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IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 9, 2009 Category: Gastroenterology Source Type: journals

Non-Alcoholic Fatty Liver Disease: Is Bariatric Surgery the Answer?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
As the worldwide obesity epidemic continues to increase, the prevalence of non-alcoholic fatty liver disease (NAFLD) and specifically non-alcoholic steatohepatitis (NASH) will become increasingly prominent. NASH will surpass chronic hepatitis C infection as the primary indication for orthotopic liver transplantation in the near future. With the evolution of surgical techniques, bariatric surgery is currently recognized as the most effective method for achieving sustained weight loss and reversing numerous comorbidities in severely obese individuals. This review focuses on the potential risks and benefits of bariatric surge...
Source: Clinics in Liver Disease - October 9, 2009 Category: Gastroenterology Authors: Anjana A. Pillai, Mary E. Rinella Source Type: journals

Pharmacologic Therapy of Non-Alcoholic SteatohepatitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article discusses this therapy, with particular emphasis on pharmacologic therapy. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 9, 2009 Category: Gastroenterology Authors: Vlad Ratziu, Shira Zelber-Sagi Source Type: journals

Lifestyle Modification as the Primary Treatment of NASHEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews the rationale and data behind recommending lifestyle changes to prevent and reverse NASH, focusing specifically on changes that lead to increased physical activity in sedentary patients, changes in dietary habits, and decreased calorie consumption to achieve gradual and sustained weight loss in those who are overweight or obese. In a culture that values avoiding even minimal exertion these are not easy changes to make. Ultimately, the success of care providers in helping patients to recognize and overcome these barriers depends on a patient's motivation, but clinicians can be more persuasive and able t...
Source: Clinics in Liver Disease - October 9, 2009 Category: Gastroenterology Authors: Brent A. Neuschwander-Tetri Source Type: journals

NASH and HCCEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Primary liver cancer is the fifth most common malignancy worldwide and the third leading cause of cancer mortality. Non-alcoholic fatty liver disease is the most common cause of chronic liver disease in the United States encompassing a spectrum of entities marked by hepatic steatosis in the absence of significant alcohol consumption. Although simple steatosis follows a generally benign course, the more aggressive form, non-alcoholic steatohepatitis, can progress to cirrhosis and result in complications including hepatocellular carcinoma. A significant number of cases of hepatocellular carcinoma remain cryptogenic without k...
Source: Clinics in Liver Disease - October 9, 2009 Category: Gastroenterology Authors: John M. Page, Stephen A. Harrison Source Type: journals

Fatty Liver and Liver TransplantationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article addresses some of these challenges. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 9, 2009 Category: Gastroenterology Authors: Edith Koehler, Kymberly Watt, Michael Charlton Source Type: journals

New Imaging Techniques for Non-Alcoholic SteatohepatitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
No imaging modality has yet been proven to reliably differentiate simple hepatic steatosis from steatohepatitis. This review focuses on the predominant non-nuclear imaging modalities available to clinicians at the present time. The key feature of the techniques outlined in this review that demonstrate the most interesting results have one thing in common: imaging is not performed in a passive manner but is undertaken as a method to investigate functional differences between simple hepatic steatosis and steatohepatitis based upon the current working model for pathogenesis and progression. The purpose of this article is to r...
Source: Clinics in Liver Disease - October 9, 2009 Category: Gastroenterology Authors: Jeffrey D. Browning Source Type: journals

Predictors of Steatohepatitis and Advanced Fibrosis in Non-Alcoholic Fatty Liver DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Non-alcoholic fatty liver disease is the most common cause of chronic liver disease in the United States. The development of non-alcoholic steatohepatitis increases the risk for cirrhosis and its complications. The gold standard for diagnosis is liver biopsy, the costs and risks of which make it impractical. Some demographic factors, blood tests, and imaging studies can be used to predict a higher risk of steatohepatitis or advanced fibrosis, but are of limited sensitivity and specificity. More accurate predictors and scoring systems would allow identifying who would benefit most from liver biopsy and monitor disease progr...
Source: Clinics in Liver Disease - October 9, 2009 Category: Gastroenterology Authors: Mangesh Pagadala, Claudia O. Zein, Arthur J. McCullough Source Type: journals

