OVERVIEW OF ALD ALCOHOLIC LIVER DISEASE DISCLOSURE
|
|
- Roderick Fleming
- 6 years ago
- Views:
Transcription
1 ALCOHOLIC LIVER DISEASE KEVIN D MULLEN MD West Virginia University Morgantown WV DISCLOSURE I have nothing to disclose. AMOUNT OF ALCOHOL PER STANDARD DRINK > (30 ) GRAM OF ALCOHOL PER DAY USA Canada UK Europe Australia and New Zealand Japan Syria/Lebanon 12 g 13.6 g 9.5 g 9.8 g 9.2 g 23.5 g 45 g OVERVIEW OF ALD Alcohol abuse costs U.S. $235 billion annually > 2 million in U.S. with some form of ALD Likely underestimated due to social stigma Turner C, et al. Br J Addict Sep;85(9): Harwood, et al., NIAAA, 05 1
2 OVERVIEW OF AH,000 admissions with average cost of $,000 > twice the cost of Myocardial Infarction Cost 2.5 fold higher in those who died LACK OF ADVANCEMENT IN THE TREATMENT OF ALCOHOL HEPATITIS 1 month 6 month 4 year Mortality (%) USA 1991 Denmark (65) 24 Harwood, et al., NIAAA, 07 SPECTRUM OF ALCOHOLIC LIVER DISEASE DIAGNOSIS OF AH Rapid onset of jaundice in a patient with heavy alcohol use, usually precipitated by binge drinking Transaminse levels AST<500/ALT<0 AST/ALT ratio >2 Exclude other causes of acute hepatitis Gastroenterology. 11;141: Clinical Pathologic Syndrome Heterogeneous Patient Population - Hospital Mortality Varies (0-100%) Patient Selection for Treatment is Important - Dependent on Accurate Markers ISSUES AT HAND Which Patients Should be Treated? What Should the Treatment be? - Corticosteroids - Anti-cytokines - Anti-oxidants Future Considerations 2
3 DIAGNOSIS OF AH Clinical diagnosis is accurate in 75 85% Liver biopsy remains the gold standard for the diagnosis N Engl J Med. 09: 3;26 J Hepatol. 12; vol. 57/399 4 PREDICTORS OF PROGNOSIS Maddrey Discriminant Function Hepatic Encephalopathy MELD O Shea, et al. Hepatology January 10 MADDREY DISCRIMINANT FUNCTION Modified Equation 4.6 x (Patient s Prothrombin time - control time )+ Serum Bilirubin Discriminant Score > % Mortality in Group PREDICTORS OF PROGNOSIS Maddrey Discriminant Function Hepatic Encephalopathy MELD 3
4 HEPATIC ENCEPHALOPATHY IN Mortality in Group Hepatic Encephalopathy Hepatic Encephalopathy Present Absent PREDICTORS OF PROGNOSIS Maddrey Discriminant Function Hepatic Encephalopathy MELD % 10% Admission MELD Score Score <18 Score >=18 p-value< Hospital days Srikureja, 05 ISSUES WITH MELD No Prospective Confirmation What MELD Score Should be Used? Study Proposed Score Sheth (02) 9 Dunn (05) Srikureja (05) 18 or SUMMARY Best Current Prognostic Measures - Maddrey Discriminant Function - Hepatic Encephalopathy MELD may be Better - Additional Studies Necessary Future Scoring Systems - Glasgow Score - Lille Model ISSUES AT HAND Which Patients Should be Treated? What Should the Treatment be? - Corticosteroids - Anti-cytokines - Anti-oxidants Future Considerations 4
5 IMMUNOSUPPRESSION AND CYTOKINE THERAPY Cytokines Hyper Immune System Alcoholic Hepatitis Oxidative Stress STEROIDS IN R A T I O N A L E Decrease Collagen Formation Increase Albumin Production Enhance Appetite Suppress Hepatic Inflammation - Cytokine mediated Suppress an Overactive Immune System IMMUNOSUPPRESSION AND CYTOKINE CORTICOSTEROID THERAPY CORTICOSTEROIDS IN ALCOHOL HEPATITIS (NO CONSENSUS) Cytokines Hyper Immune System Alcoholic Hepatitis Oxidative Stress Beneficial Effect Helman 1971 Lesesne 1978 Maddrey 1978 Carithers 1989 Ramond 1992 Mathurin 1996 No Beneficial Effect Porter 1971 Campra 1973 Blitzer 1977 Shumaker 1978 Depew 19 Theodossi 1982 Mendenhall 1984 CALCULATIONS FOR PROTECTIVE EFFICACY WITH HEPATIC ENCEPHALOPATHY STEROIDS IN ETOH HEPATITIS (SHORT TERM SURVIVAL) MORTALITY RATE Steroids = 45% = % 1. Risk Difference % - 45% = 15% 2. Reciprocal of Risk Difference 1/.15 = 6.67 The number of patients needed to treat to avoid one death=6-7. % Mortality 0 Steroids Carithers (N=66) Ramond (N=61) 5
