Liver tumors are commonly identified on diagnostic and screening imaging studies of the abdomen and require careful interpretation to distinguish between benign and malignant disease. Although malignant liver tumors such as hepatocellular carcinoma are described elsewhere (see Chapter 177 ), benign liver tumors represent one of the leading indications for consultation by gastroenterology specialist. Several nonmalignant conditions may result in the formation of nodular liver lesions…

Liver disease in pregnancy presents unique challenges to the clinician and requires careful and timely assessment. In addition to unique changes in the clinical course of chronic liver diseases (e.g., hepatitis B) which may occur during the course of pregnancy and at the time of delivery, a series of liver conditions unique to pregnancy have been described, including hyperemesis gravidarum, intrahepatic cholestasis of pregnancy (ICP), HELLP…

Hereditary hemochromatosis (HH) represents one of several primary iron overload disorders, such as aceruloplasminemia, ahypotransferrinemia, H-ferritin–associated iron overload, and African iron overload syndrome, and should be distinguished from secondary iron overload disorders such as dietary or parenteral iron overload, chronic liver disease, and iron-loading anemias (e.g., thalassemia minor, aplastic anemia), as well as other conditions such as ineffective erythropoiesis and porphyria cutanea tarda. HH represents a…

α 1 -Antitrypsin (α 1 -AT) deficiency is a rare inherited liver disorder associated with both chronic liver disease and chronic obstructive pulmonary disease (COPD) with emphysema. It is recognized as the most common genetic liver disease in infants and children and may cause cirrhosis and end-stage liver disease in adults. α 1 -AT is a serine protease inhibitor which is highly expressed in hepatocytes and…

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Drug-induced liver injury (DILI), also described as hepatotoxicity due to medications, is a common and potentially serious cause of acute and chronic liver disease. Many drugs have the capacity to cause hepatotoxicity ( Fig. 169.1 ). In addition, a growing list of over-the-counter medications, supplements, and herbal remedies have been associated with liver injury. Hepatotoxicity may be acute or chronic; occasionally, they can result in severe…

Infectious Mononucleosis Epstein-Barr virus (EBV) is the causative pathogen for infectious mononucleosis and has been associated with a number of diseases involving B cells, including Burkitt lymphoma, nasopharyngeal carcinoma, and posttransplantation lymphoproliferative disorder. Acute clinical features of infectious mononucleosis include fever, lymphadenopathy, severe pharyngitis, and atypical lymphocytosis ( Fig. 168.1 ). Results of the heterophil antibody test are usually positive. Hepatic involvement resembles other causes of…

Hepatitis B virus (HBV) is an enveloped, double-strand DNA virus within the Hepadnavirus family that can cause acute and chronic hepatitis. In certain populations, including Southeast Asians, Alaskan natives, and sub-Saharan Africans, in areas where HBV is highly endemic, the prevalence of chronic hepatitis B is as high as 20%. In these populations, the virus is transmitted primarily through the maternal-neonatal route, and infection usually develops…

Acute hepatitis with a predominant hepatocellular pattern of liver injury may occur as a consequence of a diverse spectrum of etiologies, including both nonhepatotrophic and hepatotrophic viruses. Among the latter group, hepatitis A, hepatitis B, and hepatitis E infections are the most common source for acute viral hepatitis. Acute hepatitis D infection may also occur rarely in context of coexisting acute hepatitis B infection or as…

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Primary sclerosing cholangitis (PSC) represents a rare chronic, cholestatic liver disorder characterized by fibro-obliterative inflammation of the intrahepatic and extrahepatic bile duct system. Due to its strong association with inflammatory bowel disease (IBD), it is believed to have an autoimmune basis and may result in a chronic cholangiopathy with progressive fibrosis, cirrhosis, liver failure, and an increased risk for both colorectal cancer and hepatobiliary malignancies such…

Primary biliary cholangitis (PBC), previously known as primary biliary cirrhosis, is a chronic cholestatic liver disorder characterized by lymphocytic cholangitis involving the small intralobular bile ducts within the liver ( Figs. 162.1 and 162.2 ). This first step in PBC pathophysiology is followed by hepatotoxicity caused by the retention of toxic bile acids secondary to cholestasis and bile duct loss. The putative first “hit” is immunologic…

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Nonalcoholic fatty liver disease (NAFLD) represents one of the most common causes of chronic liver disease in the United States and globally and is estimated to affect approximately 25% of the world population. The increasing prevalence of NAFLD is attributed to the concurrent rise of obesity, diabetes mellitus, hyperlipidemia, cardiovascular disease, and other manifestations of the metabolic syndrome. The spectrum of nonalcoholic liver disease ranges from…

Alcoholic liver disease remains a major primary cause of chronic liver disease in the United States and worldwide. Furthermore, alcohol is commonly implicated as a major exacerbating factor in many other liver diseases, such as hepatitis C, nonalcoholic fatty liver disease, and hemochromatosis, and therefore may play a role in a significant proportion of patients with acute and/or chronic liver disease. Despite enormous progress in the…

The diagnosis of hepatobiliary disease frequently requires the use of imaging studies to characterize the presence of vascular and parenchymal changes which may facilitate diagnosis and management. Traditional imaging studies include abdominal ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). More recent imaging techniques which incorporate liver elastography have emerged as important clinical tools to facilitate the diagnosis of liver cirrhosis, which remains an…

Liver cirrhosis is defined as the final, most advanced stage of liver fibrosis based on the Metavir, Batts-Ludwig, and Ishak histopathological staging systems. Cirrhosis represents the end stage of any process resulting in chronic injury to the liver parenchyma. Progressive fibrosis results in the alteration of hepatic architecture and the formation of small or large nodules. The associated circulatory and hemodynamic changes may result in portal…

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Although significant improvement in technology has permitted an increasing role for liver imaging, serum diagnostics, and both serum and imaging-based fibrosis tools in routine clinical practice, the liver biopsy remains the gold standard assessment tool for the diagnosis and staging of acute and chronic liver disease, and may guide clinical management. Assessment of disease activity such as in the context of autoimmune hepatitis may clarify the…