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Book Details
Abstract
The spectrum and etiology of liver diseases vary widely between East and West and hence the focus and experience of hepatologists also remain varied at two corners of the globe. Hepatology being perhaps one of the most flourishing and evolving discipline of medical sciences, a book with recent information written by experts from all over the world was much needed. The present book fulfills this need.
The book will serve as a useful reference manual to consultants, postgraduate students, and residents of Hepatology, Gastroenterology, Internal Medicine, Pathology, Virology, and Preventive Medicine as well as undergraduate clinical medical students.
Liver is a comprehensive book that discusses all aspects of diseases ranging from epidemiology to prognosis. This book is unique in its conception and presentation, as not only it provides new information but also offers a balanced and rational approach to diseases of liver, pancreas, and biliary system. One of the characteristic features of the book is inclusion of diseases of pancreas and separate chapters on important topics like cytokines and chemokines and apoptosis in liver diseases, as a sound background in these is essential for becoming a good specialist. It contains a chapter on evidence-based clinical practice in hepatology, which is the basis of modern clinical practice. It also includes a chapter on preventive aspects of hepato-biliary diseases keeping in mind that prevention of diseases is always preferred to cure.
One of the unique features of this book is, it has contributors from all over the world.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover\r | Front Cover | ||
| Front Matter\r | i | ||
| Copyright\r | iv | ||
| Foreword\r | vii | ||
| Preface\r | ix | ||
| Acknowledgements | x | ||
| Contributors | xi | ||
| Contents | xvii | ||
| Section I basics In Hepatology\r | 1 | ||
| Chapter 1 - Anatomy and Histology of the Liver | 3 | ||
| Anatomy | 3 | ||
| Lobes of the Liver | 3 | ||
| The Peritoneal Connections | 4 | ||
| Bile Ducts | 4 | ||
| Blood Supply | 4 | ||
| Embryology | 4 | ||
| Histology | 4 | ||
| Hepatocytes | 5 | ||
| Nuclei | 6 | ||
| Cytoplasm | 6 | ||
| Bile Ducts | 7 | ||
| Endothelial Cells | 7 | ||
| Sinusoidal Endothelial Cells | 7 | ||
| Other Endothelial Cells | 8 | ||
| Macrophages | 8 | ||
| Stellate Cells | 8 | ||
| Hemopoietic Cells | 8 | ||
| Extracellular Matrix | 8 | ||
| Chapter 2 - Hepatocellular Function | 10 | ||
| Structure of the Liver | 10 | ||
| Evaluation of Hepatocellular Function | 11 | ||
| Metabolic Functions of the Liver | 11 | ||
| Carbohydrate Metabolism | 11 | ||
| Fat Metabolism | 11 | ||
| Protein Metabolism | 11 | ||
| Immunological Function | 12 | ||
| Miscellaneous Metabolic Functions of the Liver | 12 | ||
| Bile Acid Metabolism | 12 | ||
| Bile Secretion | 12 | ||
| Storage of Vitamins | 12 | ||
| Storage of Iron | 12 | ||
| Removal or Excretion of Drugs, Hormones, and Other Substances | 12 | ||
| Excretion of Bilirubin in the Bile | 12 | ||
| Chapter 3 - Apoptosis in Liver Disease | 14 | ||
| Introduction | 14 | ||
| Factors Involved in Regulation of Apoptosis | 14 | ||
| Mechanisms of Regulation of Apoptosis | 14 | ||
| Elimination of Apoptotic Liver Cells | 15 | ||
| Apoptosis and Liver Disease | 15 | ||
| Viral Hepatitis | 15 | ||
| Hepatitis A | 15 | ||
| Hepatitis B | 15 | ||
| Hepatitis C | 15 | ||
| Other Viruses | 15 | ||
| Autoimmune Hepatitis | 15 | ||
| Hepatocellular Carcinoma | 15 | ||
| Cholestatic Liver Diseases | 15 | ||
| Primary Biliary Cirrhosis | 16 | ||
| Primary Sclerosing Cholangitis | 16 | ||
| Obstructive Jaundice | 16 | ||
| Drug-Induced Liver Disease | 16 | ||
| Alcoholic Liver Disease | 16 | ||
| Methods of Studying Apoptosis | 17 | ||
| Conclusion | 17 | ||
| Chapter 4 - Cytokine and Chemokine in Liver Disease | 19 | ||
| Cytokines as Immune Mediators | 19 | ||
| Adaptive Immune Response in Viral Hepatitis | 19 | ||
| Inflammation | 21 | ||
| Fibrosis | 21 | ||
| Alcoholic Liver Disease and Hepatitis C Virus | 21 | ||
| Nonalcoholic Steatohepatitis | 22 | ||
| HIV-HCV Co-Infection | 23 | ||
| Chapter 5 - Preventive Aspects of Hepatobiliary Diseases | 25 | ||
| Spectrum of Liver Diseases and Prevention | 25 | ||
| Prevention of Viral Hepatitis | 25 | ||
| Hepatitis A and E | 25 | ||
| Immunization Against Hepatitis A | 26 | ||
| Active Immunization | 26 | ||
| Passive Immunization | 26 | ||
| Hepatitis B, C, and D | 26 | ||
| Prevention of Hepatitis B and D | 26 | ||
| Precautions for Modifying Risk Factors | 26 | ||
| Injection Safety | 26 | ||
| Patient-Care Equipment | 26 | ||
| Work Environment | 26 | ||
| Hand Hygiene and Gloves | 26 | ||
| Abstinence or Reduced Alcohol Intake | 26 | ||
| Safe Sex Practices | 27 | ||
| Caution Regarding Intimate Contact | 27 | ||
| Active Immunization | 27 | ||
| Postexposure Prophylaxis | 27 | ||
| Prevention of Hepatitis D | 27 | ||
| Prevention of Hepatitis C | 27 | ||
| Prevention of Cirrhosis | 27 | ||
| Prevention of Hepatocellular Carcinoma | 27 | ||
| Prevention of Alcoholic Cirrhosis | 28 | ||
| Liver Abscesses | 28 | ||
| Prevention of Liver Abscesses | 28 | ||
| Prevention of Pyogenic Liver Abscess | 28 | ||
| Prevention of Gall Stones | 28 | ||
| Cholesterol Gall Stones | 28 | ||
| Prevention of Drug-Induced Hepatitis | 28 | ||
| Autoimmune Hepatitis | 29 | ||
| Prevention of Liver Fluke Infection | 29 | ||
| Chapter 6 - Bioethics in Hepatology | 30 | ||
| Introduction | 30 | ||
| Impact of Genetic Testing | 30 | ||
| Types of Genetic Testing | 31 | ||
| Principles of Genetic Testing and Counseling | 32 | ||
| Respect for the Autonomy of Persons | 32 | ||
| Informed Consent | 32 | ||
| Nondirectiveness | 33 | ||
| The Right not to Know | 33 | ||
| Privacy and Confidentiality | 34 | ||
| Genetic Testing for Vulnerable Groups | 34 | ||
| Ethical and Legal Resources Related to Genetic Testing | 34 | ||
| Conclusion | 35 | ||
| Chapter 7 - Evidence-Based Clinical Practice in Hepatology | 36 | ||
| Introduction | 36 | ||
| The Evidence Hierarchy | 36 | ||
| Does The Trial Have A Sufficient Sample Size And Has It Been Properly Estimated? | 38 | ||
| What Are The Risks Of Bias In The Trial? | 39 | ||
| Generation Of The Allocation Sequence | 39 | ||
| Allocation Concealment | 39 | ||
| Blinding | 40 | ||
| Are There Statistical Analyses Of Entry Data? | 40 | ||
| Are The Statistical Analyses Of The Outcomes In Accordance With The Trial Protocol And Are They Intend To Treat? | 40 | ||
| Who Are The Participants And Which Outcomes Are Reported? | 40 | ||
| Which Experimental Intervention Has Been Used? | 40 | ||
| Which Comparator Has Been Used: Placebo Or Active? | 41 | ||
| The Basic Design Of The Trial: Parallel-Group Or Cross-Over Randomized Trial? | 41 | ||
| Multiple Promising Interventions: The Factorial Design | 41 | ||
| Cluster Randomized Trials | 41 | ||
| What Is The Goal Of The Trial? | 42 | ||
| Conflicts Of Interests | 42 | ||
| Systematic Reviews And Meta-Analyses | 43 | ||
| Section II\r Assessing The Liver | 45 | ||
| Chapter 8 - Liver Function Tests | 47 | ||
| Introduction | 47 | ||
| Liver Injury Markers | 48 | ||
| Alanine and Aspartate Aminotransferases | 48 | ||
| Lactate Dehydrogenase | 49 | ||
| Cholestasis Markers | 49 | ||
| Alkaline Phosphatases | 49 | ||
| γ-Glutamyl Transpeptidase and 5' Nucleotidase | 49 | ||
| Markers of Liver Clearance of Metabolites and Drugs | 50 | ||
| Clearance of Bilirubin | 50 | ||
| Clearance of Ammonia | 51 | ||
| Markers of Liver Synthetic Function | 51 | ||
| Prothrombin Time | 51 | ||
| Albumin | 52 | ||
| Serum Protein Electrophoresis | 52 | ||
| Liver Fibrosis Biomarkers | 52 | ||
| Hyaluronic Acid Test | 52 | ||
| Combinations of LFTs as Markers of Liver Fibrosis | 53 | ||
| Panels of Biomarkers | 54 | ||
| Panels of Biomarkers for Fibrosis and Necroinflammatory Activity | 54 | ||
| Panels of Biomarkers for Liver Steatosis | 54 | ||
| Noninvasive Tests: Future Perspectives | 54 | ||
| Specific Biochemical and Serologic Tests for Liver Diseases | 55 | ||
| Conclusion | 55 | ||
| Chapter 9 - Hepatic Imaging | 57 | ||
| Introduction | 57 | ||
| Imaging Techniques | 57 | ||
| Conventional Radiography | 57 | ||
| Ultrasonography | 57 | ||
| Computed Tomography | 58 | ||
| Magnetic Resonance Imaging | 58 | ||
| Nuclear Scintigraphy | 59 | ||
| Imaging of Focal Liver Disease | 59 | ||
| Benign Liver Lesions | 59 | ||