6 DISCRIMINANT FUNCTION Hepatic Encephalopathy STEROIDS IN ETOH HEPATITIS (LONG TERM SURVIVAL) Percent Surviving Methylprednisolone Methylprednisolone Days Days % Mortality 0 1 Year 2 Years Steroids Mathurin, 1996 CORTICOSTEROIDS IN Treat Only Patients with Severe Disease - Discriminant Function/HE/MELD Survival Improved up to 6-12 months 5-7 Pts Must be Treated to Avoid one Death - Patient Selection Required - Biopsy if Diagnosis in Doubt Use Prednisolone Rather than Prednisone AND STEROIDS Why Do Hepatologists Disagree Steroids Ineffective in the Largest Study Personal Experience - Number Needed to Treat is Some Patients Just too Sick - Incorrect Diagnosis Side Effects - 4 Week Treatment May be to Long Contraindications - GI Bleeding, Infection, Pancreatitis Steroids in AH (6 months) 1. Patients in renal failure / GI bleeding 2. Should every patient have a trial of corticosteroids (?) 3. Some patients are too sick 4. Treat Sepsis 100 Prednisolone THINGS TO CONSIDER BEFORE USING CORTICOSTEROIDS 0 < >54 Discriminant Function 6
7 Steroids and Nutrition in ETOH Hepatitis Mortality (1 month) Day of Death (Median) Mortality (After 1 month) Enteral Nutrition (n=35) 31% 7 8% Steroids (n=36) 25% 23 37% Cabre, 00 A Difference is Only a Difference If it Makes a Difference 7
Alcoholic 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 informationTherapeutic Strategy in Severe Alcoholic Hepatitis: Present to future development of New
Therapeutic Strategy in Severe Alcoholic Hepatitis: Present to future development of New Philippe Mathurin Service Maladies de l Appareil Digestif Inserm U995 Hôpital Claude Huriez Lille France molecules
More informationIndian Journal of Basic and Applied Medical Research; June 2017: Vol.-6, Issue- 3, P
Original article: Study of usefulness of Discriminant Function (DF) and Glasgow Alcoholic Hepatitis Score (GAHS) in treatment of patients of Alcoholic Hepatitis in Indian Population Dr Mugdha Thakur, Dr
More informationConflicts of Interest in the last 12 months
STEATOHEPATITIS Richard K. Sterling, MD, MSc, FACP, FACG VCU Hepatology Professor of Medicine Chief, Section of Hepatology Virginia Commonwealth University Richmond, VA Conflicts of Interest in the last
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 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 informationA lcoholic hepatitis is perhaps the most florid manifestation
1174 ALCOHOLIC LIVER DISEASE Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score E H Forrest, C D J Evans, S Stewart,
More informationDRAFT FOR CONSULTATION
In patients with acute alcoholic hepatitis, what is the safety and efficacy of corticosteroids v placebo? Reference Carithers RL, Jr., Herlong HF, Diehl AM et al. Methylprednisolone therapy in patients
More informationAlcoholic Hepatitis. Christian Doppler Research Laboratory for Gut Inflammation Medical University Innsbruck. Herbert Tilg
Alcoholic Hepatitis Christian Doppler Research Laboratory for Gut Inflammation Medical University Innsbruck Herbert Tilg Overview Background I: Alcoholic steatohepatitis (ASH) is a severe and often life-threatening
