Medicine
Autoimmune hepatitis is a liver disease associated with: • hyperglobulinaemia • autoantibodies in the serum • a history of other autoimmune disorders. It was previously known as ‘chronic active hepatitis’, but this term is now outmoded, in recognition of the acute presentation in some cases. It typically occurs in young women (age at onset 20–40 years), but it may develop at any age in...
Hepatitis – pregnant women should be screened for viral hepatitis B and C. Perinatal transmission occurs principally with high levels of viraemia. All children of hepatitis B surface antigen-positive mothers should be vaccinated on the first day of life and at 1, 3 and 12 months. The risk of vertical transmission is greatest from mothers who are hepatitis B e antigen positive or have high hepatitis...
In contrast to neonates, older children with liver disease may not be jaundiced. The clinical presentation varies from acute hepatitis to insidious development of hepatosplenomegaly, portal hypertension and malnutrition.
Primary sclerosing cholangitis is a cholestatic liver disease caused by diffuse inflammation and fibrosis that can involve the entire biliary tree. The progressive pathological process obliterates intrahepatic and extrahepatic bile ducts, ultimately leading to biliary cirrhosis, portal hypertension and hepatic failure. Cholangiocarcinoma develops in about 10–30% of patients during the course of the...
Liver transplantation is the established treatment for selected patients with acute liver failure, decompensated chronic liver disease, inherited metabolic diseases or primary liver cancer. Since the early 1980s, there has been a consistent improvement in the results of transplantation; 1-year post-transplantation survival of at least 80% is now expected. As increasing numbers of patients survive...
Iron is vital for many basic cellular processes, including the transport of oxygen and electrons. In excess, these potent oxidative processes can lead to tissue damage and fibrosis, resulting in organ failure. Iron overload may occur as a genetic condition termed ‘hereditary haemochromatosis’ (HHC) or as a secondary event (Figure 1). The genetic and metabolic defects that cause HHC have recently been...
In the UK, about 50,000 cholecystectomies are performed every year and more than twice that number of patients are admitted to hospital with gallstone-related episodes. In the West, most gallstones (75–80%) are cholesterol rich with varying degrees of calcification; this contribution therefore concentrates on cholesterol gallstones. Pigment stones are less common.
The term ‘non-alcoholic steatohepatitis’ (NASH) was introduced in 1980 to define a condition that is histologically similar to alcoholic liver disease but in which alcohol has no part and that is most commonly associated with obesity and/or type 2 diabetes. The condition can lead to cirrhosis and hepatocellular cancer. It is now clear that NASH is an important part of the metabolic syndrome, which...
Hepatic encephalopathy is a potentially reversible neuropsychiatric syndrome that may complicate acute or chronic liver failure. Encephalopathy is part of the definition of the former; hepatic encephalopathy or ascites is present in the latter. Diagnosis of hepatic encephalopathy is essentially clinical. Two abnormalities (hepatocellular failure and portosystemic shunting) tend to be present in those...
Liver disease in infancy is uncommon but is an important cause of morbidity and mortality.
In severe chronic liver disease, the principal problems are: • the degree of hepatocellular failure • the complications of portal hypertension.
Primary biliary cirrhosis (PBC) is a chronic, progressive cholestatic disease of unknown aetiology that affects mainly women. There is a strong association with antimitochondrial antibodies (AMA) and the disease is characterized by granulomatous cholangitis, which leads to progressive destruction of the small and middle-sized intrahepatic bile ducts, leading to fibrosis and cirrhosis. Patients with...
Malignant tumours of the liver and biliary tract are relatively rare in the West. Metastatic tumours are 40 times as common as primary malignancies, and more benign lesions are being diagnosed with advances in diagnostic techniques.
In coeliac disease, the mucosa of the small intestine is abnormal. The condition improves morphologically and symptomatically with a gluten-free diet and relapses when gluten is re-introduced. It was previously called non-tropical sprue, gluten-sensitive enteropathy, idiopathic steatorrhoea or primary malabsorption.
Each year, more than 300 million travellers cross international boundaries–about 30 million from an industrialized country to a location in the developing world; 30-50% experience an attack of travellers' diarrhoea, depending on the country visited. Travellers' diarrhoea leads to inconvenience for holidaymakers and disruption of professional and business travel activities, and has economic implications...
Aphthae are small, well-circumscribed ulcers of the lining mucosa that are self-limiting. They are common, particularly in adolescents and young adults. Treatment options for mild cases include tetracycline/nystatin mouthwashes and topical corticosteroids (Figure 1). Severe cases may justify prednisolone or thalidomide.
In the UK, oesophageal cancer accounts for about 10 deaths/100,000 population each year and is a major health problem.
The new millennium has already proved to be an exciting time in hepatobiliary disease. In the developed world, the epidemic of obesity leading to metabolic syndrome has aroused academic and commercial interest in non-alcoholic fatty liver disease (NAFLD). This update covers some of the most recent developments in hepatology.
Diarrhoea may be defined as frequent passage of loose stools or, more accurately, passage of an increased volume of stool water. A stool volume of more than 200 ml/m2/day indicates diarrhoea, as does a stool weight of more than 150-200 g watery stool/m2/day. Such precise measurements are difficult to achieve in children, and infants would have to be admitted to a metabolic unit. Therefore, more practical...
Acute upper gastrointestinal haemorrhage is the most important gastrointestinal emergency and is responsible for about 25,000 admissions to hospital each year in the UK. The incidence is 50-150/10,000/year and is highest in areas of social deprivation. It appears that the overall incidence of admissions for upper gastrointestinal bleeding has decreased in the UK. In Hong Kong, the incidence has decreased...