| Hepatic Cysts | 59 | ||
| Hemangiomas | 59 | ||
| Focal Nodular Hyperplasia | 60 | ||
| Hepatic Adenomas | 60 | ||
| Biliary Cystadenomas and Cystadenocarcinomas | 60 | ||
| Focal Infection | 60 | ||
| Malignant Liver Lesions | 61 | ||
| Hepatocellular Carcinoma | 61 | ||
| Cholangiocarcinoma | 61 | ||
| Intrahepatic or Peripheral Cholangiocarcinoma | 61 | ||
| Hilar and Distal Extrahepatic Cholangiocarcinoma | 62 | ||
| Metastases | 62 | ||
| Imaging of Diffuse Liver Disease | 62 | ||
| Cirrhosis | 62 | ||
| Iron Overload (Hemochromatosis and Hemosiderosis) | 63 | ||
| Steatohepatitis and Fatty Liver | 63 | ||
| Budd-chiari Syndrome | 63 | ||
| Conclusion | 64 | ||
| Chapter 10 - Liver Biopsy | 65 | ||
| Introduction | 65 | ||
| Indications | 65 | ||
| Relative Contraindications | 66 | ||
| Preprocedure Evaluation | 66 | ||
| Coagulopathy Assessment | 66 | ||
| Choice of Modality for Image Guidance | 66 | ||
| Needle Selection | 66 | ||
| Technique | 66 | ||
| Complications | 67 | ||
| Chapter 11 - Histopathological Changes in Liver Diseases | 69 | ||
| Introduction | 69 | ||
| Technical Aspects of the Evaluation of Liver Tissue | 69 | ||
| Tissue Biopsy | 69 | ||
| Fixation and Sectioning | 70 | ||
| Special Histochemical Stains | 70 | ||
| Special Techniques | 72 | ||
| Immunohistochemistry | 72 | ||
| Immunofluorescence | 72 | ||
| Electron Microscopy | 73 | ||
| In Situ Hybridization | 73 | ||
| Special Microscopy | 73 | ||
| Other Newer Techniques | 73 | ||
| General Approach to the Morphological Evaluation of Liver Tissue | 74 | ||
| Gross Examination | 74 | ||
| Microscopic Examination | 75 | ||
| Terminology in Hepatic Histopathology | 75 | ||
| Specific Liver Diseases | 82 | ||
| Developmental Anomalies | 82 | ||
| Metabolic Diseases | 84 | ||
| Cholestasis and Biliary Tract Diseases | 88 | ||
| Fatty Liver Disease | 90 | ||
| Infections | 91 | ||
| Viral Hepatitis-acute and Chronic | 91 | ||
| Bacterial Infections | 92 | ||
| Fungal Infections | 93 | ||
| Parasitic Infestations | 93 | ||
| AIDS and Liver | 93 | ||
| Hepatic Fibrosis and Cirrhosis | 94 | ||
| Vascular Disorders | 96 | ||
| Granulomatous Liver Disease | 97 | ||
| Autoimmune Liver Disease | 98 | ||
| Liver in Systemic Disease | 99 | ||
| Masses of Liver-non-Neoplastic and Neoplastic | 100 | ||
| Benign Lesions of Liver | 100 | ||
| Malignant Lesions of Liver | 103 | ||
| Liver Transplant Rejection and Other Complications | 104 | ||
| Chapter 12 - Hematological Changes in Liver Diseases | 107 | ||
| Introduction | 107 | ||
| Morphological Changes in Blood Cells in Liver Disease | 108 | ||
| Macrocytosis | 108 | ||
| Target Cells | 108 | ||
| Stomatocytes | 108 | ||
| Acanthocytes | 109 | ||
| Echinocytes | 109 | ||
| Spherocytes | 109 | ||
| Schistocytes | 109 | ||
| Anemia in Liver Disease | 109 | ||
| Acute Blood Loss | 109 | ||
| Chronic Gastrointestinal Blood Loss with Resultant Iron Deficiency | 109 | ||
| Folic Acid and Vitamin B12 Deficiency | 110 | ||
| Hemolysis | 110 | ||
| Zieve's Syndrome | 110 | ||
| Spur Cell Hemolytic Anemia | 110 | ||
| Hemolysis Associated with Wilson's Disease | 110 | ||
| Hemolysis Associated with Hepatitis C Infection | 110 | ||
| Splenic Pooling and Sequestration | 111 | ||
| Inadequate Erythropoietin Response | 111 | ||
| Myelosuppression | 111 | ||
| Leucopenia and Leucocytosis | 111 | ||
| Thrombocytopenia and Impaired Platelet Function | 111 | ||
| Aplastic Anemia | 112 | ||
| Coagulation | 112 | ||
| Overview of Coagulation and Fibrinolysis | 112 | ||
| Coagulation and Liver Disease | 113 | ||
| Impaired Synthesis of Coagulation Factors | 113 | ||
| Impaired Clearance of Activated Coagulation Factors | 114 | ||
| Vitamin-k Deficiency | 114 | ||
| Enhanced Fibrinolysis and Dysfibrinogenemia | 114 | ||
| Disseminated Intravascular Coagulation | 115 | ||
| Warfarin and Liver Disease | 115 | ||
| Liver Transplantation | 115 | ||
| Cholestatic Liver Disease | 115 | ||
| Kasabach-merritt Syndrome | 115 | ||
| Pregnancy-Related Conditions | 115 | ||
| Hematological Complications of Hepatitis C Infection | 116 | ||
| Cryoglobulinemia | 116 | ||
| Lymphoma and Other Lymphoproliferative Disorders | 116 | ||
| Autoimmune Cytopenias | 117 | ||
| Hepatitis B Infection and Non-Hodgkin Lymphoma | 117 | ||
| Hematological Effects of Alcohol | 117 | ||
| Peripheral Blood | 117 | ||
| Bone Marrow Cytology | 117 | ||
| Bone Marrow Histology | 118 | ||
| Polycythemia and Liver Disease | 118 | ||
| Hepatic Manifestations of Hematological Disorders | 118 | ||
| Lymphoma and the Liver | 119 | ||
| Hematological Causes of the Budd-chiari Syndrome | 120 | ||
| Hepatic Complications of Hematopoietic Stem Cell Transplantation | 120 | ||
| Veno-Occlusive Disease | 120 | ||
| Graft-Versus-Host Disease | 120 | ||
| Conclusions | 120 | ||
| Section III\r Congenital Liver Diseases | 123 | ||
| Chapter 13 - Congenital Hyperbilirubinemias | 125 | ||
| Introduction | 125 | ||
| Unconjugated Hyperbilirubinemia | 125 | ||
| Gilbert's Syndrome | 125 | ||
| Epidemiology | 125 | ||
| Etiology | 125 | ||
| Mode of Inheritance | 126 | ||
| Clinical Features | 126 | ||
| Diagnosis | 126 | ||
| Treatment and Prognosis | 127 | ||
| Crigler-Najjar Syndrome | 128 | ||
| Epidemiology | 128 | ||
| Etiology | 128 | ||
| Mode of Inheritance | 128 | ||
| Clinical Features | 128 | ||
| Diagnosis | 129 | ||
| Treatment and Prognosis | 129 | ||
| Conjugated Hyperbilirubinemia | 130 | ||
| Rotor's Syndrome | 130 | ||
| Etiology | 130 | ||
| Clinical Features | 130 | ||
| Diagnosis and Treatment | 130 | ||
| Dubin-Johnson Syndrome | 130 | ||
| Etiology | 131 | ||
| Clinical Features | 131 | ||
| Diagnosis | 131 | ||
| Treatment and Prognosis | 131 | ||
| Chapter 14 - Wilsons Disease | 132 | ||
| Introduction | 132 | ||
| Pathophysiology | 132 | ||
| Clinical Features | 132 | ||
| Hepatic Presentation | 133 | ||
| Neurological Presentation | 133 | ||
| Psychiatric Presentation | 133 | ||
| Renal Tubular Acidosis | 133 | ||
| Orthopedic Involvement | 133 | ||
| Ocular Involvement | 133 | ||
| Other Presentations | 133 | ||
| Diagnosis | 133 | ||
| Serum Ceruloplasmin | 133 | ||
| Serum Copper | 134 | ||
| Urinary Copper | 134 | ||
| Hepatic Copper Estimation | 134 | ||
| Liver Histology | 134 | ||
| Making the Diagnosis of Wilson's Disease Causing Fulminant Liver Failure | 134 | ||
| Genetic Studies | 134 | ||
| Treatment | 135 | ||
| Penicillamine | 135 | ||
| Trientine | 135 | ||
| Zinc | 136 | ||
| Treatment During Pregnancy | 136 | ||
| Diet | 136 | ||
| Liver Transplantation | 136 | ||
| Other Agents | 136 | ||
| Copper Overload Disorders Other than Wilson's Disease | 136 | ||
| Chapter 15 - Hereditary Hemochromatosis | 138 | ||
| Introduction | 138 | ||
| History | 138 | ||
| Genetics | 138 | ||
| HFE-Related Hemochromatosis | 138 | ||
| Non-HFE-Related Hemochromatosis | 139 | ||
| Pathophysiology | 140 | ||
| Clinical Features | 140 | ||
| Clinical Classification Of Hemochromatosis | 141 | ||
| Diagnosis | 141 | ||
| Genotyping | 141 | ||
| Liver Biopsy | 141 | ||
| Treatment | 142 | ||
| Family And Population Screening | 143 | ||
| Chapter 16 - Alpha-1 Antitrypsin Deficiency | 144 | ||
| Introduction | 144 | ||
| History | 145 | ||
| The AAT protein | 145 | ||
| Nomenclature | 146 | ||
| The AAT Gene and its Evolution | 146 | ||
| Function | 147 | ||
| Biosynthesis of AAT | 147 | ||
| Prevalence of AAT Deficiency | 148 | ||
| Genetic Epidemiology of AAT Deficiency | 148 | ||
| Far East and Asia | 148 | ||
| Developing Countries | 148 | ||
| Natural History | 148 | ||
| Clinical Recognition of AAT Deficiency | 149 | ||
| Genetic Testing for AAT Deficiency | 149 | ||
| Diagnostic Testing | 149 | ||
| Pre-Dispositional Testing | 150 | ||
| Assessment of Carrier Status in Relation to Reproduction | 150 | ||
| Population Screening | 150 | ||
| Identification of Individuals with AAT Deficiency | 150 | ||
| Early Detection Prenatal | 150 | ||
| Detection in Adults | 150 | ||
| Symptoms | 151 | ||
| Physical Findings | 151 | ||
| Laboratory Tests | 152 | ||
| Quantitative Tests | 152 | ||
| Qualitative Tests | 152 | ||
| Risk Factors | 152 | ||
| Pathophysiology of AAT Deficiency | 153 | ||
| Liver Disease | 154 | ||
| Mechanism of Liver Damage | 155 | ||
| Diagnosis and Management | 155 | ||
| Follow-Up | 156 | ||
| Therapy | 156 | ||
| Prevention | 157 | ||
| Chapter 17 - Glycogen Storage Disease | 158 | ||
| Introduction | 158 | ||
| Epidemiology | 158 | ||
| Etiology and Genetic Background | 158 | ||
