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Epidemiology, Natural History, and Diagnosis of Hepatitis C

Abbreviations ALT alanine aminotransferase CDC Centers for Disease Control and Prevention EIA enzyme immunoassay GBD global burden of disease HBV hepatitis B virus HCC hepatocellular carcinoma HCV hepatitis C virus HIV human immunodeficiency virus IL28B interleukin-28B (one of the λ or type III interferons), a genomic region that has been identified to be associated with response to interferon and ribavirin therapy MSM men who have sex…

Virology and Pathogenesis of Hepatitis C

Abbreviations DAA directly acting antiviral agent HCV hepatitis C virus IFN interferon IL interleukin ISG interferon-stimulated gene NK natural killer RANTES regulated upon activation, normally T cell expressed, and presumably secreted RdRp RNA-dependent RNA polymerase TRAIL tumor necrosis factor–related apoptosis-inducing ligand Treg T-regulatory cell Introduction Hepatitis C virus (HCV) infection is a prominent cause of chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC), with up to…

Management of Nonalcoholic Fatty Liver Disease and Metabolic Syndrome

Abbreviations ALT alanine aminotransferase DM diabetes mellitus IR insulin resistance MS metabolic syndrome NAFLD nonalcoholic fatty liver disease NAS NAFLD activity score NASH nonalcoholic steatohepatitis PUFA polyunsaturated fatty acid UCDA ursodeoxycholic acid Introduction Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease worldwide and is often found in association with other features of metabolic syndrome (MS). Defined by more than 5% macrovesicular…

Epidemiology, Natural History, and Evaluation of Nonalcoholic Fatty Liver Disease

Abbreviations ALT alanine aminotransferase AST aspartate aminotransferase BMI body mass index CRN Clinical Research Network CT computed tomography ER endoplasmic reticulum GGT γ-glutamyl transferase HCC hepatocellular carcinoma IL-6 interleukin-6 IR insulin resistance KLF6 Krüppel-like factor-6 MRI magnetic resonance imaging NAFL nonalcoholic fatty liver NAFLD nonalcoholic fatty liver disease NAS NAFLD activity score NASH nonalcoholic steatohepatitis OSA obstructive sleep apnea PPAR peroxisome proliferator–activated receptor T2DM type 2…

Pathogenesis of Nonalcoholic Fatty Liver Disease

Abbreviations apoB apolipoprotein B AS160 Akt substrate 160-kDa protein ASC apoptosis-associated specklike CARD domain–containing protein ATF activating transcription factor ATG autophagy-related gene Bad Bcl2-associated agonist of cell death BIP binding Ig protein CD cluster of differentiation CHOP C/EBO homologous protein ChREBP carbohydrate-responsive element-binding protein CRTC2 cAMP response element-binding protein (CREB)-regulated transcription coactivator 2 CTGF connective tissue growth factor DAMP damage-associated molecular pattern DR5 death receptor 5…

Prevention and Management of Alcoholic Liver Disease

Abbreviations ALD alcoholic liver disease AH alcoholic hepatitis AUDIT Alcohol Use Disorder Identification Test G-CSF granulocyte colony stimulating factor HCV hepatitis C virus mDF modified discriminant function MELD Model for End-Stage Liver Disease NIAAA National Institute of Alcoholism and Alcohol Abuse STOPAH Steroids or Pentoxifylline for Alcoholic Hepatitis PTX pentoxifylline TNF tumor necrosis factor Prevention of Alcoholic Liver Disease Alcohol is known to cause liver injury…

Natural History and Cofactors of Alcoholic Liver Disease

Abbreviations ADH alcohol dehydrogenase AH alcoholic hepatitis AHHS Alcoholic Hepatitis Histologic Score ALD alcoholic liver disease ALDH aldehyde dehydrogenase ALT alanine aminotransferase ANI alcoholic liver disease/nonalcoholic fatty liver disease index AST aspartate aminotransferase CYP2E1 cytochrome P450 2E1 IL-10 interleukin-10 MELD Model for End-Stage Liver Disease NAFLD nonalcoholic fatty liver disease OR odds ratio PNPLA3 patatin-like phospholipase domain–containing protein 3 ROS reactive oxygen species TLR4 toll-like receptor…