More informationAlcoholism and Alcohol Liver Disease from a Transplant Hepatology Perspective
Alcoholism and Alcohol Liver Disease from a Transplant Hepatology Perspective Clark Kulig, MD Director, Porter Center for Liver Care Denver, CO February 2015 Does quantity of alcohol correlate with liver
More informationAmmonia level at admission predicts in-hospital mortality for patients with alcoholic hepatitis
Gastroenterology Report, 5(3), 2017, 232 236 doi: 10.1093/gastro/gow010 Advance Access Publication Date: 1 May 2016 Original article ORIGINAL ARTICLE Ammonia level at admission predicts in-hospital mortality
More informationManagement of alcoholic hepatitis: Implications for options beyond the STOPAH study
Management of alcoholic hepatitis: Implications for options beyond the STOPAH study Gyongyi Szabo, MD, PhD Professor University of Massachusetts Medical School Worcester, MA Cape Town, South Africa 2015
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 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 informationWhite cell count and platelet count associate with histological alcoholic hepatitis in jaundiced harmful drinkers
Hardy et al. BMC Gastroenterology 2013, 13:55 RESEARCH ARTICLE Open Access White cell count and platelet count associate with histological alcoholic hepatitis in jaundiced harmful drinkers Timothy Hardy
More informationAlcoholic Liver Disease
14 ACG PRACTICE GUIDELINES nature publishing group CME Alcoholic Liver Disease Robert S. O Shea, MD, MSCE 1, Srinivasan Dasarathy, MD 1 and Arthur J. McCullough, MD 1 These recommendations provide a data-supported
More informationManagement of Alcoholic Hepatitis
Management of Alcoholic Hepatitis Richard K. Sterling, MD, MSc, FACP, FACG, FAASLD, AGAF VCU Hepatology Professor of Medicine Chief, Section of Hepatology Program Director, Transplant Hepatology Virginia
More informationKey Aspects of Diagnosing Alcoholic Hepatitis. Mark Sonderup University of Cape Town & Groote Schuur Hospital
Key Aspects of Diagnosing Alcoholic Hepatitis Mark Sonderup University of Cape Town & Groote Schuur Hospital 42 year old woman, married with 3 children No significant co-morbidities or illnesses Habits
More informationAlcoholic hepatitis (AH) is an acute, inflammatory. MELD Accurately Predicts Mortality in Patients With Alcoholic Hepatitis
MELD Accurately Predicts Mortality in Patients With Alcoholic Hepatitis Winston Dunn, 1 Laith H. Jamil, 1 Larry S. Brown, 2 Russell H. Wiesner, 1 W. Ray Kim, 1 K. V. Narayanan Menon, 1 Michael Malinchoc,
More informationA Day-4 Lille Model Predicts Response to Corticosteroids and Mortality in Severe Alcoholic Hepatitis
306 ORIGINAL CONTRIBUTIONS see related editorial on page x A Day-4 Lille Model Predicts Response to Corticosteroids and Mortality in Severe Alcoholic Hepatitis Mauricio Garcia-Saenz-de-Sicilia, MD 1, 9,
More informationINVITED REVIEW THE TREATMENT OF ALCOHOLIC HEPATITIS
Alcohol & Alcoholism, Vol. 31, No. 2, pp. 117-134. 1996 INVITED REVIEW THE TREATMENT OF ALCOHOLIC HEPATITIS MARSHA Y. MORGAN Department of Medicine. The Royal Free Hospital. London NW3 2QG. UK Abstract
More informationPrise en charge de l hépatite alcoolique aiguë
Prise en charge de l hépatite alcoolique aiguë Prof Christophe Moreno M.D. Ph.D. Clinical Director, Liver Unit Dept. of Gastroenterology, Hepato-Pancreatology and Digestive Oncology CUB Hôpital Erasme
More informationPrednisolone or Pentoxifylline for Alcoholic Hepatitis