| Pathology | 158 | ||
| Type I Glycogenosis (Gierke Disease) | 160 | ||
| Pathomechanism | 160 | ||
| Clinical Picture | 160 | ||
| Treatment | 160 | ||
| Type II Glycogenosis (Pompe Disease) | 160 | ||
| Type III Glycogenosis (Cori Disease) | 161 | ||
| Chapter 18 - Porphyria | 164 | ||
| Introduction | 164 | ||
| Classification | 164 | ||
| Pathomechanism | 164 | ||
| Acute hepatic porphyrias | 165 | ||
| Clinical picture | 165 | ||
| Differential diagnosis | 166 | ||
| Therapy | 166 | ||
| Nonacute porphyrias | 166 | ||
| Porphyria cutanea tarda | 166 | ||
| Pathomechanism and genetic background | 167 | ||
| Clinical picture | 167 | ||
| Differential diagnosis | 167 | ||
| Therapy | 167 | ||
| Protoporphyria erythropoietic | 168 | ||
| Epidemiology, genetic background and pathomechanism | 168 | ||
| Clinical picture | 168 | ||
| Congenital erythropoietic porphyria | 168 | ||
| Hepatoerythropoietic porphyria | 169 | ||
| Symptomatic (secondary) porphyrias | 169 | ||
| Epilog | 169 | ||
| Section IV Jaundice\r | 171 | ||
| Chapter 19 - Hepatocellular Jaundice | 173 | ||
| Definition of Jaundice | 173 | ||
| Pathphysiology (Bilirubin Metabolism) | 173 | ||
| Clinical Presentations of Jaundice Patients | 174 | ||
| Hepatomegaly with or without Pain | 174 | ||
| Coagulation Disturbances | 175 | ||
| Circulatory Changes | 175 | ||
| Causes of Hepatocellular Jaundice | 175 | ||
| Acute Hepatocellular Jaundice | 175 | ||
| Acute Viral Hepatitis | 175 | ||
| Symptoms and Sign | 175 | ||
| Diagnosis | 176 | ||
| Treatment | 176 | ||
| Acute Hepatitis Due to Other Viruses | 176 | ||
| Infectious Mononucleosis | 176 | ||
| Cytomegalovirus | 176 | ||
| Yellow Fever | 176 | ||
| Herpes Simplex | 176 | ||
| Other Infectious Agent | 176 | ||
| Toxoplasmosis | 176 | ||
| Liver Damage Caused by Drugs | 176 | ||
| Hepatocellular Necrosis | 176 | ||
| Chronic Liver Disease | 177 | ||
| Miscellaneous Acute Reactions | 178 | ||
| Diagnosis and Treatment | 178 | ||
| Hepatic Ischemia | 178 | ||
| Ischemic Hepatitis | 178 | ||
| Hepatic Infarction | 179 | ||
| Ischemic Cholangiopathy | 179 | ||
| Acute Liver Failure (Acute Fulminant Hepatitis) | 179 | ||
| Etiology | 179 | ||
| Hemodynamic Monitoring | 180 | ||
| General Management | 180 | ||
| Liver Transplantation | 180 | ||
| Chronic Hepatocellular Jaundice | 181 | ||
| Chronic Hepatitis | 181 | ||
| Etiology and Classification | 181 | ||
| Alcoholic Liver Disease | 181 | ||
| Fatty Liver (Steatosis) | 181 | ||
| Hepatitis | 181 | ||
| Cirrhosis | 181 | ||
| Chapter 20 - Prehepatic Jaundice | 187 | ||
| Normal Metabolism of Hemoglobin to Bilirubin | 187 | ||
| Hemolysis, Ineffective Hemopoiesis, and Jaundice | 187 | ||
| Harmful Effects of Prehepatic Jaundice | 188 | ||
| Congenital Constitutional Causes of Hemolytic Jaundice | 188 | ||
| Hereditary Spherocytosis | 188 | ||
| Other Membrane Defects | 189 | ||
| Pyruvate Kinase Deficiency | 189 | ||
| G6PD Deficiency | 189 | ||
| Hemoglobinopathies | 190 | ||
| Other Inherited Hemolytic Anemia | 190 | ||
| Congenital Constitutional Causes of Ineffective Hemopoiesis-Thalassemia | 190 | ||
| Chapter 21 - Cholestatic Liver Disease | 192 | ||
| Introduction | 192 | ||
| Normal Bile Formation And Secretion | 192 | ||
| Molecular Mechanisms And Pathophysiology Of Cholestasis | 193 | ||
| Clinical Features Of Cholestasis | 194 | ||
| Biochemical Alterations In Cholestasis | 194 | ||
| Intrahepatic Cholestasis Versus Extrahepatic Cholestasis | 194 | ||
| Imaging In Cholestasis | 195 | ||
| Liver Histopathology | 195 | ||
| Differential Diagnosis Of Intrahepatic Cholestasis | 196 | ||
| Treatment | 196 | ||
| Drug-Induced Cholestasis | 197 | ||
| Pure Cholestasis | 198 | ||
| Cholestatic Hepatitis | 198 | ||
| Cholestatic Hepatitis Associated With Bile Duct Injury | 198 | ||
| Vanishing Bile Duct Syndrome | 198 | ||
| Large Bile Duct Strictures | 198 | ||
| Section V \rhepatotropic Viruses | 199 | ||
| Chapter 22 - Hepatitis A Virus | 201 | ||
| Introduction | 201 | ||
| Definition | 201 | ||
| Virology | 201 | ||
| Structure Of The Virus (Fig. 22-1) | 201 | ||
| Steps Of Viral Replication | 201 | ||
| History | 202 | ||
| Epidemiology | 202 | ||
| Clinical Types Of Hepatitis A | 202 | ||
| Acute Hepatitis | 202 | ||
| Cholestatic Hepatitis | 202 | ||
| Relapsing Hepatitis | 203 | ||
| Fulminant Hepatic Failure | 203 | ||
| Hepatitis A In Pregnancy | 203 | ||
| Laboratory Tests | 203 | ||
| Histopathology | 203 | ||
| Prevention | 204 | ||
| Prophylaxis | 204 | ||
| Preexposure Prophylaxis | 204 | ||
| Hepatitis A Vaccine | 204 | ||
| Indications | 204 | ||
| Postexposure Prophylaxis | 204 | ||
| Treatment | 204 | ||
| Chapter 23 - Hepatitis E Virus | 206 | ||
| Introduction | 206 | ||
| Hepatitis E Virus | 206 | ||
| The Virus And Genome Organization | 206 | ||
| Viral Proteins | 206 | ||
| Replication Cycle | 207 | ||
| Genetic Variation | 207 | ||
| Epidemiology | 208 | ||
| Transmission | 209 | ||
| Clinical Features | 209 | ||
| Serological And Other Tests | 209 | ||
| Serosurveys | 210 | ||
| Animal Models | 210 | ||
| Vaccine Development | 210 | ||
| Conclusion | 212 | ||
| Chapter 24 - Hepatitis B Virus | 213 | ||
| Introduction | 213 | ||
| Virology Of HBV | 213 | ||
| Molecular Virology | 213 | ||
| Life Cycle | 213 | ||
| Epidemiology Of Hepatitis B | 214 | ||
| Geographic Distribution | 214 | ||
| HBV Genotypes | 214 | ||
| Modes Of Transmission | 215 | ||
| Natural History Of HBV Infection | 216 | ||
| Clinical Dynamics Of HBV Infection | 216 | ||
| Diagnosis | 217 | ||
| Clinical Manifestations | 217 | ||
| Acute HBV Infection | 218 | ||
| Chronic HBV Infection | 218 | ||
| HBeAg Positive Chronic Hepatitis B | 218 | ||
| HBeAg Negative Chronic Hepatitis B | 218 | ||
| Inactive HBsAg \"carrier\" state | 219 | ||
| Cirrhosis Of Liver And HCC | 219 | ||
| Extra Hepatic Manifestations | 219 | ||
| Management Of Hepatitis B Infection | 219 | ||
| Evaluation Of Patients | 219 | ||
| Goals Of Treatment | 220 | ||
| Prevention Of HBV Infection | 220 | ||
| Chapter 25 - Hepatitis B Virus: Mutants | 221 | ||
| Introduction | 221 | ||
| HBV Mutants | 221 | ||
| Surface Gene Mutations | 222 | ||
| Core Gene Mutations | 223 | ||
| Precore Gene Mutations | 223 | ||
| X-gene Mutations | 223 | ||
| Polymerase Gene Mutations | 223 | ||
| Chapter 26 - Hepatitis B Virus: Advances In Management | 225 | ||
| Introduction | 225 | ||
| Advances In The Prophylaxis Of HBV | 225 | ||
| Advances In The Management Of HBV | 226 | ||
| Management Of Patients With Chronic HBV Infection | 226 | ||
| Management On The Basis Of Better Understanding About HBV Genome And Viral Life Cycle | 226 | ||
| Management On The Basis Of Advances In Natural History Of HBV | 227 | ||
| Advancement In Understanding About Pathogenesis Of Chronic HBV Infection And Their Utility In Patient Management | 228 | ||
| Conclusion | 228 | ||
| Chapter 27 - Hepatitis C Virus | 229 | ||
| The Hepatitis C Virus Discovery And Nomenclature | 229 | ||
| Epidemiology Of Hepatitis C Infection | 229 | ||
| Natural History Of HCV | 230 | ||
| HCV Coinfection With HIV And HBV | 230 | ||
| HCV And Alcohol | 230 | ||
| Extrahepatic Manifestations Of HCV Infection | 231 | ||
| Global Distribution Of HCV Genotype | 231 | ||
| Treatment Of Chronic Hepatitis C | 231 | ||
| Type I IFNs | 231 | ||
| Ribavirin | 232 | ||
| Therapy For Chronic HCV With Pegylated-IFN And Ribavirin | 232 | ||
| Management Of Patients | 232 | ||
| Patients With Genotype 1 HCV | 232 | ||
| Patients With Genotypes 2 And 3 HCV | 233 | ||
| Other Genotypes | 233 | ||
| Difficult Patient Groups | 233 | ||
| Management Of Side Effects Of Therapy | 233 | ||
| Future Developments | 234 | ||
| Conclusion | 234 | ||
| Chapter 28 - Hepatitis D Virus | 235 | ||
| History | 235 | ||
| Virion Structure | 235 | ||
| HDV Genome | 235 | ||
| Hepatitis D Antigen | 235 | ||
| Lipoprotein Envelope of HDV | 236 | ||
| HDV Life Cycle | 236 | ||
| HDV Infection | 236 | ||
| Coinfection | 236 | ||
| Superinfection | 236 | ||
| Pathogenesis of HDV-Induced Hepatitis | 237 | ||
| Natural History of Hepatitis D | 237 | ||
| Epidemiology of HDV Infection | 237 | ||
| The Mediterranean Basin | 237 | ||
| The Far East | 237 | ||
| Western Countries | 238 | ||
| HDV in South East Asia | 238 | ||
| HDV Genotypes | 238 | ||
| Genotype I | 238 | ||
| Genotype II | 238 | ||
| Genotype III | 238 | ||
| Impact of HDV on HBV | 238 | ||
| Diagnosis of HDV Infection | 239 | ||
| Detection of Serum HDV AG | 239 | ||
