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Molecular and Genetics-Based Diagnostics

Abbreviations ABC ATP-binding cassette ALT alanine aminotransferase AP alkaline phosphatase BRIC benign recurrent intrahepatic cholestasis BSEP bile salt export pump DILI drug-induced liver disease GGT γ-glutamyl transferase GWAS genome-wide association study HCC hepatocellular carcinoma HLA human leukocyte antigen ICP intrahepatic cholestasis of pregnancy LPAC low phospholipid-associated cholelithiasis LT orthotopic liver transplantation MDR multidrug resistance MHC major histocompatibility complex NASH nonalcoholic liver disease PBED partial biliary external…

Noninvasive Assessment of Disease Progression

Abbreviations AASD American Association for the Study of Liver Disease ALT alanine aminotransferase APRI AST to platelet ratio index ARFI acoustic radiation force impulse elastography AST aspartate aminotransferase AUROC area under the receiver operating curve BMI body mass index CAP controlled attenuation parameter CI confidence interval CT computed tomography FIB-4 fibrosis-4 GGT γ-glutamyltranspeptidase HA hyaluronic acid HDL high-density lipoprotein HBV hepatitis B virus HCV hepatitis C…

Approach to Jaundice and Abnormal Liver Function Test Results

Abbreviations AIH autoimmune hepatitis ALT alanine aminotransferase AP alkaline phosphatase APRI aspartate aminotransferase to platelet ratio index AST aspartate aminotransferase BMI body mass index CI confidence interval GGTP γ-glutamyl transpeptidase GI gastrointestinal HBV hepatitis B virus HCV hepatitis C virus HIV human immunodeficiency virus LDH lactate dehydrogenase LFT liver function test MRP2 multidrug resistance–associated protein 2 NAFLD nonalcoholic fatty liver disease NASH nonalcoholic steatohepatitis NHANES National…

Stem Cells and Hepatocyte Transplantation

Abbreviations DSA donor-specific antibody ESC embryonic stem cell HGF hepatocyte growth factor HLA human leukocyte antigen HPC hepatic progenitor cell Lgr5 leucine-rich repeat–containing G protein–coupled receptor 5 OLT orthotopic liver transplantation OTC ornithine transcarbamylase Introduction Regenerative medicine is a much overused phrase but at its core is the concept that the therapy being administered would work with the innate healing and regenerative properties of the host tissue…

The Liver’s Response to Injury : Inflammation and Fibrosis

Abbreviations Bambi bone morphogenetic protein and activin membrane-bound inhibitor CCL CC chemokine ligand CCR CC chemokine receptor CXCL CXC chemokine ligand CX3CR CX3C chemokine receptor DAMP damage-associated molecular pattern ECM extracellular matrix HSC hepatic stellate cell IFN interferon IL interleukin IRAK1 interleukin 1 receptor–associated kinase 1 JAK Janus kinase KLF6 Krüppel-like factor 6 LPS lipopolysaccharide mRNA messenger RNA MMP matrix metalloproteinase MYD88 myeloid differentiation primary response…

The Liver as an Immune Organ

Abbreviations AIM2 absent in melanoma 2 APC antigen-presenting cell ASC apoptosis-associated specklike protein containing a caspase activation and recruitment domain DC dendritic cell HAV hepatitis A virus HBV hepatitis B virus HCC hepatocellular carcinoma HCV hepatitis C virus HDV hepatitis D virus HEV hepatitis E virus IFN interferon MAGE-A melanoma antigen gene A MCP-1 monocyte chemoattractant protein 1 MDSC myeloid-derived suppressor cell MHC major histocompatibility complex…

Intestinal Microbiome and the Liver

Abbreviations ALD alcoholic liver disease GALT gut-associated lymphoid tissue IBD inflammatory bowel disease LEFSE linear discriminant analysis effect size MHE minimal hepatic encephalopathy OTU operational taxonomic unit The liver is the largest and one of the most intricate organs in the body, and is integral in regulating normal physiologic and biochemical processes. Liver diseases are among the prominent causes of chronic disease states and result in…

Bile Acids and Bile Flow: New Functions of Old Molecules

Abbrevations ACOX acyl-CoA oxidase ASBT apical sodium bile acid transporter CTX cerebrotendinous xanthomatosis FAB-MS fast atom bombardment ionization mass spectrometry GC-MS gas chromatography−mass spectrometry GGT γ-glutamyltranspeptidase LDL low-density lipoprotein LSIMS liquid secondary ionization mass spectrometry PFIC progressive familial intrahepatic cholestasis TUDCA taurine-conjugated form of ursodeoxycholic acid UDCA ursodeoxycholic acid VLCFA very long chain fatty acids VSG vertical sleeve gastrectomy Introduction The importance of bile acid synthesis…

