In Clinical Practice

In Clinical Practice

Taking a practical approach to clinical medicine, this series of smaller reference books is designed for the trainee physician, primary care physician, nurse practitioner and other general medical professionals to understand each topic covered. The coverage is comprehensive but concise and is designed to act as a primary reference tool for subjects across the field of medicine. More information about this series at http://www. springer.com/series/13483

Tim Cross Editor Liver Disease in Clinical Practice

Editor Tim Cross Royal Liverpool University Hospital Liverpool Merseyside United Kingdom ISSN 2199-6652 ISSN 2199-6660 (electronic) In Clinical Practice ISBN 978-3-319-43125-3 ISBN 978-3-319-43126-0 (ebook) DOI 10.1007/978-3-319-43126-0 Library of Congress Control Number: 2016960002 Springer International Publishing Switzerland 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company is: Gewerbestrasse 11, 6330 Cham, Switzerland

Dedicated to the memory of Professor Andrew K Burroughs (1953 2014).

Foreword It is well documented that the prevalence of chronic liver disease is rising across many populations. As such, medical practitioners, across a range of disciplines, are required to have a knowledge and understanding of these conditions that they are likely to encounter. This book is aimed at medical students, gastroenterology and hepatology trainees, primary care physicians, specialist nurses, and also senior physicians in need of a bit of guidance when dealing with patients with liver diseases. This book has been written by leading specialists, and follows a familiar pattern including key points, cases, and questions, all intending to emphasize the main learning objectives and clinical lessons. For such a textbook, there is a limit to what can be included and so certain conditions have not been included, and this book has been restricted to the management of parenchymal liver diseases. I hope these omissions are not too much of a hindrance and comments suggesting how the text could be improved would be welcomed. I would like to thank all the authors for their hard work and sticking to their brief, as well as Prakash, Evgenia, and Priya from Springer who have been so helpful in ensuring that this project came to fruition. Finally, thanks to my wife Rashika, and children, Arik, Hari, and Annika, for not disturbing me (too much) in the evenings and at weekends to allow the editing of this book to be completed. Lymm, UK September 2016 Tim Cross vii

Contents Part I Clinical Manifestations and Approach to Liver Disease 1 Assessment of Liver Function... 3 Larry Ee Juan Loo, Sandev Singh, and Cyril Sieberhagen 2 Liver Decompensation and Acute on Chronic Liver Failure... 19 Nowlan Selvapatt, Ameet Dhar, and C.G. Antoniades 3 Portal Hypertension: Varices... 41 Audrey Dillon and Dhiraj Tripathi 4 Hepatic Encephalopathy... 57 Mark A. Ellul and Tim Cross 5 Nutritional Management of End-Stage Liver Disease... 71 Martyn Dibb Part II Liver Diseases of Lifestyle, Genes and Metabolism 6 Alcoholic Hepatitis... 91 Farhan Gohar and Paul Richardson 7 Non-alcoholic Fatty Liver Disease... 111 Thomas Marjot and Jeremy Cobbold ix

x Foreword 8 Genetic Haemochromatosis... 131 William J.H. Griffiths 9 The Orphan liver Disease... 147 Reenam Khan and Phil Newsome Part III Viral Liver Disease 10 Chronic Hepatitis B... 163 Navjyot Hansi, Upkar Gill, and Patrick Kennedy 11 Chronic Hepatitis C... 183 Varinder Athwal and Martin Prince Part IV Immune Mediated Liver Disease 12 Autoimmune Hepatitis and Crossover Syndromes... 203 Ashnila Janmohamed and Gideon M. Hirschfield 13 Primary Biliary Cholangitis... 227 Farhan Gohar and Imran Patanwala 14 Primary Sclerosing Cholangitis... 243 Margaret Corrigan and James Ferguson Part V Areas of Special Consideration 15 Pregnancy and Liver Disease... 263 David F.W. Tai and Rachel H. Westbrook 16 Diagnosis and Management of Hepatocellular Carcinoma... 285 Tim Cross 17 Liver Transplantation... 307 Lidia Santos Roque and James O Beirne