| Detection of Serum HDV RNA | 239 | ||
| Detection of Anti-HDV Antibody | 239 | ||
| Tissue Markers of HDV Infection | 239 | ||
| Clinical Presentations of HDV Infection | 240 | ||
| Acute Hepatitis B Virus Infection | 240 | ||
| Acute Hepatitis of Undetermined Origin in a Chronic HBV Carrier | 240 | ||
| HBSAG-Positive Chronic Liver Disease | 240 | ||
| Treatment | 240 | ||
| Clinical Course of HDV Infection | 240 | ||
| AIMS of Treatment | 240 | ||
| Treatment of Acute HDV Infection | 240 | ||
| Treatment of Chronic HDV Infection | 241 | ||
| Interferon Alfa | 241 | ||
| Trials of Therapy | 241 | ||
| Pegylated IFN | 242 | ||
| Other Treatment Options | 242 | ||
| Current Recommendations for Treatment | 243 | ||
| Future Perspectives for Treatment | 243 | ||
| Prevention of HDV Infection | 244 | ||
| Summary | 244 | ||
| Chapter 29 - Other Hepatitis Viruses | 245 | ||
| Introduction | 245 | ||
| GBV-C or HGV | 245 | ||
| TTV and Related Viruses | 245 | ||
| Section VI Autoimmune Liver Diseases\r | 247 | ||
| Chapter 30 - Autoimmune Hepatitis | 249 | ||
| Introduction | 249 | ||
| Epidemiology | 249 | ||
| Etiopathogenesis of AIH | 250 | ||
| Clinical Features | 250 | ||
| Demography | 250 | ||
| Symptoms | 250 | ||
| Signs | 250 | ||
| Associated Diseases with AIH | 250 | ||
| Natural History | 251 | ||
| Laboratory Features | 251 | ||
| Diagnosis | 251 | ||
| Basic Diagnostic Tests | 251 | ||
| Clinical Criteria | 252 | ||
| Scoring System | 252 | ||
| Established Autoantibodies | 252 | ||
| Antinuclear Antibody | 252 | ||
| Antismooth Muscle Antibody | 253 | ||
| Anti-Lkm1 Antibody | 253 | ||
| Perinuclear Antineutrophil Cytoplasmic Antibodies | 253 | ||
| Histopathology | 254 | ||
| Types | 254 | ||
| Type 1 AIH | 254 | ||
| Type 2 AIH | 254 | ||
| Type 3 AIH | 255 | ||
| Variants | 255 | ||
| Overlap Syndrome with PBC | 255 | ||
| Overlap Syndrome with PSC | 255 | ||
| Autoimmune Cholangitis | 255 | ||
| Cryptogenic (Autoantibody Negative) Chronic Hepatitis | 256 | ||
| Concurrent AIH with Chronic Viral Hepatitis | 256 | ||
| Treatment | 256 | ||
| Indications for Treatment | 256 | ||
| Treatment Regimens | 256 | ||
| Side Effects of the Drugs | 256 | ||
| Monitoring of Patients on Treatment and During Follow Up | 257 | ||
| Treatment End-Points and Further Course of Action | 257 | ||
| Treatment Results | 258 | ||
| Remission | 258 | ||
| Treatment Failure | 258 | ||
| Incomplete Response | 258 | ||
| Survival | 259 | ||
| Promising Drugs | 259 | ||
| Liver Transplantation | 259 | ||
| Chapter 31 - Primary Biliary Cirrhosis | 261 | ||
| Introduction | 261 | ||
| Epidemiology | 261 | ||
| Genetic Factors | 262 | ||
| Etiology and Pathogenesis | 262 | ||
| Molecular Mimicry | 262 | ||
| Environmental Factors/Xenobiotics | 262 | ||
| Microbial Infection | 263 | ||
| Immune Response | 263 | ||
| Antimitochondrial Autoantibodies | 263 | ||
| Adaptive Immunity/T-cell Responses Against Mitochondrial Antigens | 264 | ||
| Innate Immunity in PBC | 264 | ||
| Antinuclear Antibodies in PBC | 264 | ||
| Biliary Epithelial Cells | 265 | ||
| Apoptosis and Liver Injury in PBC | 265 | ||
| Clinical Features | 265 | ||
| Presentation | 265 | ||
| Asymptomatic PBC | 265 | ||
| Symptomatic PBC | 266 | ||
| Symptoms and Disease Complications | 266 | ||
| Fatigue | 266 | ||
| Pruritus | 266 | ||
| Jaundice | 266 | ||
| Xanthomata and Xanthelasma | 266 | ||
| Abdominal Pain | 267 | ||
| Portal Hypertension | 267 | ||
| Metabolic Bone Disease | 267 | ||
| Steatorrhea and Fat Soluble Vitamin Malabsorption | 267 | ||
| Hepatocellular Carcinoma | 267 | ||
| Associated Disorders | 267 | ||
| Autoimmune Disorders | 267 | ||
| Gastrointestinal Diseases | 268 | ||
| Pulmonary Disorders | 268 | ||
| Renal Tubular Acidosis | 268 | ||
| Laboratory Tests | 268 | ||
| Biochemical Features | 268 | ||
| Serological Features | 268 | ||
| Liver Histology | 269 | ||
| Diagnosis | 269 | ||
| Differential Diagnosis | 269 | ||
| Autoimmune Cholangitis | 270 | ||
| PBC and Aih Overlap Syndrome | 270 | ||
| Natural History and Prognosis | 270 | ||
| Asymptomatic PBC | 270 | ||
| Symptomatic PBC | 271 | ||
| Prognostic Survival Models | 271 | ||
| Medical Treatment | 271 | ||
| Symptomatic Treatment | 271 | ||
| Pruritus | 271 | ||
| Sicca Syndrome | 272 | ||
| Raynaud's Syndrome | 272 | ||
| Hypercholesterolemia | 272 | ||
| Preventive Treatment | 272 | ||
| Osteoporosis | 272 | ||
| Portal Hypertension | 272 | ||
| Treatment of Underlying Liver Disease | 272 | ||
| Ursodeoxycholic Acid | 272 | ||
| Immunosuppressive Therapy | 273 | ||
| Antifibrotic Agents | 273 | ||
| Combination Therapy | 273 | ||
| Liver Transplantation | 273 | ||
| Chapter 32 - Primary Sclerosing Cholangitis | 275 | ||
| Introduction | 275 | ||
| Epidemiology | 275 | ||
| Prevalence of PSC in IBD | 276 | ||
| Etiology and Pathogenesis | 276 | ||
| Immunogenic Factors | 276 | ||
| Infections | 277 | ||
| Diagnosis | 277 | ||
| Laboratory Investigations | 277 | ||
| Radiological Features | 277 | ||
| Histology | 277 | ||
| Special Populations | 278 | ||
| Small Duct PSC | 278 | ||
| Overlap Diseases | 278 | ||
| Management of Complications | 278 | ||
| Dysplasia and Cancer | 278 | ||
| Other Complications | 278 | ||
| Nonspecific | 278 | ||
| Specific | 279 | ||
| Transplant | 279 | ||
| Prognosis | 279 | ||
| Section VII \rInfluence Of Drugs Andenvironment On Liver | 281 | ||
| Chapter 33 - Drug-Induced Liver Diseases | 283 | ||
| Introduction | 283 | ||
| Diagnosis | 283 | ||
| Epidemiology | 283 | ||
| Management | 284 | ||
| Conclusion | 284 | ||
| Chapter 34 - Arsenic-Induced Liver Disease | 285 | ||
| Introduction | 285 | ||
| The Arsenicosis Map and Its Impact | 285 | ||
| Metabolism of Arsenic | 285 | ||
| Health Effects of Arsenic Exposure | 286 | ||
| Arsenic and Liver Diseases | 286 | ||
| Epidemiological Study | 286 | ||
| Arsenic and Hepatic Fibrosis | 287 | ||
| Mechanisms of Injury | 288 | ||
| Arsenic and Liver Cancer | 289 | ||
| Chapter 35 - Alcoholic Liver Disease | 291 | ||
| Introduction | 291 | ||
| Epidemiology | 291 | ||
| Disease Spectrum | 292 | ||
| Alcoholic Fatty Liver | 292 | ||
| Alcoholic Hepatitis | 292 | ||
| Cirrhosis | 292 | ||
| Pathophysiology | 292 | ||
| Oxidative Injury | 292 | ||
| Cytokine and Immune-Mediated Injury | 293 | ||
| Contributory Factors | 293 | ||
| Sex | 293 | ||
| Malnutrition | 293 | ||
| Viral Hepatitis | 293 | ||
| Clinical Presentation | 293 | ||
| Pathology | 294 | ||
| Diagnosis | 295 | ||
| Screening | 295 | ||
| Laboratory Values | 295 | ||
| Role of Liver Biopsy | 295 | ||
| Treatment of Ald | 295 | ||
| Abstinence | 296 | ||
| Glucocorticoids | 296 | ||
| Cytokine-Directed Therapies | 296 | ||
| Nutritional Therapies | 297 | ||
| Other Therapies | 297 | ||
| Prognosis Criteria | 298 | ||
| Liver Transplantation for ALD | 298 | ||
| Chapter 36 - Nonalcoholic Fatty Liver Disease | 300 | ||
| Introduction | 300 | ||
| Prevalence | 300 | ||
| General Population | 300 | ||
| At Risk Groups | 300 | ||
| Obesity | 300 | ||
| Diabetes Mellitus | 300 | ||
| Metabolic Syndrome | 301 | ||
| Other Insulin-Resistant States | 301 | ||
| Natural History | 301 | ||
| Diagnosis | 301 | ||
| Clinical and Laboratory Features | 301 | ||
| Imaging | 302 | ||
| Biopsy | 302 | ||
| Pathogenesis | 302 | ||
| Insulin Resistance-Peripheral or Hepatic? | 302 | ||
| Additional Factors | 303 | ||
| Oxidative Stress | 303 | ||
| Mitochondrial Dysfunction | 303 | ||
| Adipocytokines | 303 | ||
| Other Potential Damaging Factors | 304 | ||
| Impaired Fat Handling Within the Hepatocyte | 304 | ||
| Genetic Factors | 304 | ||
| Dietary Factors | 304 | ||
| Treatment of NAFLD | 305 | ||
| Nonpharmacological Approach for Insulin Resistance | 305 | ||
| Weight Reduction | 300 | ||
| Diet | 305 | ||
| Exercise | 305 | ||
| Antiobesity Agents | 306 | ||
| Orlistat | 306 | ||
| Sibutramine | 306 | ||
| Cannabinoid Receptor Antagonist | 306 | ||
| Bariatric Surgery | 306 | ||
| Insulin-Sensitizing Agents | 307 | ||
| Metformin | 307 | ||
| Thiazolidinediones | 307 | ||
| Fibrates | 308 | ||
| Hepatoprotective Agents | 308 | ||
| Antioxidant/Anticytokine Agents | 308 | ||
| Ursodeoxycholic Acid | 309 | ||
| Pentoxifylline | 309 | ||
| Vitamin E (-tocopherol) | 309 | ||
| Betaine and SAMe | 309 | ||
| The Use of HMG Co a Reductase Inhibitor (Statins) in NAFLD | 309 | ||
| Other Potential Therapies | 309 | ||
| Angiotensin II Blockade | 309 | ||
| Section VIII\rLiver Failure | 311 | ||