Epidemiology and Pathogenesis of Alcoholic Liver Disease

Abbreviations 2-AG 2-arachidonoylglycerol ACC acetyl-CoA carboxylase ADH alcohol dehydrogenase AH alcoholic hepatitis ALD alcoholic liver disease ALDH aldehyde dehydrogenase ALT alanine aminotransferase AMPK AMP-activated protein kinase AP-1 activator protein-1 transcription factor ASH alcoholic steatohepatitis AST aspartate aminotransferase BAC blood alcohol concentration C1qa subcomponent of complement C1 C3 complement component 3 CCL chemokine (C-C motif) ligand CPT1 carnitine palmitoyltransferase I CYP2E1 cytochrome P450 2E1 CXCL C-X-C motif…

Acute-on-Chronic Liver Failure

Abbreviations ACLF acute-on-chronic liver failure ALF acute liver failure HCC hepatocellular carcinoma INR international normalized ratio LT liver transplantation MELD Model for End-Stage Liver Disease SLK simultaneous liver-kidney transplantation Introduction Cirrhosis had traditionally been classified into two stages: compensated cirrhosis and decompensated cirrhosis. Within the period of compensated cirrhosis, the major risks for mortality are cardiovascular disease, stroke, and extrahepatic malignancy. However, the majority of patients…

Acute Liver Failure

Abbreviations ALF acute liver failure APAP acetaminophen BCAA branched-chain amino acid CPP cerebral perfusion pressure GABA γ-aminobutyric acid CRRT continuous renal replacement therapy CVP central venous pressure HAV hepatitis A virus HBV hepatitis B virus HCV hepatitis C virus HDV hepatitis D virus HEV hepatitis E virus ICP intracranial pressure INR international normalized ratio MAP mean arterial pressure MOSF multiorgan system failure NAC N -acetylcysteine OLT…

The Hemostatic and Hematopoietic System in Liver Disease

Abbreviations ADP adenosine diphosphate AT antithrombin DDAVP desmopressin EPO erythropoietin FFP fresh frozen plasma GAVE gastric antral vascular ectasia G-CSF granulocyte stimulating factor INR international normalized ratio LMWH low molecular weight heparin PCC prothrombin complex concentrate PSC primary sclerosing cholangitis PT prothrombin time PVT portal vein thrombosis ROTEM rotational thromboelastometry rVIIa activated recombinant factor VII TAFI thrombin activated fibrinolysis inhibitor TEG thromboelastography TF tissue factor TGA…

Cardiopulmonary Complications of Cirrhosis

Abbreviations BNP brain natriuretic peptide CBDL common bile duct ligation CCM cirrhotic cardiomyopathy HO-1 heme oxygenase-1 HPS hepatopulmonary syndrome iNOS inducible nitric oxide synthase mPAP mean pulmonary artery pressure PAH pulmonary arterial hypertension POPH portopulmonary hypertension TDI tissue Doppler imaging TIPS transjugular intrahepatic portosystemic shunt TNF-α tumor necrosis factor α Introduction The impact of cirrhosis on cardiac function was largely ignored until the 1960s because the…

Renal Failure in Cirrhosis

Abbreviations ADQI Acute Dialysis Quality Initiative AKI acute kidney injury AKIN Acute Kidney Injury Network ATN acute tubular necrosis C-AKI cirrhosis–acute kidney injury CKD chronic kidney disease DAMP damage-associated molecular pattern GFR glomerular filtration rate HRS hepatorenal syndrome HRS1 Type 1 hepatorenal syndrome HRS2 Type 2 hepatorenal syndrome IAC International Ascites Club ICU intensive care unit MARS molecular adsorbent recirculating system MELD Model for End-Stage Liver…