The new england journal of medicine Original Article Prednisolone or Pentoxifylline for Alcoholic Hepatitis Mark R. Thursz, M.D., Paul Richardson, M.D., Michael Allison, Ph.D., Andrew Austin, M.D., Megan
More informationControlled trial of methylprednisolone therapy in
Clinical trial Controlled trial of methylprednisolone therapy in severe acute alcoholic hepatitis A THEODOSSI, A L W F EDDLESTON, AND ROGER WILLIAMS From the Liver Unit, King's College Hospital and Medical
More informationAcute Liver Failure. Neil Shah, MD UNC School of Medicine High-Impact Hepatology Saturday, Dec 8 th, 2018
Acute Liver Failure Neil Shah, MD UNC School of Medicine High-Impact Hepatology Saturday, Dec 8 th, 2018 Disclosures None Outline Overview of ALF Management of ALF Diagnosis of ALF Treatments and Support
More informationGlucocorticoids are ineffective in alcoholic hepatitis: A meta-analysis adjusting for
Gut 1995; 37: 113-118 Department of Medicine B, Bispebjerg University Hospital, Copenhagen, Denmark E Christensen Institute of Preventive Medicine, Kommunehospitalet, The Copenhagen Health Services, Copenhagen,
More informationManagement of Alcoholic Liver Disease. Hafez Fakheri Professor of medicine, Sari, Iran
Management of Alcoholic Liver Disease Hafez Fakheri Professor of medicine, Sari, Iran Alcoholic Hepatitis Scores DF = (4.6 x [ PT- control PT]) + (bili ) MELD = 10 * ((0.957 * ln(cr)) + (0.378 * ln(bil))
More informationMishra et al., IJPSR, 2018; Vol. 9(5): E-ISSN: ; P-ISSN:
IJPSR (2018), Volume 9, Issue 5 (Research Article) Received on 11 August, 2017; received in revised form, 01 February, 2018; accepted, 11 March, 2018; published 01 May, 2018 PROGNOSTIC UTILITY OF LILLE
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 informationAlcoholic hepatitis (AH), in its severe form, is associated
LIVER FAILURE AND LIVER DISEASE Early Change in Bilirubin Levels Is an Important Prognostic Factor in Severe Alcoholic Hepatitis Treated With Prednisolone Philippe Mathurin, 1,2 Marcelle Abdelnour, 3,5
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 informationAccepted Manuscript. Controversies in Hepatology. Controversies in Clinical Trials for Alcoholic Hepatitis
Accepted Manuscript Controversies in Hepatology Controversies in Clinical Trials for Alcoholic Hepatitis Sarah R. Lieber, John P. Rice, Michael R. Lucey, Ramon Bataller PII: S0168-8278(17)32325-5 DOI:
More informationPredicting utility of a model for end stage liver disease in alcoholic liver disease
PO Box 2345, Beijing 00023, China World J Gastroenterol 2006 July 7; 2(25): 4020-4025 World Journal of Gastroenterology ISSN 007-9327 wjg@wjgnet.com 2006 The WJG Press. All rights reserved. CLINICAL RESEARCH
More informationUNIVERSITY OF CALGARY. Jack X.Q. Pang A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE
UNIVERSITY OF CALGARY Epidemiology and Outcomes of Alcoholic Hepatitis in Calgary: A Population-based Study by Jack X.Q. Pang A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILMENT
More informationLiver Transplant: Alcoholic liver disease as first indication
Monotematica AISF The future of liver disease: beyond HCV there is a role for hepatologist? Milano, 13-15 Ottobre 2016 Liver Transplant: Alcoholic liver disease as first indication Giacomo Germani Multivisceral
More informationTreatment of Alcoholic Hepatitis
REVIEW REVIEW Treatment of Alcoholic Hepatitis Timothy R. Morgan, M.D.,*, Daniel Chao, M.D,*, Gregory Botwin, M.D. Three steps must be completed before starting treatment for alcoholic hepatitis (AH).
