BOOK
Diagnosis and Management of Chronic Liver Diseases, An Issue of Medical Clinics, E-Book
(2014)
Additional Information
Book Details
Abstract
Chronic liver diseases progressively destruct liver tissue, leading to fibrosis and cirrhosis. Liver diseases can be caused by viral, autoimmune, or toxic (drugs/alcohol). Most conditions can be managed pharmacologically for indefinite periods of time. The articles in this issue will review best practices for managing and treating patients who present with these chronic problems, like hepatitis, nonalcoholic fatty liver, end stage liver disease, and drug-induced injuries.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Diagnosis andManagement of Chronic Liver Diseases\r | i | ||
| Copyright\r | ii | ||
| Medical Clinics Of North America\r | v | ||
| Contributors | vii | ||
| Contents | ix | ||
| Foreword | xiii | ||
| Preface | xv | ||
| Evaluation of Abnormal Liver Tests | 1 | ||
| Key points | 1 | ||
| Introduction | 1 | ||
| Markers of hepatocellular injury | 2 | ||
| Aminotransferases | 2 | ||
| Cholestasis | 5 | ||
| Alkaline phosphatase | 5 | ||
| γ-glutamyltransferase | 9 | ||
| 5′ nucleotidase | 9 | ||
| Tests of liver metabolism: total bilirubin | 9 | ||
| Tests of liver synthetic function | 12 | ||
| Noninvasive markers of fibrosis | 12 | ||
| Approach to patient evaluation and diagnosis | 12 | ||
| Summary | 14 | ||
| Acknowledgments | 14 | ||
| References | 15 | ||
| An Overview of Emerging Therapies for the Treatment of Chronic Hepatitis C | 17 | ||
| Key points | 17 | ||
| Hepatitis C life cycle and therapeutic targets | 18 | ||
| Protease (NS3/4A) inhibitors | 18 | ||
| Telaprevir | 20 | ||
| Phase 2 studies of telaprevir for treatment-naive patients | 20 | ||
| PROVE 1 | 20 | ||
| PROVE 2 | 20 | ||
| Phase 2 studies of telaprevir for treatment-experienced patients | 21 | ||
| PROVE 3 | 21 | ||
| Alternative telaprevir dosing regimens | 21 | ||
| Phase 3 studies of telaprevir | 22 | ||
| Telaprevir for Treatment-naive Patients | 22 | ||
| ADVANCE | 22 | ||
| ILLUMINATE | 23 | ||
| Telaprevir for Treatment-experienced Patients Who Failed to Achieve SVR with Previous Peg-IFN-α and Ribavirin Therapy | 23 | ||
| REALIZE | 23 | ||
| Telaprevir long-term study | 24 | ||
| EXTEND | 24 | ||
| Boceprevir | 24 | ||
| Phase 2 study of boceprevir for treatment-naive patients | 25 | ||
| SPRINT 1 | 25 | ||
| Phase 3 studies of boceprevir | 25 | ||
| Boceprevir for Treatment-naive Patients | 25 | ||
| SPRINT 2 | 25 | ||
| Boceprevir for Treatment-experienced Patients Who Had Partial or Relapse Responses to Treatment with Previous Peg-IFN-α and ... | 26 | ||
| RESPOND 2 | 26 | ||
| Predictors of SVR in SPRINT-2 and RESPOND-2 | 27 | ||
| Viral resistance to linear NS3 protease inhibitors telaprevir and boceprevir | 27 | ||
| Second-generation NS3 protease inhibitors | 28 | ||
| NS5B polymerase inhibitors | 28 | ||
| NIs | 28 | ||
| NNIs | 30 | ||
| NS5A inhibitors | 31 | ||
| Strategies to prevent resistance to DAAs | 31 | ||
| Combination therapies | 32 | ||
| Other antiviral therapeutics | 33 | ||
| Pegylated IFN-λ | 33 | ||
| Cyclophilin Inhibitors | 33 | ||
| Caspase inhibitors | 34 | ||
| Therapeutic vaccine GI-5005 | 34 | ||
| Matrix metalloprotease inhibitors | 35 | ||
| Summary | 35 | ||
| References | 35 | ||
| Chronic Hepatitis B Virus Infection | 39 | ||
| Key points | 39 | ||
| Introduction | 39 | ||
| Epidemiology of HBV and screening for patients with chronic HBV infection | 39 | ||
| Prevalence of HBV Worldwide and Whom to Screen for HBV in Developed Countries | 39 | ||
