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Eosinophilic Gastrointestinal Disease and Eosinophilic Esophagitis

1. How is eosinophilic gastrointestinal disease (EGID) defined? EGID is a global term that describes an increasingly recognized heterogeneous group of gastrointestinal (GI) diseases found in both children and adults. It is characterized by chronic, nonspecific GI symptoms and a dense eosinophilic inflammatory response that is found in various tissues throughout the GI tract. It can manifest as eosinophilic gastroenteritis, colitis, or the well-studied eosinophilic esophagitis…

Crohn’s Disease

Diagnosis 1. What are the usual symptoms and signs suggestive of Crohn’s disease? The symptoms of Crohn’s disease are determined by the site and type of involvement (i.e., inflammatory, stenotic, or fistulizing). The most common site of involvement is ileocolitis (approximately 45% or patients). These patients present with diarrhea and abdominal pain that is usually insidious, in the right lower quadrant, frequently triggered or aggravated after…

Celiac Disease

1. How does celiac disease (CD) manifest? CD is a systemic immunologic disorder affecting multiple organ systems in genetically predisposed individuals triggered by ingestion of gluten-containing products such as wheat, rye, or barley. CD has a wide clinical spectrum ranging from gastrointestinal and extraintestinal symptoms to a completely asymptomatic state. It frequently manifests as chronic diarrhea, weight loss, bloating and gas, distention, and abdominal discomfort in…

Liver Histopathology

Liver Biopsy 1. Explain the role of liver biopsy. Diagnosis: The biopsy is particularly useful in patients with atypical clinical features and coexisting disorders such as steatosis and hepatitis C virus. Indications include abnormal liver tests of unknown cause, multiple parenchymal diseases, fever of unknown cause, and focal and diffuse abnormalities on an imaging study indicating conditions such as amyloidosis or granulomatous diseases. Prognosis: Assessing fibrosis…

Inheritable Forms of Liver Disease

Hemochromatosis 1. How do we classify the various iron-loading disorders in humans? The usual way to classify iron-overload syndromes is to distinguish between hereditary hemochromatosis (HH), secondary iron overload, and parenteral iron overload. HH results in increased iron absorption from the gut, with preferential deposition of iron in the parenchymal cells of the liver, heart, pancreas, and other endocrine glands. Most HH (approximately 85% to 90%)…

Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis

1. What is the difference between nonalcoholic fatty liver disease ( NAFLD ) and nonalcoholic steatohepatitis ( NASH ) ? NAFLD is an umbrella classification for a group of diseases marked by excess accumulation of intrahepatic fat (steatosis), usually as the result of insulin resistance without significant alcohol use (~ 2-3 drinks per day in a man or ~ 1-2 drinks per day in a woman).…

Vascular Liver Disease

Background 1. What vessels supply blood and are responsible for oxygen delivery to the liver ? The portal vein is responsible for approximately 70% of total liver blood flow and supplies slightly less than half the needed oxygen. Although of lower oxygen content, the portal vein delivers intestinal nutrients, drugs, and inflammatory mediators directly to the liver after intestinal absorption. The hepatic artery (branch of the…