| Chapter 37 - Acute Liver Failure | 313 | ||
| Introduction | 313 | ||
| Definition | 313 | ||
| Classification | 313 | ||
| Incidence | 314 | ||
| Etiologies of ALF | 314 | ||
| Nonacetaminophen-Induced ALF | 314 | ||
| Acetaminophen-Induced ALF | 315 | ||
| Other Drugs Implicated in ALF | 315 | ||
| Causes of ALF | 316 | ||
| Vascular | 316 | ||
| Metabolic | 316 | ||
| Miscellaneous | 316 | ||
| Prognosis | 316 | ||
| Different Diagnostic Criteria | 316 | ||
| King's College Criteria | 317 | ||
| Clichy Criteria | 317 | ||
| Meld and ALF | 317 | ||
| Pathogenesis of Hepatic Encephalopathy Due to ALF | 318 | ||
| Investigations for the Etiology of ALF | 318 | ||
| Management of ALF | 318 | ||
| Initial Management | 319 | ||
| Paracetamol-Induced ALF | 319 | ||
| Nonparacetamol-Induced ALF | 319 | ||
| Specific Management | 319 | ||
| Encephalopathy | 319 | ||
| Clinical Manifestations | 319 | ||
| Monitoring of ICP | 320 | ||
| Treatment | 320 | ||
| Experimental Therapies | 321 | ||
| Induction of Hypothermia | 321 | ||
| Prophylactic Phenytoin | 321 | ||
| Induction of Hypernatremia | 321 | ||
| Complications | 321 | ||
| Cardiovascular and Pulmonary Complications | 321 | ||
| Renal Complications | 321 | ||
| Treatment | 322 | ||
| Metabolic Disturbances | 322 | ||
| Infection and Sepsis | 322 | ||
| Malnutrition | 323 | ||
| Coagulopathy | 323 | ||
| Liver Transplantation and Support Systems | 323 | ||
| Unhelpful Treatments | 323 | ||
| Newer Approaches | 323 | ||
| Artificial Hepatic Assist Devices | 324 | ||
| Auxiliary Liver Transplantation | 324 | ||
| Liver Support Systems | 324 | ||
| Xenotransplantation | 324 | ||
| Chapter 38 - Liver Dialysis | 325 | ||
| Introduction | 325 | ||
| Principles of MARS and Role of Albumin | 325 | ||
| Impact on Central and Local Hemodynamics | 326 | ||
| Impact on Kidney Function | 327 | ||
| Impact on Central Nervous Function | 328 | ||
| Impact on Liver Function and Cytokine Profile | 328 | ||
| Impact on Pruritus | 329 | ||
| Conclusion | 329 | ||
| Section IX \rCirrhosis And Complications | 331 | ||
| Chapter 39 - Cirrhosis of Liver | 333 | ||
| Introduction | 333 | ||
| From fibrosis to cirrhosis | 333 | ||
| Epidemiology | 334 | ||
| Classification of Cirrhosis | 335 | ||
| Morphological Classification of Cirrhosis | 335 | ||
| Etiology of Cirrhosis | 335 | ||
| Clinical Presentation | 336 | ||
| Symptoms | 336 | ||
| Physical Examination Findings | 336 | ||
| Hepatocellular Dysfunction | 337 | ||
| Jaundice | 337 | ||
| Skin Findings | 337 | ||
| Hand Findings | 337 | ||
| Palmar Eythema | 337 | ||
| Dupuytren's Contracture | 337 | ||
| Nail Changes | 337 | ||
| Clubbing and HOA | 338 | ||
| Asterixis (Flapping Tremor) | 338 | ||
| Gynecomastia | 338 | ||
| Testicular Atrophy | 338 | ||
| Findings Related to Portal Hypertension | 338 | ||
| Splenomegaly | 338 | ||
| Ascites | 338 | ||
| Dilated Abdominal Veins | 339 | ||
| Cruveilhier-Baumgarten Murmur | 339 | ||
| Fetor Hepaticus | 339 | ||
| Other Features | 339 | ||
| Eye Signs | 339 | ||
| Hepatomegaly | 339 | ||
| Clinical Conditions Associated with Liver Cirrhosis | 339 | ||
| Type II Diabetes | 339 | ||
| Bacterial Infections | 340 | ||
| Malnutrition | 340 | ||
| Extrahepatic Autoimmune Diseases | 340 | ||
| Chronic Relapsing Pancreatitis and Pancreatic Calcifications | 340 | ||
| Peptic Ulcer Disease | 340 | ||
| Diagnosis of Cirrhosis | 340 | ||
| Laboratory Findings | 340 | ||
| Hematology | 340 | ||
| Serum Biochemistry | 341 | ||
| Serological, Immunological, or Genetic Tests in Liver Cirrhosis | 341 | ||
| Imaging in Liver Cirrhosis | 342 | ||
| Liver Biopsy | 342 | ||
| Complications of Cirrhosis | 343 | ||
| Prognosis of Cirrhosis | 344 | ||
| Treatment of cirrhosis | 345 | ||
| Liver Transplantation for End-Stage Liver Cirrhosis | 346 | ||
| Chapter 40 - Hepatic Encephalopathy | 348 | ||
| Introduction | 348 | ||
| Burden of HE | 348 | ||
| Nomenclature and Grading of HE | 349 | ||
| Diagnosis of HE | 350 | ||
| Pathogenesis of HE | 350 | ||
| Ammonia | 350 | ||
| GABA/Endogenous Benzodiazepines | 350 | ||
| Infection/Inflammation | 351 | ||
| Treatment of HE | 351 | ||
| Management of Precipitating Factors | 351 | ||
| Dietary Proteins | 351 | ||
| Nonabsorbable Disaccharides | 351 | ||
| Antibiotics | 352 | ||
| Probiotics | 352 | ||
| l-ornithine l-aspartate (LOLA) | 352 | ||
| Oral Zinc | 352 | ||
| Sodium Benzoate | 352 | ||
| Flumazenil | 352 | ||
| Branched Chain Amino Acids | 352 | ||
| Bromocriptine | 352 | ||
| Minimal Hepatic Encephalopathy | 353 | ||
| Historical Aspects | 353 | ||
| Clinical significance of MHE | 353 | ||
| Diagnostic Tools for MHE | 353 | ||
| Neuropsychological assessment | 353 | ||
| EEG | 354 | ||
| Critical flicker frequency | 354 | ||
| Diagnosis of MHE | 354 | ||
| Treatment of MHE | 354 | ||
| Nonabsorbable Disaccharides | 355 | ||
| Prebiotics and synbiotics | 355 | ||
| Is It Time to Recognize and Treat MHE? | 356 | ||
| Chapter 41 - Portal Hypertension: Pathophysiology | 357 | ||
| Introduction | 357 | ||
| Embryology | 357 | ||
| The Portal Vein | 357 | ||
| Hepatic Arterial Supply | 357 | ||
| Control of Intrahepatic Circulation | 358 | ||
| Definition of Portal Hypertension | 358 | ||
| Basic Hemodynamics | 358 | ||
| Pathogenesis | 358 | ||
| Increased Resistance | 358 | ||
| Factors that Control Stellate Cell Contractility | 359 | ||
| Vasoconstrictors | 360 | ||
| Adrenergic Agonists | 360 | ||
| Angiotensin II | 360 | ||
| Endothelins | 360 | ||
| Vasodilators | 360 | ||
| Nitric Oxide | 360 | ||
| Carbon Monoxide | 360 | ||
| Prostaglandins | 360 | ||
| Cannabinoids | 360 | ||
| Increased Portal Venous Flow | 361 | ||
| Increased Hepatic Arterial Flow | 361 | ||
| Clinical Features of Portal Hypertension | 361 | ||
| Etiology of Portal Hypertension | 361 | ||
| Presinusoidal Portal Hypertension | 362 | ||
| Portal Vein Thrombosis | 362 | ||
| Schistosomiasis | 362 | ||
| Idiopathic Portal Hypertension | 362 | ||
| Sinusoidal Portal Hypertension | 362 | ||
| Alcoholic Liver Disease | 362 | ||
| Hepatitis B | 362 | ||
| Hepatitis C | 362 | ||
| Postsinusoidal Portal Hypertension | 363 | ||
| Budd-Chiari Syndrome | 363 | ||
| Conclusions | 363 | ||
| Chapter 42 - Portal Hypertension: Management | 364 | ||
| Introduction | 364 | ||
| Etiology | 364 | ||
| Pathophysiology Of Portal Hypertension | 365 | ||
| Diagnosis | 365 | ||
| Endoscopy | 365 | ||
| Pulsed Doppler Together With Abdominal Ultrasonography | 365 | ||
| Portal Pressure Measurements | 365 | ||
| Endosonography | 365 | ||
| Measurement Of Variceal Pressure | 365 | ||
| Natural History And Clinical Manifestations Of Portal hypertension | 365 | ||
| Esophageal Varices | 365 | ||
| Gastric Varices | 365 | ||
| Ectopic Varices | 366 | ||
| Portal Hypertensive Gastropathy | 366 | ||
| Management Of Variceal Bleed | 366 | ||
| Preprimary Prophylaxis | 366 | ||
| Primary Prophylaxis | 366 | ||
| Pharmacological Treatment | 366 | ||
| Nonselective -Blockers | 366 | ||
| Organic Nitrates | 366 | ||
| Spironolactone | 366 | ||
| Endoscopic Therapy | 366 | ||
| Endoscopic Sclerotherapy | 366 | ||
| Endoscopic Variceal Ligation | 366 | ||
| Acute Variceal Hemorrhage | 366 | ||
| Resuscitation | 366 | ||
| Antibiotic Prophylaxis | 367 | ||
| Pharmacological Treatment | 367 | ||
| Vasopressin | 367 | ||
| Terlipressin | 367 | ||
| Somatostatin | 367 | ||
| Octreotide | 367 | ||
| Endoscopic Treatment | 367 | ||
| Emergency EST | 367 | ||
| Emergency EVL | 367 | ||
| Balloon Tamponade | 367 | ||
| Chapter 43 - Ascites | 370 | ||
| Introduction | 370 | ||
| Definition | 370 | ||
| Prevalence | 370 | ||
| Pathogenesis | 370 | ||
| Clinical Aspects | 371 | ||
| Diagnosis and Investigation | 371 | ||
| Complementary Studies | 371 | ||
| Classification | 372 | ||
| Uncomplicated Ascites | 372 | ||
| Refractory Ascites | 372 | ||
| Management of Ascites | 372 | ||
| General Measures | 372 | ||
| Specific Measures | 372 | ||
| Bed Rest | 372 | ||
| Sodium Restriction | 372 | ||
| Therapeutic Paracentesis | 373 | ||
| Diuretics | 374 | ||
| Peritoneovenous Shunt | 374 | ||
| Transjugular Intrahepatic Portosystemic Shunt | 375 | ||
| Liver Transplantation | 376 | ||
| Prognosis | 376 | ||
| Section \tX \rLiver In Cardiovascular Diseases | 379 | ||
| Chapter 44 - Budd-Chiari Syndrome | 381 | ||
| Introduction | 381 | ||
| Pathology | 382 | ||
| Clinical Features | 382 | ||
| Prognosis | 383 | ||
| Diagnosis | 383 | ||
| Real Time Doppler Sonography | 383 | ||
