Physical Address

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Dorchester Center, MA 02124

Instrumentation

A surgeon’s tools are analogous to those of a carpenter, a mechanic, a research chemist, or an atomic physicist. High-quality instruments are required for the performance of precise and excellent surgery. Although a fine surgeon may overcome the deficits of inferior instruments, the real and potential difficulties presented by using second-rate tools make doing first-rate surgery harder. Good instruments coupled with good surgeons yield the best…

Advanced Pelvic Anatomy

Autonomic Nervous System The motor innervation of the intestines, ureter, urinary bladder, uterus, and adnexa is derived from the autonomic nervous system ( Fig. 2.1 ). The latter system in turn is divided into sympathetic and parasympathetic components. The sympathetic cells are located within the lower thoracic and lumbar segments of the spinal cord; the parasympathetic cells are located in the sacral portion of the spinal…

Viral Hepatitis in Children

Abbreviations AAP American Academy of Pediatrics ACIP Advisory Committee on Immunization Practices ALT alanine aminotransferase CDC Center for Disease Control and Prevention CMV cytomegalovirus EBV Epstein-Barr virus ELISA enzyme-linked immunosorbent assay ELU ELISA-linked units HAI histologic activity index HAV hepatitis A virus HBeAg hepatitis B e antigen HBsAg hepatitis B surface antigen HBV hepatitis B virus HCC hepatocellular carcinoma HCV hepatitis C virus HDV hepatitis D…

Fibrocystic Diseases of the Liver

Abbreviations ADPKD autosomal dominant polycystic kidney disease AP-1 adaptor protein complex 1 ARPKD autosomal recessive polycystic kidney disease cAMP cyclic adenosine monophosphate Cdc25A cell division cycle 25A CHF congenital hepatic fibrosis CXCR2 chemokine (C-X-C motif) receptor 2 DPM ductal plate malformation ENA-78 epithelial-derived neutrophil-activating protein 78 ER endoplasmic reticulum ERCP endoscopic retrograde cholangiopancreatography ERK extracellular signal–regulated kinase HDAC6 histone deacetylase 6 IGF1 insulin-like growth factor 1…

Pediatric Cholestatic Syndromes

Abbreviations A1AT α 1 -antitrypsin ABC ATP-binding cassette AGS Alagille syndrome ASBT apical sodium-dependent bile acid transporter BRIC benign recurrent intrahepatic cholestasis CMV cytomegalovirus FIC1 familial intrahepatic cholestasis 1 JAG1 jagged-1 gene MCT medium-chain triglyceride MDR3 multidrug resistance protein 3 MMR measles, mumps, and rubella MRP2 multidrug resistance–associated protein-2 PCR polymerase chain reaction PFIC progressive familial intrahepatic cholestasis PN parenteral nutrition Introduction Cholestasis, the impairment of formation,…

Approach to and Evaluation of Metabolic Liver Diseases

Introduction The liver is, arguably, the principal orchestrator of metabolism in the body, essentially acting as the responder, arbiter, and transformer of the molecules of life. It is anatomically positioned to be the first organ to receive substances from the gut (food as well as various ingestions and molecules from microbes), spleen, endocrine pancreas, and visceral fat stores, thereby integrating multiple molecular inputs. Moreover, from a…

α 1 -Antitrypsin Deficiency

Abbreviations α 1 AT α1-antitrypsin ER endoplasmic reticulum IL interleukin MPT mitochondrial permeability transition PBA 4-phenylbutyric acid SERPIN serine protease inhibitor SNP single nucleotide polymorphism Introduction α 1 -Antitrypsin (α 1 AT) deficiency is an autosomal codominant disorder associated with premature development of pulmonary emphysema, chronic liver disease, and hepatocellular carcinoma. A point mutation results in a protein that is misfolded and retained in the endoplasmic…

Hemochromatosis

Abbreviations BMP bone morphogenic protein DMT1 divalent-metal transporter 1 FPN1 ferroportin HAMP hepcidin gene HC hemochromatosis HJV hemojuvelin IRIDA iron-refractory iron-deficiency anemia LCI labile cellular iron LEAP-1 liver expressed antimicrobial protein 1 LPI labile plasma iron NTBI non–transferrin-bound forms of iron SF serum ferritin TfR1 transferrin receptor 1 TfR2 transferrin receptor 2 TS transferrin saturation Introduction Iron is the most abundant element (by mass) on Earth…

Wilson Disease

Abbreviations ALT alanine aminotransferase AST aspartate aminotransferase ATPase adenosine triphosphatase CTR1 copper transporter 1 LT liver transplantation Introduction Copper is essential for biologic processes in plants, bacteria, fungi, and complex organisms. Because copper can exist in two oxidation states (Cu + or Cu 2+ ), it is a versatile cofactor for numerous enzymes but it can also participate in reactions that produce activated oxygen species. Although…