Anatomy and Cellular Functions of the Liver

Abbreviations AGE advanced glycation end-product APC antigen-presenting cell CGRP calcitonin gene-related peptide GERL Golgi-SER-lysosome HD high density HSC hepatic stellate cell ICAM-1 intercellular adhesion molecule-1 LAL liver-associated lymphocyte LD low density LFA-1 lymphocyte associated antigen-1 LGL large granular lymphocyte LPS lipopolysaccharide MDSC myeloid-derived suppressor cell NK natural killer nNOS neuronal nitric oxide syndrome NPY neuropeptide Y PG prostaglandin RER rough endoplasmic reticulum SDF stromal-derived factor SER…

Palliative Care Medicine in Patients with Advanced Gastrointestinal and Hepatic Disease

The purpose of this chapter is to review the physical and emotional care of patients with advanced chronic and serious illnesses, many of whom have debilitating GI symptoms. Management of common GI symptoms, important aspects of setting appropriate life goals of care, and communication skills are reviewed. What is palliative medicine? Palliative care is interdisciplinary care that aims to improve the quality of life (QOL) of…

Complementary, Alternative, and Integrative Medicine

Definition and Epidemiology Complementary and alternative medicine (CAM) is a group of medical practices and products neither taught widely in medical schools nor generally available in USA hospitals. Complementary medicine is used together with traditional medicine, alternative medicine is used in lieu of conventional medicine, and integrative medicine combines both standard medical practices with CAM modalities. The prevalence of CAM therapies has increased at an exponential…

Probiotics

Given the intimate relationships that are known to exist between what happens in the lumen of the GI tract and various homeostatic phenomena, both locally in the intestine and throughout the organism, it should come as no surprise that considerable interest has been kindled in the modulation of one critical component of the enteric microenvironment—the intestinal microbiota (see Chapter 3 ). The possibility that one could…

Anal Diseases

Anatomy The anal canal is about 4 cm long in adults, and is the terminal and most inferior part of the large intestine. It begins where the rectal ampulla narrows abruptly below the level of the U-shaped sling formed by the puborectalis muscle and ends at the anal verge, which is the external outlet of the GI tract. The anus is normally contracted, forming an anteroposterior…

Other Diseases of the Colon

Cathartic colon and the effect of laxatives on the colon The original suggestion that irritant laxatives, predominantly anthraquinones (cascara, aloe, senna), damage the colon was based on studies in laboratory animals and in colons resected from laxative abusers. Although mucosal atrophy and abnormalities of the enteric nervous system had been described in cases of so-called “cathartic colon,” detailed information concerning pre-existing conditions that might have prompted…

Colorectal Cancer

Cancer of the colon and rectum (colorectal cancer [CRC]) is a major cause of cancer-associated morbidity and mortality in North America, Europe, and other regions with similar lifestyles and dietary habits. CRC is the fourth most common newly diagnosed internal cancer overall in the USA, after cancers of the breast, lung, and prostate, and currently constitutes 9% of new cancers in men and 8% of new…

Colonic Polyps and Polyposis Syndromes

Colorectal cancer (CRC) is the third most common cancer diagnosed in the USA. In 2020, it is estimated that 147,951 new cases of CRC will be diagnosed, and that approximately 53,200 deaths would result. Adenomatous polyps, including conventional adenomas and sessile serrated adenomas (SSAs), are recognized as important precursors to the majority of CRCs, and are estimated to be present in 20% to 53% of those…

Tumors of the Small Intestine

Small intestinal (SI) tumors (tumors of the duodenum, jejunum, and ileum) are uncommon in comparison with those occurring elsewhere in the GI tract. Whereas the SI is approximately 20 ft long and comprises 75% of the length of the GI tract and 90% of its mucosal surface area, SI tumors only account for 5% of newly diagnosed cancers of the intraluminal digestive tract. SI tumors are…

Ileus and Pseudo-Obstruction Syndromes

Ileus and pseudo-obstruction refer to intestinal dysmotility syndromes that have signs, symptoms, and the radiologic appearance of obstruction (i.e., a dilated viscus) in the absence of a mechanical cause. These conditions—which may be acute, chronic, or acute on chronic—affect the small intestine or colon, and infrequently both organs. By convention, acute dysmotility of the small intestine, which most frequently occurs after abdominal surgery, is referred to…

Intestinal Obstruction

Severe narrowing or occlusion of the intestinal lumen results in the accumulation of air and fluid in the bowel proximal to the point of obstruction and is associated with a range of clinical signs and symptoms. The location of the obstruction, the degree of narrowing, and the underlying etiology influence the presentation, natural history, and management of this condition. Causes of intestinal obstruction can be broadly…

Irritable Bowel Syndrome

IBS is an important disease entity because of its high prevalence, substantial morbidity, and enormous costs. In the USA, 7% to 16% of adults report symptoms compatible with IBS, for which up to 50% will consult a GI physician. In GI practices, more than one third of patients have functional GI disorders, with IBS being the most common diagnosis. Because a substantial proportion of gastroenterology practice…