Portal Hypertension Related to Bleeding

Abbreviations AIDS acquired immunodeficiency syndrome ARPKD autosomal recessive polycystic kidney disease BRTO balloon-occluded retrograde transvenous obliteration of varices DSRS distal splenorenal shunt EMT epithelial-mesenchymal transactivation FHVP free hepatic vein pressure GAVE gastric antral vascular ectasia GVE gastric vascular ectasia HHT hereditary hemorrhagic telangiectasia HV hepatic vein HVPG hepatic venous pressure gradient ICG indocyanine green IGV isolated gastric varices IVC inferior vena cava MELD Model for End-Stage…

Ascites and Hyponatremia

Abbreviations AFB acid-fast bacilli COX-2 cyclooxygenase-2 CT computed tomography FHVP free hepatic vein pressure HVPG hepatic venous pressure gradient IV intravenous LVP large-volume paracentesis MELD Model for End-Stage Liver Disease NO nitric oxide PCD postparacentesis circulatory dysfunction PRA plasma renin activity PTFE polytetrafluoroethylene PVS peritoneovenous shunt RAAS renin-angiotensin-aldosterone system RCT randomized controlled trial SAAG serum-ascites albumin gradient SBP spontaneous bacterial peritonitis TIPS transjugular intrahepatic portosystemic shunt…

Neurologic Consequences of Liver Disease

Abbreviations BCAA branched-chain amino acids BBB blood-brain barrier CDR Cognitive Drug Research CHE covert hepatic encephalopathy DST digit symbol test EP evoked potential FDA Food and Drug Administration GABA γ-aminobutyric acid HE hepatic encephalopathy HRQOL health-related quality of life ICT inhibitory control test IL interleukin LOLA l -ornithine- l -aspartate MHE minimal hepatic encephalopathy OHE overt hepatic encephalopathy PSE portosystemic encephalopathy RCT randomized controlled trial SONIC…

Critical Care Management of Patients With Liver Disease

Abbreviations AAC acute acalculous cholecystitis AASLD American Association for the Study of Liver Diseases ADH antidiuretic hormone ADL activity of daily life ALT alanine aminotransferase aPTT activated partial thromboplastin time AST aspartate aminotransferase CAT computerized axial tomography CLIF-SOFA chronic liver failure-SOFA COPD chronic obstructive pulmonary disease CTP Child-Turcotte-Pugh CVP central venous pressure ddAVP desmopressin acetate ESLD end-stage liver disease FDA Food and Drug Administration GI gastrointestinal…

Assessment of Liver Histology

Abbreviations AFLD alcoholic fatty liver disease AIH autoimmune hepatitis AMA antimitochondrial antibody ANA antinuclear antibody BMI body mass index CCa cholangiocarcinoma CD68 cluster designation 68 CMV cytomegalovirus CRP C-reactive protein DILI drug-induced liver injury DM diabetes mellitus DN dysplastic nodule EBV Epstein-Barr virus FFPE formalin fixed, paraffin embedded FNH focal nodular hyperplasia GS glutamine synthetase GVHD graft-versus-host disease H&E hematoxylin and eosin HAV hepatitis A virus…

Evaluation of the Hepatic Mass

Abbreviations ACR American College of Radiology CT computed tomography DWI diffusion-weighted imaging FNH focal nodular hyperplasia HCC hepatocellular carcinoma HNF-1α hepatocyte nuclear factor 1α LI-RADS Liver Imaging Reporting and Data System MR magnetic resonance OPTN Organ Procurement and Transplantation Network Introduction Focal hepatic masses may be encountered during routine medical imaging done for other reasons, staging for extrahepatic malignancies, and surveillance for primary hepatic malignancies. Advances…

Imaging in Assessment of Liver Disease and Lesions

Abbreviations ALD active liver disease BDH cystic bile duct hamartoma CT computed tomography DWI diffusion-weighted imaging FNH focal nodular hyperplasia HCC hepatocellular carcinoma MRE magnetic resonance elastography MRI magnetic resonance imaging MRS magnetic resonance spectroscopy NASH nonalcoholic steatohepatitis T1W T1 weighted T2W T2 weighted US ultrasonography Introduction Liver disease is a major public health problem in the United States and worldwide. Diffuse liver disease and focal…