Bilirubin Metabolism and Its Disorders

Abbreviations ABC ATP-binding cassette ATP8B1 ATPase class I type 8B member 1 BSEP bile salt export pump BSP bromosulfophthalein CAR constitutive androstane receptor CO carbon monoxide ELB “early-labeled peak” of bilirubin FXR farnesoid X receptor HO heme oxygenase MDR1 multidrug resistance protein 1 MDR2 multidrug resistance protein 2 MDR3 multidrug resistance protein 3 mRNA messenger RNA MRP multidrug resistance–associated protein NTCP Na + -taurocholate–cotransporting polypeptide OATP…

Preoperative and Postoperative Hepatic Dysfunctions

Abbreviations ALT alanine aminotransferase AST aspartate aminotransferase LDH lactate dehydrogenase MELD Model for End-Stage Liver Disease rFVIIa recombinant factor VIIa Introduction It is estimated that up to 10% of cirrhotic patients will undergo surgery in the final 2 years of their lives. This leads to the need for a careful review of preoperative and postoperative liver dysfunction in this group of patients. In this chapter we…

Drug-Induced Liver Injury

Abbreviations ADR adverse drug reaction ALF acute liver failure ALT alanine aminotransferase AP alkaline phosphatase AST aspartate aminotransferase ATP adenosine triphosphate BHDS botanicals, herbal products, and dietary supplements CI confidence interval CYP cytochrome P450 DILI drug-induced liver injury DILIN Drug-Induced Liver Injury Network FDA Food and Drug Administration GSH glutathione HAART highly active antiretroviral therapy HLA human leukocyte antigen MMPT mitochondrial membrane permeability transition NAPQI N…

Nutrition and the Liver

Abbreviations αKG alpha ketoglutarate/2 oxoglutarate BCAA branched chain amino acids DRP1 dynamin-related protein 1 eIF2α eukaryotic initiation factor 2 alpha ESPEN European Society for Parenteral and Enteral Nutrition GCN2 general control nonderepressible 2 K m Michaelis constant mTORC1 mammalian target of rapamycin complex 1 NAFLD nonalcoholic fatty liver disease TCA tricarboxylic acid TGF transforming growth factor Introduction The components of nutrition include food intake, digestion, absorption,…

The Liver in Pregnancy

Abbreviations AFLP acute fatty liver of pregnancy AIH autoimmune hepatitis ALT alanine aminotransferase APAP acetaminophen AST aspartate aminotransferase BCS Budd-Chiari syndrome DIC disseminated intravascular coagulopathy EIA enzyme immunoassay ERCP endoscopic retrograde cholangiopancreatography HAV hepatitis A virus HBIG hepatitis B immunoglobulin HBV hepatitis B virus HCC hepatocellular carcinoma HCV hepatitis C virus HELLP hemolysis, elevated liver enzymes, and low platelet count HEV hepatitis E virus HG hyperemesis…

Recurrent Primary Disease After Liver Transplantation

Abbreviations AR acute rejection AIH autoimmune hepatitis ALD alcoholic liver disease CMV cytomegalovirus CI confidence interval DAA direct-acting antiviral DDLT deceased donor liver transplant DRI donor risk index ESLD end-stage liver disease HBIG hepatitis B immunoglobulin HBcAg hepatitis B core antigen HBeAg hepatitis B e antigen HBsAg hepatitis B surface antigen HBV hepatitis B virus HCC hepatocellular carcinoma HCV hepatitis C virus HDV hepatitis D virus…

Post–Liver Transplant Management

Abbreviations AASLD American Association for the Study of Liver Diseases ACR acute cellular rejection AMR antibody-mediated rejection CMV cytomegalovirus DSA donor-specific HLA antibody HAT hepatic artery thrombosis HCC hepatocellular carcinoma IL interleukin LT liver transplantation MHC major histocompatibility complex mTOR mammalian target of rapamycin PNF primary nonfunction PTLD posttransplant lymphoproliferative disorder Introduction Liver transplantation (LT) has become a regularly scheduled surgical procedure throughout the developed world,…

Transplantation of the Liver

Abbreviations A2ALL adult-to-adult living donor liver transplantation study cohort CTP Child-Turcotte-Pugh DCD donation after cardiac death ECD extended criteria donors ERCP endoscopic retrograde cholangiopancreatography GBWR graft-to-recipient body weight ratio GV/SV graft volume to standard weight volume HAART highly active antiretroviral therapy HCV hepatitis C virus HIV human immunodeficiency virus IVC inferior vena cava MELD Model for End-Stage Liver Disease OPO organ procurement organization PELD pediatric end-stage…

Pretransplant Evaluation and Care

Abbreviations BMI body mass index CAD coronary artery disease HBV hepatitis B virus HCC hepatocellular carcinoma HCV hepatitis C virus HIV human immunodeficiency virus LRT locoregional therapy LT liver transplantation MELD Model for End-Stage Liver Disease NASH nonalcoholic steatohepatitis PBC primary biliary cholangitis PELD pediatric end-stage liver disease PSC primary sclerosing cholangitis SLK simultaneous liver and kidney TACE transarterial chemoembolization TARE transarterial radioembolization Introduction Liver transplantation…