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 informationEnterprise Interest Nothing to declare
Enterprise Interest Nothing to declare 29 th European Congress of Pathology, Amsterdam, Sept 2 nd -6 th, 2017 What s new in alcohol-mediated liver injury? Carolin Lackner Institute of Pathology Medical
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 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 41 year-old woman, coming to emergency department for fatigue
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 informationLewis W. Teperman, MD The Mary Lea Johnson Richards Organ Transplantation Center at NYU and the ELAD Development Team
Lewis W. Teperman, MD The Mary Lea Johnson Richards Organ Transplantation Center at NYU and the Development Team Bilirubin Improvement Correlates with 90-Day Survival with the Use of the System in a Randomized,
More informationVIRAL HEPATITIS. Definitions. Acute Liver Disease (Hepatitis A &E, Alcoholic hepatitis, DILI and ALF) Acute Viral Hepatitis Symptoms
Acute Liver Disease (Hepatitis A &E, Alcoholic hepatitis, DILI and ALF) Definitions AST and ALT Markers of hepatocellular injury Ryan M. Ford, MD Assistant Professor of Medicine Director of Viral Hepatitis
More informationAlcoholic Liver Disease Strategies for Seamless Care or An Clinical Approach to the Jaundiced Alcoholic Patient
Alcoholic Liver Disease Strategies for Seamless Care or An Clinical Approach to the Jaundiced Alcoholic Patient Liver Disease for the General Physician Royal College of Physicians July 2017 Dr Ewan Forrest
More informationPositioning Biologics in Ulcerative Colitis
Positioning Biologics in Ulcerative Colitis Bruce E. Sands, MD, MS Acting Chief, Gastrointestinal Unit Massachusetts General Hospital Associate Professor of Medicine Harvard Medical School Sequential Therapies
More informationPBC features and management in the era of UDCA and Budesonide
PBC features and management in the era of UDCA and Budesonide Raoul Poupon, MD Université P&M Curie, AP-Hôpitaux de Paris, Inserm, Paris, France The changing pattern of PBC Over the last 2 decades: More
More informationCase Report: Acute-on-Chronic Liver Failure: Making the Diagnosis between Infection and Acute Alcoholic Hepatitis
Diagnostic Problems in Hepatology 181 Case Report: Acute-on-Chronic Liver Failure: Making the Diagnosis between Infection and Acute Alcoholic Hepatitis Carmen Sendra, MD 1 Javier Ampuero, MD, PhD 1,2 Álvaro
More informationInt J Clin Exp Med 2016;9(6): /ISSN: /IJCEM
Int J Clin Exp Med 2016;9(6):10364-10373 www.ijcem.com /ISSN:1940-5901/IJCEM0023853 Original Article Early bilirubin response in acute-on-chronic hepatitis B liver failure patients treated with corticosteroids
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 informationPrognosis of NASH VII Workshop Intenracional de Actualizaçao em Hepatologia, Aug 29th 2014
Prognosis of NASH VII Workshop Intenracional de Actualizaçao em Hepatologia, Aug 29th 2014 Vlad Ratziu, Université Pierre et Marie Curie, Hôpital Pitié Salpêtrière, Paris, France NASH : a severe hepatic
More informationAssessing the patient with a new diagnosis of Hepatitis C LAUREN MYERS MMSC, PA-C OREGON HEALTH & SCIENCE UNIVERSITY
Assessing the patient with a new diagnosis of Hepatitis C LAUREN MYERS MMSC, PA-C OREGON HEALTH & SCIENCE UNIVERSITY Disclosures Nothing to Disclose Assessing the patient with a new diagnosis of Hepatitis
More informationHHS Public Access Author manuscript J Clin Gastroenterol. Author manuscript; available in PMC 2016 July 01.