Endoplasmic Reticulum Stress and the Unfolded Protein ResponseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews the pathways by which the UPR unfolds and its potential role in the development and progression of NAFLD. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 9, 2009 Category: Gastroenterology Authors: Ashwani Kapoor, Arun J. Sanyal Source Type: journals

Apoptosis and Cytokines in Non-Alcoholic SteatohepatitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article summarizes the process of apoptosis and roles of putative cytokines in progressive NAFLD. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 9, 2009 Category: Gastroenterology Authors: Wing-Kin Syn, Steve S. Choi, Anna Mae Diehl Source Type: journals

Role of Insulin Resistance and Lipotoxicity in Non-Alcoholic SteatohepatitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
It is well established that the development of NAFLD and NASH are closely linked to an excess flow of free fatty acids (FFA) arising from dysfunctional/insulin resistant adipose tissue causing ectopic fat deposition in many organs. In the liver, when chronic lipid supply surpasses the metabolic ability to adapt it will induce hepatocellular damage as FFA are redirected into harmful pathways of non-oxidative metabolism with intracellular accumulation of toxic lipid-derived metabolites. Multiple mechanisms have been implicated including mitochondrial dysfunction, endoplasmic reticulum stress, and activation of multiple infla...
Source: Clinics in Liver Disease - October 9, 2009 Category: Gastroenterology Authors: Kenneth Cusi Source Type: journals

Histopathology of Non-Alcoholic Fatty Liver DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Current imaging methodologies can detect steatosis with increasing accuracy but cannot detect inflammation or pre-cirrhotic fibrosis or remodeling of the liver parenchyma. Imaging also cannot assess types or localization of hepatic steatosis. With the increased use of rodents to study NAFLD/NASH, careful analysis or reading highlights the fact that liver tissue evaluations reported in many of the popular animal models of NAFLD/NASH often do not imitate many of the significant aspects of the human disease, despite similar terminology applied by investigators. This review will focus on the findings in human disease. (Source:...
Source: Clinics in Liver Disease - October 9, 2009 Category: Gastroenterology Authors: Elizabeth M. Brunt Source Type: journals

Epidemiology and Natural History of Non-Alcoholic SteatohepatitisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article describes the epidemiology and natural history of this disorder. It also describes current diagnostic and treatment methods and describes future implications NAFLD may have. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 9, 2009 Category: Gastroenterology Authors: Curtis K. Argo, Stephen H. Caldwell Source Type: journals

PrefaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Our understanding of nonalcoholic fatty liver disease (NAFLD) has grown exponentially in the past 29 years since Ludwig and colleagues first described the histologic lesions that comprise a subset of NAFLD known as nonalcoholic steatohepatitis (NASH). A recent PubMed search using the term “nonalcoholic fatty liver disease” generated 1475 articles published since 1980, of which 1405 were published since the year 2000. Concern for this liver disease is validated, as NAFLD is becoming, if it has not already become, the number one chronic liver disease in this country and in many others around the world. As the prevalence ...
Source: Clinics in Liver Disease - October 9, 2009 Category: Gastroenterology Authors: Stephen A. Harrison Source Type: journals

Forthcoming issuesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 9, 2009 Category: Gastroenterology Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 9, 2009 Category: Gastroenterology Source Type: journals

IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - July 23, 2009 Category: Gastroenterology Source Type: journals

Thrombopoietin Agonists for the Treatment of Thrombocytopenia in Liver Disease and Hepatitis CEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article examines the nature of thrombocytopenia, ITP, and TPO. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - July 23, 2009 Category: Gastroenterology Authors: Geoffrey Dusheiko Source Type: journals

Monoclonal and Polyclonal Antibodies Against the HCV Envelope ProteinsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The potential for developing efficient and efficacious therapies for hepatitis C virus continues to improve. Insight into the molecular processes involved in attachment, entry, and fusion suggests that antibodies could potentially inhibit viral replication at any or all of these stages, and the attachment and entry stages present the best target for antibodies that can attack the virus. Monoclonal and polyclonal antibodies present an important therapeutic option in this area, and this article assesses current investigations of several antibodies. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - July 23, 2009 Category: Gastroenterology Authors: Heshaam M. Mir, Aybike Birerdinc, Zobair M. Younossi Source Type: journals