| Hepatic Venography | 383 | ||
| Liver Biopsy | 384 | ||
| Treatment | 384 | ||
| Liver Decompression | 384 | ||
| Surgical Shunt | 384 | ||
| Do Shunts Improve Liver Histology and Fibrosis? | 384 | ||
| TIPS | 385 | ||
| Liver Transplantation | 385 | ||
| Chapter 45 - Extrahepatic Portal Vein Obstruction | 386 | ||
| Introduction | 386 | ||
| Etiology | 386 | ||
| In Children | 386 | ||
| In Adults | 386 | ||
| Clinical Features | 386 | ||
| Pathology | 388 | ||
| Diagnosis | 389 | ||
| Laboratory Abnormalities | 389 | ||
| Prognosis | 389 | ||
| Treatment | 389 | ||
| Chapter 46 - Hepatic Vena Cava Disease | 390 | ||
| Introduction | 390 | ||
| Nomenclature of the Disease | 390 | ||
| History of HVD | 391 | ||
| Epidemiology of HVD | 392 | ||
| Etiology of HVD | 392 | ||
| Congenital Vascular Malformation Theory (Hirooka 1969) | 392 | ||
| Thrombosis Theory (Okuda 1986) | 392 | ||
| Thrombophlebitis Theory | 392 | ||
| Pathophysiology of HVD | 393 | ||
| Acute Disease | 393 | ||
| Chapter 47 - Liver in Congestive Cardiac Failure | 399 | ||
| Introduction | 399 | ||
| Congestive Hepatopathy | 399 | ||
| Clinical Features and Diagnosis | 400 | ||
| Clinical Course | 400 | ||
| Treatment | 400 | ||
| Cardiogenic Ischemic Hepatitis | 400 | ||
| Diagnosis | 401 | ||
| Clinical Course | 401 | ||
| Treatment | 401 | ||
| Congestive Liver Fibrosis and Congestive Cirrhosis (Cardiac Cirrhosis) | 401 | ||
| Diagnosis | 402 | ||
| Treatment | 402 | ||
| Cardiac Drugs in Hepatic Dysfunction | 402 | ||
| Chapter 48 - The Liver in Shock | 403 | ||
| Introduction | 403 | ||
| Acute Right Heart Failure | 403 | ||
| Acute Left Heart Failure | 403 | ||
| Chronic Passive Congestion (Cardiac Sclerosis) | 404 | ||
| Shock Liver | 404 | ||
| Treatment and Prognosis | 405 | ||
| Section XI \rNon-Viral Infections Of Liver | 407 | ||
| Chapter 49 - Amebic Liver Abscess | 409 | ||
| Introduction | 409 | ||
| Epidemiology | 409 | ||
| Etiology | 410 | ||
| The Organism | 410 | ||
| Life Cycle | 410 | ||
| Morphology of ALA | 410 | ||
| Pathogenesis | 411 | ||
| Clinical Features | 411 | ||
| Demography | 411 | ||
| Symptoms | 411 | ||
| Atypical Presentations | 412 | ||
| Complications | 412 | ||
| Diagnosis | 413 | ||
| Laboratory Findings | 413 | ||
| Imaging | 413 | ||
| Stool Examination | 413 | ||
| Serology | 414 | ||
| Diagnostic Aspiration | 414 | ||
| Differential Diagnosis | 414 | ||
| Treatment | 414 | ||
| Prognosis | 415 | ||
| Prevention | 416 | ||
| Chapter 50 - Pyogenic Liver Abscess | 417 | ||
| Introduction | 417 | ||
| Epidemiology | 417 | ||
| Etiology | 417 | ||
| Biliary Tree | 417 | ||
| Hematogenous Dissemination of Microorganism | 417 | ||
| Direct Extension from a Contiguous Focus of Infection | 418 | ||
| Trauma | 418 | ||
| Cryptogenic | 418 | ||
| Predisposing Factors | 418 | ||
| Microbiology | 418 | ||
| Organism by Source of Infection | 418 | ||
| Clinical Manifestations | 418 | ||
| Laboratory Findings | 419 | ||
| Imaging Studies | 419 | ||
| Microbial Cultures | 419 | ||
| Difference Between Amebic and PLA | 419 | ||
| Treatment | 420 | ||
| Antibiotic Therapy | 420 | ||
| Abscess Drainage | 420 | ||
| Percutaneous Drainage of PLA | 420 | ||
| Percutaneous vs. Surgical Drainage | 420 | ||
| Endoscopic Retrograde Cholangiopancreatography | 420 | ||
| Prognosis | 420 | ||
| Chapter 51 - Hydatid Disease of Liver | 422 | ||
| Introduction | 422 | ||
| Epidemiology | 422 | ||
| Characteristics of the Parasite and Cycle | 422 | ||
| Hepatic Hydatid Disease in Humans | 424 | ||
| Diagnosis | 425 | ||
| Clinical Presentation | 425 | ||
| Clinical Laboratory | 426 | ||
| Imaging | 427 | ||
| Therapy | 435 | ||
| Surgical Therapy | 436 | ||
| Indications of Surgical Therapy | 436 | ||
| Preoperative Work-Up | 436 | ||
| Hepatic Hydatidosis Surgery | 436 | ||
| Treatment of the Parasite | 436 | ||
| Managing the Pericystic Membrane or Adventitia | 436 | ||
| Comparison between Conservative and Radical Techniques | 438 | ||
| Hydatid Relapse after Surgical Therapy | 438 | ||
| Laparoscopic Surgery | 439 | ||
| Chemotherapy | 439 | ||
| Percutaneous Procedures | 440 | ||
| Complications of Hepatic Hydatidosis | 441 | ||
| Biliary Complications | 441 | ||
| Suppurated Hydatid Cyst | 442 | ||
| Peritoneal Rupture | 442 | ||
| Thoracic Complications of Hepatic Hydatidosis | 443 | ||
| Chapter 52 - Human leptospirosis | 445 | ||
| Introduction | 445 | ||
| Historical Aspects | 446 | ||
| Etiological Agent | 446 | ||
| Classification | 446 | ||
| Modes of Transmission | 447 | ||
| Environmental Factors | 447 | ||
| Occupational Factors | 447 | ||
| Epidemiology | 447 | ||
| Clinical Picture and Manifestations | 449 | ||
| Septicemic Phase | 450 | ||
| Immune Phase | 450 | ||
| Pathogenesis and Pathology | 451 | ||
| Hemorrhagic Form | 451 | ||
| Hepatic Form | 451 | ||
| Renal Form | 451 | ||
| Myocardial Form | 452 | ||
| Pulmonary Form | 452 | ||
| Ophthalmic Lesions | 452 | ||
| Meningeal Lesions | 452 | ||
| Diagnostic Approaches | 452 | ||
| Laboratory Diagnosis | 452 | ||
| Blood and Urinary Profile | 452 | ||
| Microscopic Methods | 453 | ||
| Dark-Field/Phase Contrast Microscopy | 453 | ||
| Silver Impregnation | 453 | ||
| Fluorescent Method | 453 | ||
| Serological Methods | 453 | ||
| Macroscopic Agglutination Test | 453 | ||
| Microscopic Agglutination Test | 453 | ||
| Microcapsule Agglutination Test | 453 | ||
| Enzyme-linked Immunosorbent Assay | 454 | ||
| Lepto-dipstick | 454 | ||
| Latex Agglutination Test | 454 | ||
| Indirect Hemagglutination Test | 454 | ||
| Complement Fixation Test | 454 | ||
| Molecular Methods | 454 | ||
| Nucleic Acid Hybridization | 454 | ||
| Polymerase Chain Reaction | 454 | ||
| Ribotyping Methods | 454 | ||
| Pulsed-field Gel Electrophoresis | 454 | ||
| Restriction Enzyme Analysis | 454 | ||
| Culture | 454 | ||
| Animal Inoculation | 455 | ||
| Differential Diagnosis | 455 | ||
| Treatment | 455 | ||
| Prognosis | 455 | ||
| Prevention and Control | 456 | ||
| Conclusion | 456 | ||
| Section XII \rLiver Diseases In Pregnancy And Childhood | 457 | ||
| Chapter 53 - Pregnancy and Liver Diseases | 459 | ||
| Introduction | 459 | ||
| Liver in Normal Pregnancy | 459 | ||
| Intrahepatic Cholestasis of Pregnancy | 459 | ||
| Toxemias | 460 | ||
| Hellp Syndrome | 460 | ||
| Acute Fatty Liver of Pregnancy | 460 | ||
| Hepatic Rupture and Hemorrhage | 461 | ||
| Acute Viral Hepatitis in Pregnancy | 461 | ||
| Other Liver Diseases in Pregnancy | 461 | ||
| Chapter 54 - Pediatric Liver Diseases | 463 | ||
| Introduction | 463 | ||
| Infants | 464 | ||
| The Jaundiced Infant | 464 | ||
| Unconjugated hyperbilirubinemia | 464 | ||
| Differential diagnosis of unconjugated hyperbilirubinemia in neonates | 464 | ||
| Crigler-Najjar syndrome types 1 and 2 | 464 | ||
| Gilbert's syndrome | 464 | ||
| Conjugated hyperbilirubinemia | 464 | ||
| Differential diagnosis of conjugated hyperbilirubinemia | 464 | ||
| Biliary atresia | 465 | ||
| Choledochal cysts | 467 | ||
| Caroli disease in infancy | 467 | ||
| Neonatal sclerosing cholangitis | 467 | ||
| Endocrine causes of neonatal conjugated hyperbilirubinemia | 467 | ||
| Chromosomal causes of conjugated hyperbilirubinemia | 468 | ||
| Progressive familial intrahepatic cholestasis | 468 | ||
| Alagille's syndrome, arteriohepatic dysplasia, syndromic paucity of bile ducts, Watson-Miller syndrome | 469 | ||
| Peroxisomal disorders | 470 | ||
| Infections | 470 | ||
| Acute liver failure in infancy | 471 | ||
| HIV | 471 | ||
| Leishmaniasis | 471 | ||
| Tuberculosis | 471 | ||
| Dengue infection | 472 | ||
| Tyrosinemia type 1 | 472 | ||
| Galactosemia | 472 | ||
| Inborn errors of metabolism | 472 | ||
| Mitochondrial disorders | 473 | ||
| Neonatal hemochromatosis (NNH) | 473 | ||
| Familial hemophagocytic lymphohistiocytosis | 474 | ||
| Neonatal lupus erythematosus | 474 | ||
| Hepatosplenomegaly in infancy | 474 | ||
| Glycogen storage disorders | 475 | ||
| Lysosomal storage disorders | 475 | ||
| Gaucher disease | 475 | ||
| Niemann Pick disease | 475 | ||
| Older children | 476 | ||
| Infections in Older Children | 476 | ||
| Hepatitis A | 476 | ||
| Hepatitis E | 476 | ||
| Herpesviruses | 476 | ||
| Treatment of herpesvirus infection | 476 | ||
| Parvovirus B19 | 476 | ||
| Group A streptococcus | 476 | ||
| Tuberculosis | 477 | ||
| Malaria | 477 | ||
| Prevention | 477 | ||
| Typhoid fever | 477 | ||
| Dengue fever | 477 | ||
| Leptospirosis | 477 | ||