Trends in Alcoholic Hepatitis related Hospitalizations, Financial Burden, and Mortality in the United States Raxitkumar Jinjuvadia, MD, MPH 1 and Suthat Liangpunsakul, MD, MPH 2,3 1 Division of Gastroenterology
More informationIntentional Transplantation of Hepatitis C Positive Livers into Hepatitis C Negative Recipients- Report of the first Case Series in World
Intentional Transplantation of Hepatitis C Positive Livers into Hepatitis C Negative Recipients- Report of the first Case Series in World Paulo Martins MD PhD, Aaron Ahearn MD PhD, Babak Movahedi MD PhD,
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 informationInfections In Cirrhotic patients. Dr Abid Suddle Institute of Liver Studies King s College Hospital
Infections In Cirrhotic patients Dr Abid Suddle Institute of Liver Studies King s College Hospital Infection in cirrhotic patients Leading cause morbidity/mortality Common: 30-40% of hospitalised cirrhotic
More informationPrognostic models for alcoholic hepatitis
Rahimi and Pan Biomarker Research (2015) 3:20 DOI 10.1186/s40364-015-0046-z REVIEW Prognostic models for alcoholic hepatitis Erik Rahimi * and Jen-Jung Pan Open Access Abstract Alcoholic hepatitis (AH)
More informationGlucocorticosteroids for people with alcoholic hepatitis (Review)
Cochrane Database of Systematic Reviews Glucocorticosteroids for people with alcoholic hepatitis (Review) Pavlov CS, Varganova DL, Casazza G, Tsochatzis E, Nikolova D, Gluud C Pavlov CS, Varganova DL,
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 informationEarly Liver Transplantation for Severe Alcoholic Hepatitis in the United States A Single-Center Experience
American Journal of Transplantation 2016; 16: 841 849 Wiley Periodicals Inc. Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/ajt.13586
More informationHealthy Liver Cirrhosis
Gioacchino Angarano Clinica delle Malattie Infettive Università degli Studi di Foggia Healthy Liver Cirrhosis Storia naturale dell epatite HCVcorrelata in assenza di terapia Paestum 13-15 Maggio 24 The
More informationLIVER DISORDERS (PRACTICAL MANAGEMENT) Dr Pok Kern (PK) TAN Gastroenterologist Calvary hospital, ACT 1 st April 2017
LIVER DISORDERS (PRACTICAL MANAGEMENT) Dr Pok Kern (PK) TAN Gastroenterologist Calvary hospital, ACT 1 st April 2017 TOPICS TO COVER Acute liver failure Chronic liver failure Portal hypertension : Ascites
More informationUpdate on HIV-HCV Epidemiology and Natural History
Update on HIV-HCV Epidemiology and Natural History Jennifer Price, MD Assistant Clinical Professor of Medicine University of California, San Francisco Learning Objectives Upon completion of this presentation,
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 informationKing s College Hospital NHS Foundation Trust. Acute on Chronic Liver Failure: Practical management outside the tertiary centre.
King s College Hospital NHS Foundation Trust NHS Acute on Chronic Liver Failure: Practical management outside the tertiary centre. William Bernal Professor of Liver Critical Care Liver Intensive Therapy
More informationPrognosis of untreated Primary Sclerosing Cholangitis (PSC) Erik Christensen Copenhagen, Denmark
Prognosis of untreated Primary Sclerosing Cholangitis (PSC) Erik Christensen Copenhagen, Denmark Study of Prognosis of PSC Difficulties: Disease is rare The duration of the course of disease may be very
More informationManagement of acute alcoholic hepatitis
Management of acute alcoholic hepatitis Yesim ALAHDAB Marmara University Hospital, Istanbul/TURKEY 5 th European Young Hepatologists Workshop August, 27-29, 2015 Moulin de Vernègues, France 1.4L ALCOHOL
More informationChemotherapy-induced HBV reactivation in cancer patients
Chemotherapy-induced HBV reactivation in cancer patients On behalf of Taiwan Cooperative Oncology Group (TCOG) HBV reactivation in lymphoma patients: What we have known HBV reactivation and hepatitis flares