Caspase Inhibitors for the Treatment of Hepatitis CEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Decreasing hepatocyte injury and death is an attractive therapeutic target in chronic hepatitis C and other liver diseases. Apoptotic cell death is a critical mechanism responsible for liver injury in hepatitis C, and contributes to hepatic fibrogenesis. At the cellular level, apoptosis is executed by a family of cysteine proteases termed caspases. Caspase inhibitors have been developed to inhibit these proteases and attenuate cellular apoptosis in vivo. By reducing hepatocyte apoptosis these agents have the potential to serve as hepatoprotective agents, minimizing liver injury and fibrosis. Studies on a variety of animal ...
Source: Clinics in Liver Disease - July 23, 2009 Category: Gastroenterology Authors: Howard C. Masuoka, Maria Eugenia Guicciardi, Gregory J. Gores Source Type: journals

HCV NS5B Polymerase InhibitorsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Chronic hepatitis C virus (HCV) infection affects approximately 4 million persons and is the major indication for liver transplantation in the United States. The current standard for treatment of HCV is pegylated interferon in combination with ribavirin. Despite significant advances in treatment, only approximately 50% of patients of treated patients clear HCV infection. Polymerase inhibitors, given their potent antiviral effects, represent a major contribution to the future of HCV treatment. Whether these new drugs will have a role in the treatment of the difficult patient (non-responders, those co-infected with HIV, deco...
Source: Clinics in Liver Disease - July 23, 2009 Category: Gastroenterology Authors: James R. Burton, Gregory T. Everson Source Type: journals

Telaprevir: Hope on the Horizon, Getting CloserEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In this report, the current experience using telaprevir to treat chronic HCV infection as monotherapy and in combination with other agents is reviewed. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - July 23, 2009 Category: Gastroenterology Authors: Ilan S. Weisberg, Ira M. Jacobson Source Type: journals

Boceprevir, an NS3 Protease Inhibitor of HCVEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Hepatitis C virus (HCV) is a major cause of chronic liver disease leading to death from liver failure or hepatocellular carcinoma. Hepatitis C is the most common indication for liver transplantation worldwide and is a major cause of the increased incidence of hepatocellular cancer in the United States. The current paradigm for HCV treatment relies on pegylated interferon and ribavirin as agents that enhance endogenous mechanisms for viral clearance and are dependent on host factors. In patients with genotype 1 HCV infection, sustained viral response (SVR) rates remain suboptimal, with less than half of genotype 1–infecte...
Source: Clinics in Liver Disease - July 23, 2009 Category: Gastroenterology Authors: Kenneth Berman, Paul Y. Kwo Source Type: journals

Ribavirin AnalogsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Ribavirin is ineffective against hepatitis C virus as mono-therapy but is critical in attaining both early virologic response and sustained virologic response when combined with pegylated interferon. Ribavirin has significant dose-limiting toxicities, the most important of which is hemolytic anemia. Taribavirin is a ribavirin pro-drug, which targets the liver and has less incidence of anemia, and it may be a promising alternative to ribavirin in the future. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - July 23, 2009 Category: Gastroenterology Authors: William W. Shields, Paul J. Pockros Source Type: journals

Cyclophilin InhibitorsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The percentage of patients chronically infected with hepatitis C virus (HCV) who have reached sustained antiviral response has increased since the introduction of the pegylated interferon-alpha (pIFNa) and ribavirin (RBV) treatment. However, the current standard pIFNa/RBV therapy not only has a low success rate (about 50%) but is often associated with serious side effects. Thus, there is an urgent need for the development of new anti-HCV agents. Cyclophilin (Cyp) inhibitors are among the most promising of the new anti-HCV agents under development. Recent clinical studies demonstrate that Cyp inhibitors are potent anti-HCV ...
Source: Clinics in Liver Disease - July 23, 2009 Category: Gastroenterology Authors: Philippe A. Gallay Source Type: journals

