
Extrahepatic Biliary Obstruction Stones Tumors Ductal Diseases: Ductal Diseases: Primary Biliary Primary Biliary Cirrhosis Cirrhosis Sclerosing Cholangitis Sclerosing Cholangitis Acute Injury: Viral Hepatitis
More informationALCOHOLIC LIVER DISEASE (ALD) Nayan Patel, DO Transplant Hepatology/GI Banner Advanced Liver Disease and Transplant Center
ALCOHOLIC LIVER DISEASE (ALD) Nayan Patel, DO Transplant Hepatology/GI Banner Advanced Liver Disease and Transplant Center Objectives Spectrum of alcoholic liver disease Focus on Alcoholic Hepatitis (AH)
More informationHepatitis B Virus therapy. Maria Buti Hospital Universitario Valle Hebron Barcelona Spain
Hepatitis B Virus therapy Maria Buti Hospital Universitario Valle Hebron Barcelona Spain Disclosures Advisor: AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck Sharp &
More informationIntron A Hepatitis B. Intron A (interferon alfa-2b) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.01.01 Subject: Intron A Hepatitis B Page: 1 of 7 Last Review Date: November 30, 2018 Intron A Hepatitis
More informationACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries
ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries Ashwani K. Singal, MD, MS, FACG 1, Ramon Bataller, MD, PhD, FACG 2, Joseph Ahn, MD, MS, FACG (GRADE Methodologist) 3, Patrick S. Kamath,
More informationBasic patterns of liver damage what information can a liver biopsy provide and what clinical information does the pathologist need?
Basic patterns of liver damage what information can a liver biopsy provide and what clinical information does the pathologist need? Rob Goldin r.goldin@imperial.ac.uk @robdgol FATTY LIVER DISEASE Brunt
More information