| Seronegative hepatitis (Non A-G hepatitis) | 477 | ||
| Treatment | 477 | ||
| Liver Abscess | 477 | ||
| Presenting features | 477 | ||
| Diagnosis | 477 | ||
| Predisposing factors | 478 | ||
| Treatment | 478 | ||
| Drug-Induced Liver Disease | 478 | ||
| Presenting features | 478 | ||
| Section XIII \rSpace Occupying Lesions Of Liver | 491 | ||
| Chapter 55 - Benign Liver Lesions | 493 | ||
| Introduction | 493 | ||
| Hepatocellular Lesions | 493 | ||
| Hepatocellular Adenoma | 493 | ||
| Epidemiology | 493 | ||
| Pathogenesis | 494 | ||
| Macroscopic Appearance | 494 | ||
| Microscopic Appearance | 494 | ||
| Presentation | 494 | ||
| Natural History | 494 | ||
| Diagnosis | 494 | ||
| Laboratory Investigations | 494 | ||
| Imaging | 495 | ||
| Management | 495 | ||
| Focal Nodular Hyperplasia | 495 | ||
| Epidemiology | 495 | ||
| Pathogenesis | 496 | ||
| Macroscopic Appearance | 496 | ||
| Microscopic Appearance | 496 | ||
| Presentation | 496 | ||
| Natural History | 496 | ||
| Diagnosis | 496 | ||
| Management | 497 | ||
| Nodular Regenerative Hyperplasia | 497 | ||
| Epidemiology | 497 | ||
| Pathogenesis | 497 | ||
| Macroscopic Appearance | 497 | ||
| Chapter 56 - Hepatocellular Carcinoma | 505 | ||
| Introduction | 505 | ||
| Epidemiology, Risk Factors, And Pathogenesis | 505 | ||
| Clinical Features | 506 | ||
| Screening, Surveillance, And Diagnosis | 506 | ||
| Serological Markers | 507 | ||
| Alpha-Fetoprotein | 507 | ||
| Other Serological Markers | 507 | ||
| Radiological Imaging Of HCC | 508 | ||
| Ultrasonography | 508 | ||
| CT Scanning | 508 | ||
| MR Imaging | 508 | ||
| Histological Confirmation | 509 | ||
| Screening Protocols | 509 | ||
| Staging And Prognosis | 509 | ||
| Management Of HCC | 509 | ||
| Surgical Resection | 510 | ||
| Liver Transplantation | 510 | ||
| Ablative Approaches | 513 | ||
| Percutaneous Ethanol Injection | 513 | ||
| Cryosurgery | 513 | ||
| Radiofrequency Ablation | 514 | ||
| Transarterial Chemoembolization | 514 | ||
| Other Ablative Modalities | 514 | ||
| New Frontiers | 515 | ||
| Prevention Of HCC | 515 | ||
| Conclusions | 515 | ||
| Chapter 57 - Hepatic Metastases | 517 | ||
| Introduction and Epidemiology | 517 | ||
| Imaging Techniques | 517 | ||
| Computed Tomography | 517 | ||
| Magnetic Resonance Imaging | 518 | ||
| Ultrasonography | 518 | ||
| Hepatic Angiography and CT Portography | 518 | ||
| Inferior Vena Cavography | 519 | ||
| Positron Emission Tomography | 519 | ||
| Laparoscopic Staging | 519 | ||
| Classification | 519 | ||
| Hepatic Metastases from Colorectal Cancer | 520 | ||
| Incidence | 520 | ||
| Natural History | 520 | ||
| Treatment | 520 | ||
| Liver Resection | 520 | ||
| Rationale | 520 | ||
| Decision Making | 521 | ||
| Prognosis | 523 | ||
| Basingstoke Predictive Index | 523 | ||
| Molecular Determinants of Outcome | 523 | ||
| Repeat Resection for Recurrent Disease | 524 | ||
| Laparoscopic Resection | 524 | ||
| Long-term Results | 524 | ||
| Medical Treatment | 525 | ||
| Systemic Chemotherapy | 525 | ||
| HAI Chemotherapy | 525 | ||
| Neoadjuvant Chemotherapy | 526 | ||
| Nonresective Destructive Techniques | 527 | ||
| Radiofrequency Ablation | 527 | ||
| Cryoablation | 527 | ||
| Brachytherapy | 527 | ||
| High Intensity Focused Ultrasound (HIFU) | 527 | ||
| Others | 527 | ||
| Conclusion | 527 | ||
| Neuroendocrine Hepatic Metastases | 528 | ||
| Classification of NECs | 528 | ||
| Small Intestine Carcinoids | 528 | ||
| Pancreatic Neuroendocrine Cancers | 528 | ||
| Treatment | 529 | ||
| Liver Resection | 529 | ||
| Liver Transplantation | 529 | ||
| Radiofrequency, Ethanol, and Cryoablation | 529 | ||
| Medical Treatment | 529 | ||
| Primary Hepatic Neuroendocrine Tumors | 529 | ||
| Section XIV \rSurgery And Liver | 533 | ||
| Chapter 58 - Liver Transplantation | 535 | ||
| Introduction | 535 | ||
| Indications for Liver Transplantation | 535 | ||
| Patient Evaluation | 537 | ||
| Pretransplantation Management Issues | 537 | ||
| Waiting-List Monitoring of Hepatitis B Liver Transplant Candidates | 537 | ||
| Waiting-List Monitoring and Treatment of Hepatitis C Liver Transplant Candidates | 537 | ||
| Adjunctive Treatment and Staging of Hcc Transplant Candidates | 538 | ||
| Living Donor Liver Transplantation: Indications, Donor Evaluation, and Outcome | 538 | ||
| LDLT for Hepatocellular Carcinoma | 539 | ||
| Perioperative Complications | 539 | ||
| Long-Term Complications after Liver Transplantation | 540 | ||
| Opportunistic Infections | 540 | ||
| Chronic Rejection | 540 | ||
| Calcineurin Inhibitor-Induced Nephrotoxicity | 541 | ||
| Other Side Effects of CNI | 541 | ||
| De Novo Malignancies | 542 | ||
| Biliary Complications | 542 | ||
| Metabolic Bone Disease | 543 | ||
| Recurrent Diseases after Liver Transplantation | 543 | ||
| Recurrence of Hepatitis C in the Allograft | 543 | ||
| Recurrence of Hepatitis B in the Allograft | 544 | ||
| Recurrence of Cholestatic Liver Diseases and AIH | 545 | ||
| Tumor Recurrence | 546 | ||
| Recurrent Alcohol Abuse after Liver Transplantation for Alcoholic Liver Disease | 547 | ||
| Outcome of Liver Transplantation in Hiv Patients | 547 | ||
| Experiences with Liver Transplantation in Inherited Metabolic Liver Diseases | 547 | ||
| Outcome after Liver Transplantation for Acute Hepatic Failure | 548 | ||
| Conclusion | 548 | ||
| Chapter 59 - Surgery in Liver Diseases | 550 | ||
| Recent Advances in Liver Resection for Hepatocellular Carcinoma | 550 | ||
| Indication for Safe Hepatectomy | 550 | ||
| Ultrasound-Guided Hepatectomy | 550 | ||
| Inflow Occlusion for Hepatectomy | 551 | ||
| PVE before Hepatectomy | 551 | ||
| Summary | 551 | ||
| Section XV \rDiseases Of Gallbladder And Biliary Tree | 553 | ||
| Chapter 60 - Gallstone Disease | 555 | ||
| Introduction | 555 | ||
| Composition of Gallstones | 555 | ||
| Prevalence | 556 | ||
| Risk factors (Table 60-1) | 556 | ||
| Genetic and Racial Factors | 556 | ||
| Sex | 556 | ||
| Pregnancy and Parity | 556 | ||
| Obesity | 556 | ||
| Weight Loss | 557 | ||
| Total Parenteral Nutrition | 557 | ||
| Dietary Factors | 557 | ||
| Hyperlipidemia | 557 | ||
| Drugs | 557 | ||
| Cirrhosis | 557 | ||
| Hemolysis | 557 | ||
| Pathogenesis | 557 | ||
| Cholesterol Gallstones | 557 | ||
| Nucleating and Antinucleating Factors | 558 | ||
| Gallbladder Hypomotility | 558 | ||
| Recent Advances in Pathogenesis of Gallstones | 558 | ||
| Pathogenesis of Pigment Stones | 558 | ||
| Black Pigment Stones | 558 | ||
| Natural History of Gallstone Disease | 559 | ||
| Clinical Manifestations of Gallstone Disease | 559 | ||
| Gallstones and Gallbladder Cancer | 559 | ||
| Gallstones and Xanthogranulomatous Cholecystitis | 559 | ||
| Diagnosis | 560 | ||
| Management of Gallstones (Table 60-5) | 560 | ||
| Asymptomatic Gallstones | 561 | ||
| Symptomatic Gallstones | 561 | ||
| Comparison of Open Cholecystectomy and Laparoscopic Cholecystectomy | 561 | ||
| Nonoperative Therapies | 562 | ||
| Acute Cholecystitis | 562 | ||
| Choledocholithiasis | 562 | ||
| Chapter 61 - Other Gallbladder Diseases | 564 | ||
| Introduction | 564 | ||
| Anatomy | 564 | ||
| Acute Acalculous Cholecystitis | 565 | ||
| Acute Hydrops Gallbladder | 565 | ||
| Adenomyomatosis of the Gallbladder | 565 | ||
| Definition | 566 | ||
| Incidence and Prevalence | 566 | ||
| Polyps of Gallbladder | 566 | ||
| Pathology | 566 | ||
| Cholesterol Polyps | 566 | ||
| Inflammatory Polyps | 566 | ||
| Adenomas | 566 | ||
| Clinical Manifestations | 566 | ||
| Treatment | 566 | ||
| Chapter 62 - Carcinoma of Gallbladder | 568 | ||
| Introduction | 568 | ||
| Epidemiology | 568 | ||
| Etiology and Pathogenesis | 568 | ||
| Gallbladder Anatomy: Relevance to Gallbladder Cancer | 569 | ||
| Clinical Presentation | 569 | ||
| Imaging | 570 | ||
| Ultrasonography | 570 | ||
| Computed Tomography Scan | 571 | ||
| Magnetic Resonance Imaging | 571 | ||
| Positive Emission Tomography | 571 | ||
| Staging | 571 | ||
| Laboratory Abnormalities | 571 | ||
| Prognosis | 571 | ||
| Treatment | 572 | ||
| Gallbladder Polyps | 572 | ||
| T1 Tumors | 573 | ||
| T2 Tumors | 573 | ||
| T3 and T4 Tumors | 573 | ||
| Chapter 63 - Cysts and Congenital Biliary Anomalies | 574 | ||
| Introduction | 574 | ||
| Development of the Fetal Liver | 574 | ||
| Congenital Anomalies of the Biliary Tree | 574 | ||
| Choledochal Cysts | 574 | ||
| Caroli's Disease and Caroli's Syndrome | 575 | ||
| Congenital (Simple) Liver Cysts | 576 | ||