Hepatitis C Virus Infection and Immunomodulatory TherapiesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Hepatitis C virus (HCV) infection remains a large-scale and significant health concern. The combination of subcutaneously administered pegylated interferon and oral ribavirin is the FDA-approved regimen for the treatment of chronic HCV infection. Combination therapy may result in a sustained virologic response leading to HCV eradication, with a reduction in risk for cirrhosis, hepatic decompensation, and hepatocellular carcinoma.9,10 However, the combination of PEG-IFN and ribavirin does not universally result in cure in all patients who undergo treatment. In this article, the authors discuss immunomodulatory therapies and...
Source: Clinics in Liver Disease - July 23, 2009 Category: Gastroenterology Authors: Kimberly A. Forde, K. Rajender Reddy Source Type: journals

Antisense Inhibitors, Ribozymes, and siRNAsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The current standard of care for the treatment of hepatitis C virus infection, pegylated interferon-α and ribavirin, is costly, associated with significant side effects, and effective in only 50% of patients. There is therefore a need for the development of novel antiviral therapies. One such approach involves the application of gene silencing technologies, including antisense oligonucleotides, ribozymes, RNA interference, and aptamers. However, despite great scientific advances over the past decade, and promising in vitro data, several significant challenges continue to limit the translation of this technology to the cli...
Source: Clinics in Liver Disease - July 23, 2009 Category: Gastroenterology Authors: Alexander J.V. Thompson, Keyur Patel Source Type: journals

Antifibrotics for Chronic Hepatitis CEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Development and testing of antifibrotic agents for the treatment of chronic hepatitis C have generally been targeted toward hepatic stellate cells, transforming growth factor-β, the inflammatory response, or extracellular matrix accumulation. Although several agents such as interferon-γ, long-term pegylated interferon, and caspase inhibitors have been studied, none have proved to be effective to date. There is a clear need for drugs that inhibit or reverse hepatic fibrosis as these would be immediately applicable to patients for whom antiviral therapy has failed or who have contraindications to antiviral therapy such as ...
Source: Clinics in Liver Disease - July 23, 2009 Category: Gastroenterology Authors: Paul J. Pockros Source Type: journals

Novel Interferons for Treatment of Hepatitis C VirusEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The current standard of care for treatment of hepatitis C is pegylated interferon and ribavirin. Despite the large number of new oral agents under development, interferon will likely remain the backbone of future therapy. Interferon has unique antiviral and immunomodulatory properties, which have been critical in limiting resistance to protease inhibitors and improving efficacy. Hence, optimizing pharmacokinetics and promoting adherence to interferon dosing regimens will become even more critical as new regimens enter the clinical arena. This review highlights novel interferons under development that may offer therapeutic ...
Source: Clinics in Liver Disease - July 23, 2009 Category: Gastroenterology Authors: Virginia Clark, David R. Nelson Source Type: journals

PrefaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The current standard of care for chronic hepatitis C therapy is a combination of pegylated interferon and ribavirin. Eradication of the hepatitis C virus (HCV) has been proved to be possible in roughly half of all patients treated; however, viral eradication rates are superior in patients with viral genotypes 2 and 3 compared with genotype 1 patients. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - July 23, 2009 Category: Gastroenterology Authors: Paul J. Pockros Source Type: journals

Forthcoming issuesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - July 23, 2009 Category: Gastroenterology Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - July 23, 2009 Category: Gastroenterology Source Type: journals

IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 1, 2009 Category: Gastroenterology Source Type: journals

Care of the Cirrhotic PatientEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Timely surveillance for varices and hepatocellular carcinoma, prophylaxis against spontaneous bacterial peritonitis (SBP) improve survival in patients awaiting transplantation. Early diagnosis of minimal or overt hepatic encephalopathy can delay life threatening complications, reduce need for hospitalization, and potentially improve survival pending liver transplantation. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 1, 2009 Category: Gastroenterology Authors: Priya Grewal, Paul Martin Source Type: journals

Hepatitis Vaccination and ProphylaxisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article discusses current recommendations for vaccination and other forms of prophylaxis aimed at minimizing the clinical effects of these viruses. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 1, 2009 Category: Gastroenterology Authors: Carolyn T. Nguyen, Tram T. Tran Source Type: journals