More informationEuropean. Young Hepatologists Workshop. Organized by : Quantification of fibrosis and cirrhosis outcomes
supported by from Gilea Quantification of fibrosis and cirrhosis outcomes th 5 European 5 European Young Hepatologists Workshop Young Hepatologists Workshop August, 27-29. 2015, Moulin de Vernègues Vincenza
More informationNUTRITIONAL OPTIMIZATION IN PRE LIVER TRANSPLANT PATIENTS
NUTRITIONAL OPTIMIZATION IN PRE LIVER TRANSPLANT PATIENTS ACHIEVING NUTRITIONAL ADEQUACY Dr N MURUGAN Consultant Hepatologist Apollo Hospitals Chennai NUTRITION IN LIVER FAILURE extent of problem and consequences
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 informationGI bleeding in chronic liver disease
GI bleeding in chronic liver disease Stuart McPherson Consultant Hepatologist Liver Unit, Freeman Hospital, Newcastle upon Tyne and Institute of Cellular Medicine, Newcastle University. Case 54 year old
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 informationTitle: Treatment of hepatic encephalopathy by on-line hemodiafiltration: A case series study
Author's response to reviews Authors: Shinju Arata (s_arata@yokohama-cu.ac.jp) Katsuaki Tanaka (k_tanaka@urahp.yokohama-cu.ac.jp) Kazuhisa Takayama (k-takayama@star.ocn.ne.jp) Yoshihiro Moriwaki (qqc3@urahp.yokohama-cu.ac.jp)
More informationAccepted Manuscript. S (18) DOI: /j.gastro Reference: YGAST 61873
Accepted Manuscript Corticosteroids Reduce Risk of Death Within 28 Days for Patients With Severe Alcoholic Hepatitis, Compared With Pentoxifylline or Placebo a Meta-analysis of Individual Data Alexandre
More informationHepatology For The Nonhepatologist
Hepatology For The Nonhepatologist Andrew Aronsohn, MD Associate Professor of Medicine University of Chicago Chicago, Illinois Learning Objectives After attending this presentation, learners will be able
More informationACG Clinical Guideline: Alcoholic Liver Disease
CLINICAL GUIDELINES 1 ACG Clinical Guideline: Alcoholic Liver Disease Ashwani K. Singal, MD, MS, FACG 1, R amon B at a l l e r, M D, Ph D, FAC G 2, Joseph Ahn, MD, MS, FACG (GRADE Methodologist) 3, Patrick
More informationIntron A (interferon alfa-2b) with ribavirin, (Copegus, Moderiba, Rebetol, Ribapak, Ribasphere, RibaTab, ribavirin tablets/capsules - all strengths)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Intron A Ribavirin Page: 1 of 5 Last Review Date: November 30, 2018 Intron A Ribavirin Description
More informationManagement of Decompensated Chronic Hepatitis B
Management of Decompensated Chronic Hepatitis B Dr James YY Fung, FRACP, MD Department of Medicine The University of Hong Kong Liver Transplant Center Queen Mary Hospital State Key Laboratory for Liver
More informationCritical care resources are often provided to the too well and as well as. to the too sick. The former include the patients admitted to an ICU
Literature Review Critical care resources are often provided to the too well and as well as to the too sick. The former include the patients admitted to an ICU following major elective surgery for overnight
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 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 informationThe Liver for the Nonhepatologist
The Liver for the Nonhepatologist Michael R. Charlton, MBBS, FRCP Hepatology Director and Medical Director of Liver Transplantation Intermountain Medical Center Salt Lake City, Utah FORMATTED: 05-14-15
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 informationLiver Transplantation for the Primary Care Provider. Atif Zaman MD MPH Oregon Health & Sciences University
Liver Transplantation for the Primary Care Provider Atif Zaman MD MPH Oregon Health & Sciences University Disclosures 1. The speaker/planner Atif Zaman, MD MPH have no relevant financial relationships
More informationEsophageal Varices Beta-Blockers or Band Ligation. Cesar Yaghi MD Hotel-Dieu de France University Hospital Universite Saint Joseph