| Risk of Developing Chronic HBV After Acute Infection | 40 | ||
| Natural History of Chronic HBV | 40 | ||
| HBV Genotypes | 44 | ||
| Management of chronic HBV | 44 | ||
| Routine Monitoring of Patients with Chronic HBV | 45 | ||
| Use of Liver Biopsy | 46 | ||
| Selection of Treatment Candidates and Criteria | 47 | ||
| Choice of Antiviral Medications for Chronic HBV | 47 | ||
| Length of Antiviral Treatment in Patients on Oral Antiviral Medications | 48 | ||
| Special considerations | 48 | ||
| HBV/HDV Coinfection | 48 | ||
| HBV/HIV Coinfection | 49 | ||
| HBV/HCV Coinfection | 49 | ||
| Reactivation of HBV with Cancer Chemotherapy or Immunosuppressive Therapy | 49 | ||
| Management of HBV After Liver Transplantation | 50 | ||
| Screening for HCC | 50 | ||
| The Health Care Worker with Chronic HBV Infection | 50 | ||
| Summary | 51 | ||
| References | 51 | ||
| Review of Treatment Options for Nonalcoholic Fatty Liver Disease | 55 | ||
| Key points | 55 | ||
| Introduction | 55 | ||
| Epidemiology | 56 | ||
| Definition and natural history | 57 | ||
| Associations and pathogenesis | 57 | ||
| Clinical manifestations and diagnosis | 58 | ||
| Treatment | 59 | ||
| Lifestyle modifications | 60 | ||
| Bariatric surgery | 62 | ||
| Pharmacologic agents | 63 | ||
| Weight Loss Medications | 63 | ||
| Insulin Sensitizing Agents | 63 | ||
| Lipid-Lowering Agents | 64 | ||
| Antioxidants | 64 | ||
| Cytoprotective Agents | 65 | ||
| New Therapeutics of Interest | 65 | ||
| Summary | 66 | ||
| References | 66 | ||
| Cholestatic Liver Disease | 73 | ||
| Key points | 73 | ||
| Introduction | 73 | ||
| Diagnosis and management | 73 | ||
| Symptoms | 73 | ||
| Diagnosis | 74 | ||
| Differential Diagnosis | 75 | ||
| Management | 78 | ||
| Primary Biliary Cirrhosis | 78 | ||
| Primary Sclerosing Cholangitis | 78 | ||
| Pruritus | 78 | ||
| Fatigue | 79 | ||
| Osteoporosis | 79 | ||
| Vitamin Deficiency | 80 | ||
| Dyslipidemia | 80 | ||
| Portal Hypertension | 80 | ||
| Malignancy | 81 | ||
| Summary | 81 | ||
| References | 81 | ||
| Metal Storage Disorders | 87 | ||
| Key points | 87 | ||
| Introduction | 87 | ||
| Hereditary hemochromatosis | 88 | ||
| Diagnosis | 88 | ||
| Clinical features | 89 | ||
| Biochemical testing | 89 | ||
| Genetic testing | 89 | ||
| Hepatic iron concentration | 90 | ||
| Treatment | 91 | ||
| Survival and Screening | 92 | ||
| Wilson disease | 93 | ||
| Diagnosis | 93 | ||
| Clinical presentation | 93 | ||
| Laboratory testing | 94 | ||
| Liver biopsy | 95 | ||
| Genetic testing | 95 | ||
| Treatment | 96 | ||
| Transplant and Survival | 97 | ||
| References | 97 | ||
| Hepatocellular Carcinoma and Other Liver Lesions | 103 | ||
| Key points | 103 | ||
| Introduction | 103 | ||
| Risk factors | 104 | ||
| Surveillance | 104 | ||
| Diagnosis and staging | 105 | ||
| Symptoms | 106 | ||
| Differential diagnosis | 107 | ||
| Malignant Lesions | 107 | ||
| Benign Lesions | 107 | ||
| Management and treatment | 109 | ||
| Early-stage HCC | 109 | ||
| Intermediate-stage HCC | 110 | ||
| Advanced-stage HCC | 112 | ||
| Multidisciplinary Management | 112 | ||
| Summary and future considerations | 112 | ||
| References | 113 | ||
| Management of End-stage Liver Disease | 119 | ||
| Key points | 119 | ||
| Introduction | 119 | ||
| Ascites | 120 | ||
| Evaluation of Ascites | 120 | ||
| History and physical examination | 120 | ||
| Diagnostic and therapeutic paracentesis | 120 | ||
| Initial evaluation of cause of ascites | 120 | ||
| Albumin and total protein | 120 | ||