Management of Autoimmune and Cholestatic Liver DisordersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The management of autoimmune and cholestatic liver disorders is a challenging area of hepatology. Autoimmune and cholestatic liver diseases represent a comparatively small proportion of hepatobiliary disorders, yet their appropriate management is of critical importance for patient survival. In this article, management strategies are discussed, including the indications and expectations of pharmacologic therapy, endoscopic approaches, and the role of liver transplantation. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 1, 2009 Category: Gastroenterology Authors: Karen L. Krok, Santiago J. Munoz Source Type: journals

Drug-Induced Hepatotoxicity or Drug-Induced Liver InjuryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Drug-induced hepatotoxicity is underreported and underestimated in the United States. It is an important cause of acute liver failure. Common classes of drugs causing drug-induced hepatotoxicity include antibiotics, lipid lowering agents, oral hypoglycemics, psychotropics, antiretrovirals, acetaminophen, and complementary and alternative medications. Hepatotoxic drugs often have a signature or pattern of liver injury including patterns of liver test abnormalities, latency of symptom onset, presence or absence of immune hypersensitivity, and the course of the reaction after drug withdrawal. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 1, 2009 Category: Gastroenterology Authors: Aaron J. Pugh, Ashutosh J. Barve, Keith Falkner, Mihir Patel, Craig J. McClain Source Type: journals

Management of Alcoholic Liver DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Understanding alcohol addiction and abstinence is key to treating alcoholic liver disease, since abstinence leads to improvement in all forms of alcoholic liver damage. Although pharmacotherapy for alcoholism, using agents such as naltrexone, acamprosate, topiramate, and baclofen, is an exciting field, few studies have included patients with liver disease or cirrhosis. To treat alcoholic liver injury, corticosteroids have become the standard of care in patients with severe alcoholic hepatitis. In contrast, the role of pharmacotherapy to treat alcoholic fibrosis is unclear, with failure to observe a benefit in randomized, p...
Source: Clinics in Liver Disease - May 1, 2009 Category: Gastroenterology Authors: Michael R. Lucey Source Type: journals

Nonalcoholic Fatty Liver Disease: A Practical Approach to Evaluation and ManagementEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Non-alcoholic fatty liver disease (NAFLD) has become one of the most common forms of chronic liver disease in the Western world. The rise in NAFLD is thought to be associated with the prevalence of metabolic syndrome. NASH is a subtype of NAFLD that may progress to cirrhosis and end stage liver disease. Although there are no approved treatment regimens for NAFLD or NASH, a number of different interventions are being tested. Meanwhile, most experts advocate that components of metabolic syndrome should be effectively treated. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 1, 2009 Category: Gastroenterology Authors: Nila Rafiq, Zobair M. Younossi Source Type: journals

Modern Diagnosis and Management of Hepatocellular CarcinomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The incidence of hepatocellular carcinoma (HCC) is rising, and the number of patients with HCC is expected to more than double over the next 1 to 2 decades. HCC meets the criteria for establishment of a surveillance program. Patients with cirrhosis, regardless of the cause, are at the highest risk for developing HCC and this is the population in which surveillance should be performed. (Alpha-fetoprotein and hepatic ultrasonography are the currently recommended surveillance tests. If a surveillance test is abnormal, there is a need for a recall test for diagnostic evaluation of HCC. Triple-phase imaging is recommended for e...
Source: Clinics in Liver Disease - May 1, 2009 Category: Gastroenterology Authors: Jorge A. Marrero, Theodore Welling Source Type: journals

Surgery in the Patient with Liver DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The advent of liver transplantation has greatly improved the long-term survival of patients with decompensated cirrhosis, and surgery is now performed more frequently in patients with advanced liver disease. The estimation of perioperative mortality is limited by the retrospective nature of and biased patient selection in the available clinical studies. The overall experience is that, in patients with cirrhosis, use of the Child classification and Model for End-Stage Liver Disease (MELD) score provides a reasonably precise estimation of perioperative mortality. Careful preoperative preparation and monitoring to detect comp...
Source: Clinics in Liver Disease - May 1, 2009 Category: Gastroenterology Authors: Jacqueline G. O'Leary, Patrick S. Yachimski, Lawrence S. Friedman Source Type: journals