Esophageal Varices Beta-Blockers or Band Ligation Cesar Yaghi MD Hotel-Dieu de France University Hospital Universite Saint Joseph Esophageal Varices Beta-Blockers or Band Ligation? Risk of esophageal variceal
More informationWhat is NAFLD?.NASH? Presenter Disclosure Information. Learning Objectives. Case 1: Rob. Questions Pertinent to Rob
Presenter Disclosure Information 5 6pm Nonalcoholic Fatty Liver Disease (NAFLD): Another Obesity-Related Epidemic SPEAKER Elliot Tapper, MD The following relationships exist related to this presentation:
More informationNon-Alcoholic Fatty Liver Disease
Non-Alcoholic Fatty Liver Disease None Disclosures Arslan Kahloon M.D Chief, Division of Gastroenterology and Hepatology University of Tennessee College of Medicine Chattanooga Objectives Understand the
More informationCanine Chronic Idiopathic Hepatitis
Canine Chronic Idiopathic Hepatitis David C. Twedt DVM, DACVIM Problem Acute Rt rear leg lameness History Probably stepped on by owner s horse Healthy otherwise No medications Physical exam Possible partial
More informationThe CARI Guidelines Caring for Australasians with Renal Impairment. Membranous nephropathy role of steroids GUIDELINES
Membranous nephropathy role of steroids Date written: July 2005 Final submission: September 2005 Author: Merlin Thomas GUIDELINES There is currently no data to support the use of short-term courses of
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 informationCIRROSI E IPERTENSIONE PORTALE NELLA DONNA
Cagliari, 16 settembre 2017 CIRROSI E IPERTENSIONE PORTALE NELLA DONNA Vincenza Calvaruso, MD, PhD Ricercatore di Gastroenterologia Gastroenterologia & Epatologia, Di.Bi.M.I.S. Università degli Studi di
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 informationNCEPOD - Measuring the Units; A review of patients who died with alcohol-related liver disease
NCEPOD - Measuring the Units; A review of patients who died with alcohol-related liver disease Hospital Number Admission to hospital 5. Trusts should ensure that medical patients are reviewed by a consultant
More information58 Year-old Male with Alcoholic Cirrhosis Presents with Hyponatremia. Jess Hwang 11/8/12
58 Year-old Male with Alcoholic Cirrhosis Presents with Hyponatremia Jess Hwang 11/8/12 HPI Fluid leaking from umbilical hernia secondary to his ascites Went to OR for drain placement which was complicated
More informationSystemic Inflammatory Response Syndrome and MELD Score in Hospital Outcome of Patients with Liver Cirrhosis
168 Original Article Systemic Inflammatory Response Syndrome and MELD Score in Hospital Outcome of Patients with Liver Cirrhosis Ramin Behroozian 1*, Mehrdad Bayazidchi 1, Javad Rasooli 1 1. Department
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 informationAlbumin-to-bilirubin score for assessing the in-hospital death in cirrhosis
Original Article Albumin-to-bilirubin score for assessing the in-hospital death in cirrhosis Lichun Shao 1 *, Bing Han 1 *, Shu An 2, Jiaxin Ma 1, Xiaozhong Guo 3, Fernando Gomes Romeiro 4, Andrea Mancuso
More informationAlcoholic Hepatitis To Transplant or Not To Transplant, That is the Question
Alcoholic Hepatitis To Transplant or Not To Transplant, That is the Question Arjmand Mufti, MD, MRCP (UK) Division of Digestive and Liver Diseases University of Texas Southwestern Medical Center Internal
More informationStressed Out: Evaluating the Need for Stress Ulcer Prophylaxis in the ICU
Stressed Out: Evaluating the Need for Stress Ulcer Prophylaxis in the ICU Josh Arnold, PharmD PGY1 Pharmacy Resident Pharmacy Grand Rounds November 8, 2016 2016 MFMER slide-1 Objectives Identify the significance
More informationThe management of alcoholic liver disease
Journal of Hepatology 38 (2003) S2 S13 www.elsevier.com/locate/jhep The management of alcoholic liver disease Stephen F. Stewart, Christopher P. Day* Centre for Liver Research, Medical School, Framlington
More information