| Cell count and cultures | 122 | ||
| Other tests | 122 | ||
| Persistent ascites caused by cirrhosis | 122 | ||
| Basic Management of Ascites | 122 | ||
| Treatment of the underlying disorder | 122 | ||
| Dietary sodium restriction | 122 | ||
| Fluid restriction | 123 | ||
| Diuretics | 123 | ||
| Medications to be avoided | 123 | ||
| Management of tense ascites | 123 | ||
| Management of Refractory Ascites | 123 | ||
| Serial large-volume therapeutic paracenteses | 123 | ||
| Albumin infusions with therapeutic paracentesis | 124 | ||
| Transjugular intrahepatic portosystemic shunt | 124 | ||
| Contraindications | 124 | ||
| Outcome after TIPS | 124 | ||
| Peritoneovenous shunts | 124 | ||
| Complications Associated with Ascites | 125 | ||
| Spontaneous Bacterial Peritonitis | 125 | ||
| Indications for testing | 125 | ||
| Diagnostic criteria | 125 | ||
| Distinguishing from secondary bacterial peritonitis | 126 | ||
| Criteria for treatment | 127 | ||
| Treatment regimens | 127 | ||
| Adjunctive IV albumin | 128 | ||
| Secondary prophylaxis of SBP | 128 | ||
| Primary prophylaxis of SBP | 129 | ||
| Primary and secondary SBP prophylaxis | 129 | ||
| Gastrointestinal hemorrhage | 129 | ||
| Infection prophylaxis after gastrointestinal hemorrhage | 129 | ||
| Dilutional Hyponatremia | 130 | ||
| Hepatorenal Syndrome | 130 | ||
| Diagnostic criteria for HRS | 131 | ||
| Umbilical Hernia | 132 | ||
| Hepatic Hydrothorax | 132 | ||
| Varices | 132 | ||
| Pathophysiology and Portal Dynamics | 132 | ||
| Hepatic Venous Pressure Gradient | 132 | ||
| Indications and Methods for Variceal Screening | 133 | ||
| Variceal screening | 133 | ||
| Special circumstances | 133 | ||
| Preprimary and Primary Prophylaxis of Variceal Bleeding | 133 | ||
| Absence of varices | 133 | ||
| Small esophageal varices | 133 | ||
| Large esophageal varices | 133 | ||
| Treatment of Acute Variceal Bleeding | 134 | ||
| General management | 134 | ||
| Pharmacologic therapy | 135 | ||
| When to Consider Liver Transplant During the Management of Chronic Liver Disease | 153 | ||
| Key points | 153 | ||
| Introduction | 153 | ||
| Keeping an eye on transplant timing during long-term management of cirrhosis | 154 | ||
| Goals and success of liver transplantation | 155 | ||
| Disparities in the use of liver transplantation | 156 | ||
| Indications for liver transplantation | 156 | ||
| Absolute contraindications to liver transplantation | 156 | ||
| Cardiac and Pulmonary Diseases | 156 | ||
| Sepsis or Active Infection | 158 | ||
| Extrahepatic Malignancy | 158 | ||
| AIDS-Defining Illness or Poorly Controlled Human Immunodeficiency Virus | 158 | ||
| Inadequate Social Support | 158 | ||
| Active Substance Use | 158 | ||
| Relative contraindications to liver transplantation | 158 | ||
| Advanced Age | 158 | ||
| Obesity | 158 | ||
| HIV Infection | 159 | ||
| Malnutrition | 159 | ||
| History of Poor Medical Adherence | 159 | ||
| Importance of timing of initial referral | 159 | ||
| Timing Based on Severity of End-Stage Liver Disease | 159 | ||
| Model for End-Stage Liver Disease Score | 159 | ||
| Child-Turcotte-Pugh Score | 161 | ||
| Evidence of Decompensated Cirrhosis | 162 | ||
| Timing based on the specific underlying liver disease | 162 | ||
| Hepatocellular Carcinoma | 162 | ||
| Cholangiocarcinoma | 163 | ||
| Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis | 163 | ||
| Roles for the referring physician in optimizing patients for transplant referral | 163 | ||
| Summary | 164 | ||
| References | 165 | ||
| Index | 169 |