| Other Inherited Abnormalities of Extrahepatic Bile Ducts | 576 | ||
| Mesenchymal Hamartoma of the Liver | 576 | ||
| Biliary Atresia | 576 | ||
| Chapter 64 - Benign Biliary Stricture | 578 | ||
| Introduction | 578 | ||
| Anatomy of the Bile Ducts | 578 | ||
| Etiology of Benign Biliary Strictures | 578 | ||
| Bismuth Classification of Benign Postoperative Biliary Strictures | 580 | ||
| Pathogenesis and Pathophysiology | 580 | ||
| Portal Hypertension | 581 | ||
| Effects of Biliary Obstruction | 581 | ||
| Nutritional Effects of Biliary Obstruction | 581 | ||
| Cardiovascular and Renal Effects of Obstructive Jaundice | 581 | ||
| Infectious Complications of Obstructive Jaundice | 581 | ||
| Clinical Presentation | 582 | ||
| Diagnostic Evaluation | 582 | ||
| Liver Function Test | 582 | ||
| Imaging Modalities | 583 | ||
| Ultrasonography | 583 | ||
| Computerized Tomography Scan | 583 | ||
| Cholangiography | 583 | ||
| Magnetic Resonance Cholangiopancreatography | 583 | ||
| Percutaneous Transhepatic Cholangiography | 583 | ||
| Endoscopic Retrograde Cholangiography | 583 | ||
| Hepatobiliary Scintigraphy | 583 | ||
| Endoscopic Ultrasound | 584 | ||
| Intraductal Ultrasound | 584 | ||
| Liver Biopsy | 584 | ||
| Other Investigations | 584 | ||
| Assessing and Accessing Biliary Strictures | 585 | ||
| Management of Biliary Strictures | 585 | ||
| General Measures | 585 | ||
| Biliary Drainage | 585 | ||
| Percutaneous Approach | 585 | ||
| Endoscopic Treatment | 586 | ||
| Surgical Management | 587 | ||
| Biliary Stents in Benign Biliary Strictures | 588 | ||
| Metal Stents | 588 | ||
| Bioabsorbable Stents | 588 | ||
| Nonpostoperative Biliary Strictures | 588 | ||
| Chronic Pancreatitis Related Biliary Strictures | 588 | ||
| Biliary Strictures Following Liver Transplantation | 589 | ||
| Primary Sclerosing Cholangitis | 589 | ||
| Portal Biliopathy | 589 | ||
| Biliary Tuberculosis | 589 | ||
| Aids-Related Biliary Stricture | 589 | ||
| Biliary Parasitosis | 589 | ||
| Conclusions | 589 | ||
| Chapter 65 - Hepatobiliary Ascariasis | 591 | ||
| Introduction | 591 | ||
| Pathogenesis | 591 | ||
| Clinical Manifestations (Tables 65-1 and 65-2) | 592 | ||
| Common Presentations | 592 | ||
| Uncommon Presentations | 593 | ||
| Investigations | 593 | ||
| Treatment | 594 | ||
| Antihelminthic Drugs | 594 | ||
| Endoscopic Interventions | 594 | ||
| Surgery | 595 | ||
| Recurrent Infection | 595 | ||
| Chapter 66 - Cholangiocarcinoma | 596 | ||
| Introduction | 596 | ||
| Classification of cca | 596 | ||
| Epidemiology | 597 | ||
| Etiology and risk factors | 598 | ||
| Pathogenesis | 599 | ||
| Pathology and staging | 599 | ||
| Clinical features | 600 | ||
| Diagnosis | 601 | ||
| Investigations | 602 | ||
| Imaging of the biliary system | 602 | ||
| Management | 604 | ||
| Conclusion | 606 | ||
| Section XVI Diseases Of Pancreas\r | 609 | ||
| Chapter 67 - Acute Pancreatitis | 611 | ||
| Introduction | 611 | ||
| Structure and Function | 611 | ||
| Endocrine Function | 612 | ||
| Exocrine Functions | 612 | ||
| Functional Units | 612 | ||
| Pathophysiology | 612 | ||
| Injury to Acinar Cells | 612 | ||
| Marked Disturbance of Subcellular Membrane Trafficking | 612 | ||
| Activated Neutrophils | 612 | ||
| Macrophages Release Cytokines | 612 | ||
| Epidemiology | 612 | ||
| Incidence | 612 | ||
| Age, Sex, and Race Distribution | 613 | ||
| Relapse Rate | 613 | ||
| Morbidity and Mortality | 613 | ||
| Etiology | 613 | ||
| Gallstones and Biliary Tract Disease (30-60%) | 613 | ||
| Alcohol (30-35%) | 613 | ||
| Idiopathic | 614 | ||
| Post-ercp (8%) | 614 | ||
| Trauma (∼1.5%) | 614 | ||
| Drugs (∼1.4%) | 614 | ||
| Definitely Associated | 614 | ||
| Probably Associated | 614 | ||
| Infection (<1%) | 614 | ||
| Viral | 614 | ||
| Bacterial | 614 | ||
| Ascariasis | 614 | ||
| Aids | 614 | ||
| Hereditary Pancreatitis (< 1%) | 615 | ||
| Hypercalcemia (< 1%) | 615 | ||
| Hyperparathyroidism | 615 | ||
| Developmental and Structural Abnormalities of Pancreas and Biliary System (< 1%) | 615 | ||
| Hyperlipidemia (< 1%) | 615 | ||
| Pregnancy | 615 | ||
| Tumor (< 1%) | 615 | ||
| Postoperative (< 1%) | 615 | ||
| After Organ Transplantation | 615 | ||
| Scorpion and Snake Bite (< 1%) | 615 | ||
| Toxins (< 1%) | 615 | ||
| Clinical Features | 616 | ||
| Complications | 616 | ||
| Intra-abdominal Infections | 616 | ||
| Pancreatic Necrosis | 616 | ||
| Diagnosis | 617 | ||
| Laboratory Tests | 617 | ||
| Pancreatic Enzymes | 617 | ||
| Amylase | 617 | ||
| Lipase | 617 | ||
| Hepatic Enzymes | 617 | ||
| Full Blood Count | 617 | ||
| CRP | 617 | ||
| Blood Culture | 617 | ||
| Fasting Lipid Profile | 617 | ||
| Calcium | 617 | ||
| Urea, Creatinine and Electrolytes, and Blood Sugar | 617 | ||
| Arterial Blood Gases | 617 | ||
| Imaging Studies | 617 | ||
| Plain X-ray of Abdomen | 617 | ||
| Abdominal Ultrasonography | 617 | ||
| CT Abdomen | 617 | ||
| Dynamic Spiral CT | 618 | ||
| Magnetic Resonance Cholangiopancreatography (MRCP) | 618 | ||
| Endoscopic Ultrasonography (EUS) | 618 | ||
| ERCP | 618 | ||
| CT-guided Needle Aspiration | 618 | ||
| Histologic Findings | 618 | ||
| Mild Cases | 618 | ||
| Severe Cases | 618 | ||
| Staging | 618 | ||
| Acute Physiology and Chronic Health Evaluation (APACHE) | 618 | ||
| Management | 619 | ||
| Medical Care | 619 | ||
| Surgical Care | 619 | ||
| Management of Complications | 619 | ||
| Pseudocyst | 619 | ||
| Percutaneous Aspiration | 619 | ||
| Endoscopic Approach | 619 | ||
| Pancreatic Duct Disruption | 620 | ||
| Infected Pancreatic Necrosis | 620 | ||
| Nutritional Management of Pancreatitis | 621 | ||
| Pancreatic Response to Nutritional Intake | 621 | ||
| Nutritional Support in Pancreatitis | 621 | ||
| Jejunal Feeding | 622 | ||
| TPN | 622 | ||
| Total Enteral Nutrition (TEN) | 622 | ||
| Initiation of Enteral Feeding | 622 | ||
| Enteral Feeding in Severe Acute Pancreatitis | 622 | ||
| Criteria for Advancement to Oral Diet | 622 | ||
| Acute Complicated Pancreatitis (or Where Surgery is Needed) | 622 | ||
| Chapter 68 - Chronic Pancreatitis | 623 | ||
| Definition | 623 | ||
| Epidemiology | 623 | ||
| Etiology | 623 | ||
| Alcohol | 623 | ||
| Pancreatic Duct Obstruction | 624 | ||
| Pancreas Divisum | 624 | ||
| Metabolic Changes | 624 | ||
| Sphincter Of Oddi Dysfunction | 624 | ||
| Cystic Fibrosis | 624 | ||
| Hereditary Causes | 624 | ||
| Autoimmune Causes | 625 | ||
| Nutritional Causes | 625 | ||
| Pathophysiology | 625 | ||
| Clinical Features | 625 | ||
| Complications | 625 | ||
| Pain | 625 | ||
| Malabsorption | 625 | ||
| Diabetes Mellitus | 625 | ||
| Pseudocyst Formation | 625 | ||
| Venous Thrombosis | 626 | ||
| Bile Duct Obstruction | 626 | ||
| Duodenal Obstruction | 626 | ||
| Pseudoaneurysm | 626 | ||
| Pancreatic Cancer | 626 | ||
| Diagnosis | 627 | ||
| Histology | 627 | ||
| Pancreatic Exocrine Function Testing | 627 | ||
| Imaging | 628 | ||
| Plain Radiography/Transabdominal Ultrasound | 628 | ||
| Computerized Tomography | 629 | ||
| Endoscopic Retrograde Cholangiopancreatography | 629 | ||
| Endoscopic Ultrasonography | 629 | ||
| Magnetic Resonance Imaging | 629 | ||
| Management | 629 | ||
| Pain Control | 629 | ||
| Analgesics | 629 | ||
| Pancreatic Enzyme Supplements | 630 | ||
| Antioxidants | 630 | ||
| Endoscopic Therapies | 630 | ||
| Denervation Procedures | 630 | ||
| Surgical Options | 630 | ||
| Malabsorption/Exocrine Insufficiency | 631 | ||
| Possible Causes For Poor Response To Pancreatic Enzyme Supplements | 631 | ||
| Diabetes Mellitus | 631 | ||
| Pseudocysts | 631 | ||
| Venous Obstruction | 632 | ||
| Bile Duct Obstruction | 632 | ||
| Duodenal Obstruction | 632 | ||
| Pseudoaneurysm | 632 | ||
| Chapter 69 - Pancreatic Carcinoma | 634 | ||
| Introduction | 634 | ||
| Clinical Features | 634 | ||
| Physical Findings | 634 | ||
| Laboratory Values | 634 | ||
| Differential Diagnosis | 635 | ||
| Diagnostic Procedures | 635 | ||
| Prognosis | 635 | ||
| Operative Findings | 636 | ||
| Resection | 637 | ||
| Chemotherapy | 637 | ||
| Index\r | 638 | ||
| A | 638 | ||
| B | 638 | ||
| C | 639 | ||
| D | 639 | ||
| E | 640 | ||
| F | 640 | ||
| G | 640 | ||
| H | 641 | ||
| I | 641 | ||
| J | 642 | ||
| K | 642 | ||
| L | 642 | ||
| M | 642 | ||
| N | 642 | ||
| O | 643 | ||
| P | 643 | ||
| Q | 644 | ||
| R | 644 | ||
| S | 644 | ||
| T | 645 | ||
| U | 645 | ||
| V | 645 | ||
| W | 645 | ||
| X | 645 | ||
| Y | 645 | ||
| Z | 645 |