Approach to a Liver MassEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Incidentally discovered liver masses are becoming more common with the increasing application and power of imaging techniques for the evaluation of abdominal conditions. Although such masses are often benign, conclusive diagnoses must be established in order to provide appropriate patient care. Various imaging modalities can be utilized to accurately diagnose such masses without resort to more invasive diagnostic measures. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 1, 2009 Category: Gastroenterology Authors: Oren Shaked, K. Rajender Reddy Source Type: journals

The Hospitalized Patient with Abnormal Liver Function TestsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Evaluation of abnormal liver function tests (LFTs) in the hospitalized patient is typically more urgent than the outpatient setting. This process is best organized into four steps. The first step is to determine whether the abnormal LFTs are associated with the illness resulting in the admission to the hospital or preceded the present illness. The second is to determine the etiology of the underlying liver disease. The third step is to evaluate the severity of the liver dysfunction and determine if acute liver failure (ALF) or acute decompensation of chronic liver failure is present. The final step is to look for the prese...
Source: Clinics in Liver Disease - May 1, 2009 Category: Gastroenterology Authors: Christopher B. O'Brien Source Type: journals

The Asymptomatic Outpatient with Abnormal Liver Function TestsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Traditionally, the constellation of biochemistry tests including liver enzymes, total bilirubin, and hepatic synthetic measures (prothrombin time (PT) and serum albumin level) are referred to as liver function tests (LFTs). Abnormal LFTs can be encountered during primary health care visits, routine blood donation, and insurance screening. A reported 1% to 4% of asymptomatic patients exhibit abnormal LFTs, leading to a sizeable number of annual consultations to a gastroenterology and/or hepatology practice. A cost-effective and systematic approach is essential to the interpretation of abnormal LFTs. A review of pattern of a...
Source: Clinics in Liver Disease - May 1, 2009 Category: Gastroenterology Authors: Michael Krier, Aijaz Ahmed Source Type: journals

PrefaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A consequence of the rapid advances in the science and practice of hepatology has been an expanding number of diagnostic tests and therapeutic interventions. Although these new modalities have transformed the care of patients with liver disease, effective use of invasive, and often expensive, diagnostics is crucial. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 1, 2009 Category: Gastroenterology Authors: Paul Martin Source Type: journals

Forthcoming issuesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 1, 2009 Category: Gastroenterology Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 1, 2009 Category: Gastroenterology Source Type: journals

Human NOTES Cholecystectomy: Transgastric Hybrid Technique.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
CONCLUSIONS: NOTES hybrid transgastric cholecystectomy can be performed safely in human patients. This procedure is still technically challenging given the current instrumentation that is available. In order to perform a pure NOTES transgastric cholecystectomy, a safe blind access method, improved retraction, endoscopic hemostatic clips, and reliable closure methods need to be developed. PMID: 19198959 [PubMed - as supplied by publisher] (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - February 7, 2009 Category: Gastroenterology Authors: Auyang ED, Hungness ES, Vaziri K, Martin JA, Soper NJ Tags: J Gastrointest Surg Source Type: journals

Preface.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
PMID: 19150303 [PubMed - in process] (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - January 22, 2009 Category: Gastroenterology Authors: Caldwell SH, Sanyal AJ Tags: Clin Liver Dis Source Type: journals

The coagulation cascade in cirrhosis.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The coagulation "cascade" model accurately represents the mechanisms of the prothrombin time and activated partial thromboplastin time tests. However, these tests and the "cascade" model do not accurately reflect the risk of hemorrhage or thrombosis in vivo. In hepatic insufficiency, a balanced reduction in the levels of most of pro- and anticoagulant proteins produced in the liver does not impair thrombin generation until levels are quite low. However, the ability of the coagulation system to tolerate or recover from an insult is markedly impaired in liver disease. This allows the coagulation system to be more easily ...
Source: Clinics in Liver Disease - January 22, 2009 Category: Gastroenterology Authors: Monroe DM, Hoffman M Tags: Clin Liver Dis Source Type: journals