Foreword xi 18 The Hepatological Curiosities... 331 Lalitha Chinnappan and Tim Cross 19 End-of-Life Care for Patient with Liver Disease... 355 Lynda Greenslade Erratum... E1 Index... 369

Contributors C.G. Antoniades Division of Digestive Diseases, Imperial College London & Institute of Liver Sciences, King s College London, London, UK Varinder Athwal Manchester University, Manchester, UK Lalitha Chinnappan, MBBS, MRCP The Royal Liverpool Hospital, Liverpool, UK Jeremy Cobbold, MA, MBBS, MRCP, PhD Oxford University Hospitals NHS Foundation Trust, Oxford, UK Margaret Corrigan NIHR Birmingham Liver Biomedical Research Unit, University of Birmingham, Birmingham, UK Tim Cross, BMedSci (hons), MD, FRCP The Royal Liverpool Hospital, Liverpool, UK Ameet Dhar, PhD, MRCP St Mary s Hospital, Paddington, London, UK Martyn Dibb, BSc (MedSci), MB ChB, MD, FRCP Royal Liverpool University Hospital, Liverpool, UK Audrey Dillon, MRCP Liver Unit, Queen Elizabeth Hospital, Birmingham, UK Mark A. Ellul Institute of Infection and Global Health, University of Liverpool, Liverpool, UK James Ferguson Queen Elizabeth Hospital, Birmingham, UK xiii

xiv Contributors Upkar Gill Clinical Research fellow, Blizard Institute, Barts and The London, SMD, QMUL, London, UK Farhan Gohar, MBBS, MRCP Department of Gastroenterology and Hepatology, The Royal Liverpool Hospital, Liverpool, UK Lynda Greenslade, MSc, RGN Royal Free London NHS Foundation Trust, Royal Free Hospital, London, UK William J.H. Griffiths, PhD, FRCP Department of Hepatology, Cambridge University Teaching Hospitals NHS Trust, Addenbrooke s Hospital, Cambridge, UK Navjyot Hansi, MBBS, MRCP, BSc Clinical Research fellow, Blizard Institute, Barts and The London, SMD, QMUL, London, UK Gideon M. Hirschfield Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham, UK Ashnila Janmohamed Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham, UK Patrick Kennedy, MBBCh, BAO, BMedSci, MRCP, MD Reader in Hepatology, Blizard Institute, Barts and The London SMD, QMUL, London, UK Reenam Khan, MRCP Liver Unit, Queen Elizabeth Hospital, Birmingham, UK Larry Ee Juan Loo Aintree University Hospital, Liverpool, Merseyside, UK Thomas Marjot, MBBS, BSc, MRCP University of Oxford, Oxford, UK Phil Newsome, PhD Institute of Biomedical Research, The Medical School, University of Birmingham, Birmingham, UK

Contributors xv James O Beirne, MBBS, MD, EDIC, FRCP Royal Free London NHS Foundation Trust, Royal Free Hospital, London, UK Imran Patanwala, MBBS, MD, DOT, FRCP The Royal Liverpool Hospital, Liverpool, UK Martin Prince, MRCP, PhD The Manchester Royal Infirmary, Manchester, UK Lidia Santos Roque Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal Paul Richardson, FRCP Department of Gastroenterology and Hepatology, The Royal Liverpool Hospital, Liverpool, UK Nowlan Selvapatt, MBBS, PhD, MRCP Division of Digestive Diseases, Imperial College, London, UK Cyril Sieberhagen, MD, MRCP Aintree University Hospital, Liverpool, Merseyside, UK Sandev Singh, MBBS, MRCP Aintree University Hospital, Liverpool, Merseyside, UK David F.W. Tai Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK Dhiraj Tripathi, MD, FRCP The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK Rachel H. Westbrook, PhD, MRCP Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK