The new edition of this pocket guide has been fully updated to cover the common manifestations of liver disease, how to treat them and when to refer patients on to specialist centers. New chapters on Acute Liver Failure, Nutrition and Congenital Heart Disease have been added to reflect the key issues in management of liver diseases. The book outlines the common clinical liver diseases such as fatty liver disease and viral hepatitis, among others, and their current up to date management.
Written by experts in the field and containing figures and tables, as well as case histories and questions, this is an enjoyable and reader-friendly book for the busy physician. With its authoritative, didactic style and short chapters, it covers the common presentations and complications of liver disease, and how to deal with them.
Given the increasing prevalence of liver disease in the UK and Worldwide, this is an ideal reference book for primary care physicians, doctors in specialist training, clinical nurse specialists and for gastroenterologists, who see patients with liver disease in their working lives.
Author(s): Tim Cross
Edition: 2
Publisher: Springer
Year: 2022
Language: English
Pages: 423
City: Cham
Preface
Contents
Contributors
Chapter 1: Assessment of Liver Function
Case Study
An Overview of Anatomy and Functions of the Liver
Metabolic
Immunologic
Common Risk Factors for Deranged Liver Enzyme Tests
Alcohol
Metabolic Factors
Risk Factors for Viral Hepatitis
Drug-Induced Liver Injury
Interpretation of Liver Function Tests
Initial Approach to Potential Liver Disease
Parenchymal Liver Screen
Tests of Hepatocellular Damage
Serum Aminotransferases (ALT and AST) [3, 4]
Alkaline Phosphatase (ALP)
Isolated GGT Elevation
Bilirubin
Test of Liver Synthetic Function
Prothrombin Time
Albumin
Platelets
Liver Fibrosis
Special Circumstances: Pregnancy [6]
References
Chapter 2: Acute Liver Failure
Introduction
Epidemiology
Prognosis
Initial Resuscitation and Referral
Respiratory Support
Cardiovascular Support
Neurological Support
Coagulopathy Management
Metabolic Support
Renal Support
Microbiological Considerations
Liver Transplantation
Plasma Exchange
Extra-Corporeal Liver Support
References
Chapter 3: Drug-Induced Liver Injury
Introduction and Epidemiology
Risk Factors Associated with DILI
Pathogenesis
Case Definitions and Phenotypes of Idiosyncratic DILI
Patterns of DILI
Hepatocellular DILI
Cholestatic DILI
Specific Phenotypes of DILI
Drug-Induced Autoimmune Hepatitis
Checkpoint Inhibitor-Induced Liver Injury (ChILI)
Causality Assessment
Severity of DILI
Stepwise Approach to Clinical Diagnosis of DILI
Role of Liver Biopsy
Role of Pharmacogenetic Testing
Management
References
Chapter 4: Liver Decompensation and Acute on Chronic Liver Failure
Introduction
ACLF and Prognostication Models
Pathogenesis of Acute-on-Chronic Liver Failure
Principles of Management of Liver Decompensation
General Approach to Management
Variceal Haemorrhage
Ascites
Encephalopathy
Alcoholic Hepatitis
Infections and Sepsis
Renal Failure and Hepatorenal Syndrome
Adrenal Failure
Coagulopathy
Summary
References
Chapter 5: Portal Hypertension: Varices
Clinical Case
Pathophysiology of Portal Hypertension
Classification of Portal Hypertension
Portal Hypertension Due to Cirrhosis
Development of Varices
Manifestations of Varices
Diagnosis of Varices
Surveillance of Varices
Treatment
Treatment to Prevent Development of Varices
Prophylactic Treatment to Prevent First Variceal Haemorrhage
Treatment of Variceal Haemorrhage
Medical Therapy
Endoscopic Variceal Ligation
Failure of First Line Therapy
TIPSS Placement
Secondary Prophylaxis
Gastric Varices
References
Chapter 6: Frailty and Sarcopenia in Cirrhosis
Introduction
Pathophysiology of Frailty and Sarcopenia
Measuring Frailty and Its Clinical Impact
Karnofsky Performance Status (KPS)
Fried Frailty Index (FFI)
Liver Frailty Index (LFI)
CT Muscle Measurement
Frailty Interventions and the Future
Summary
References
Chapter 7: Non-alcoholic Fatty Liver Disease
Introduction
Pathophysiology
Natural History
Making the Diagnosis of NAFLD
Clinical History and Examination
Blood Tests
Imaging
Non-invasive Markers of Fibrosis in NAFLD
Scoring Systems
Transient Elastography
The Role of Liver Biopsy
Management
Weight Loss and Lifestyle Modification
Interventions for Metabolic Syndrome +/− Secondary Benefits on the Liver
Liver-Specific Agents
Monitoring Cirrhosis, Liver Transplantation and the Multidisciplinary Approach
Future Directions
References
Chapter 8: Chronic Hepatitis B
Introduction
Epidemiology
Preventative Measures
Screening
Immunisation
Diagnosis and Disease Work-Up
Virology
Structure
Viral Replication
Natural History and Immunology
Acute HBV Infection
Phases of Chronic HBV Infection
Management of Hepatitis B
Nucleos(t)ide Analogs (NUCs)
Pegylated-Interferon (Peg-IFN)
Patient Selection/Who to Treat
e-Antigen Positive
e-Antigen Negative
Special Populations
Cirrhotic
Immunosuppressed
Pregnancy
Biomarkers
HCC Surveillance
Future Therapies
Conclusion
References
Chapter 9: Chronic Hepatitis C
Case Study
Background
Presentation
Investigations
Management
Summary
References
Chapter 10: Autoimmune Hepatitis and Overlap Syndromes
Introduction
Epidemiology
Aetiology and Pathogenesis
Clinical Features
Diagnosis
Biochemical
Immunological
Pathology
Differential Diagnosis
Scoring Systems Used in Diagnosis
Other Investigations
Management
Who Should Be Treated?
Pharmacological Treatment
Managing Medication Side Effects and Treatment Considerations
Assessing Response to Treatment, Treatment Cessation, Outcomes, and Prognosis
Liver Transplantation
Special Circumstances
Pregnancy
Overlap Syndromes
PBC-AIH Overlap
PSC-AIH Overlap
References
Chapter 11: IgG4-Related Hepato-Pancreato-Biliary Disease
Introduction
Disease Phenotypes
Pathophysiology
Epidemiology
Disease Associations
Demographics and Clinical Presentation
Laboratory Parameters
Radiological Features
Histopathological Characteristics
Diagnosis
Disease Monitoring
Management
Induction Treatment
Maintenance Treatment
Outcome
References
Chapter 12: Hereditary Haemochromatosis
Background
Iron Pathophysiology
Disease Expression
Diagnosis
Treatment
Non-HFE Haemochromatosis
Conclusion
References
Chapter 13: Pregnancy and Liver Disease
Introduction
Normal Physiology in Pregnancy
Pregnancy Related Liver Diseases
Hyperemesis Gravidarum
Intrahepatic Cholestasis of Pregnancy
Pre-eclampsia/Eclampsia/HELLP Syndrome
Acute Fatty Liver of Pregnancy (AFLP)
Hepatic Haemorrhage and Rupture
Non-pregnancy Related Liver Diseases
Cirrhosis and Portal Hypertension
Hepatitis B and C Virus Infection and Pregnancy
Autoimmune Hepatitis and Pregnancy
Liver Transplantation
Liver Disease De Novo in Pregnancy
Acute Viral Infections and Pregnancy
Pregnancy and Thrombosis
Gallstones in Pregnancy
Summary
References
Chapter 14: The Orphan Liver Disease
Porphyria
Overview
Classification of Porphyrias
Alpha-1-Antitrypsin Deficiency
Overview
Genetics and Epidemiology
Clinical Presentation
Diagnosis
Treatment
Cystic Fibrosis and Liver Disease
Overview
Investigations
Treatment
References
Chapter 15: Fontan-Associated Liver Disease (FALD)
The Evolving Fontan Procedure
Defining Fontan-Associated Liver Disease
Fontan Circulatory Dynamics
The Timescale of Events
Clinical Presentation
Diagnosing Cirrhosis in FALD
Biochemical Markers
Non-invasive Composite Scores of Liver Disease
Radiological Imaging
Elastography
Portal Hypertension
Hepatocellular Carcinoma
Transplantation: Heart Versus Combined Heart–Liver Transplant
FALD Screening
Recommended Therapeutic Approaches
References
Further Readings
Chapter 16: Diagnosis and Management of Hepatocellular Carcinoma
Introduction
Diagnosis of Hepatocellular Carcinoma
Current Treatment Modalities for Treatment of Hepatocellular Carcinoma
The Role of HCC Surveillance in at Risk Patients
The Role of Liver Transplantation in the Management of HCC
The Role of Downstaging
Treatment on the Waiting List
Liver Transplantation as Salvage Therapy
Delisting HCC Patients
Improving Existing Therapies
Systemic Therapy
Getting More from Sorafenib
Conclusion
References
Chapter 17: Liver Transplantation
Introduction
Candidates
Indications for Liver Transplantation
Prognostic Scoring Systems for End-Stage Liver Disease
The Model of End-Stage Liver Disease (MELD)
Modification of MELD (MELD-Na)
The United Kingdom Model for End-Stage Liver Disease (UKELD)
Super-Urgent LT
Malignant Liver Disease
Absolute and Relative Contraindications to LT
Pre-transplant Assessment
Cardiopulmonary Assessment
Renal Assessment
Imaging
Nutritional Assessment
Liver Graft Allocation
Liver Transplant Surgery
Post-transplant Care
Primary Graft Non-function
Acute Cellular Rejection (ACR)
Post-transplantation Infections
Vascular Complications
Biliary Complications
Long-Term Follow-Up
Prognosis
Bibliography
Chapter 18: The Hepatological Curiosities
Familial Non-haemolytic Hyperbilirubinaemias
Gilbert’s Syndrome
Background
Diagnosis
Treatment
Prognosis
Alagille Syndrome
Background
Diagnosis
Treatment
Prognosis
Caroli Disease
Background
Diagnosis
Prognosis and Treatment
Benign Recurrent Intrahepatic Cholestasis (BRIC) and Progressive Familial Intrahepatic Cholestasis (PFIC)
Background
Diagnosis
Treatment
Prognosis
Amyloidosis
Background
Diagnosis
Treatment
Prognosis
Sarcoidosis
Background
Diagnosis
Treatment and Prognosis
Budd-Chiari Syndrome
Background
Diagnosis
Treatment
Prognosis
Hepato-pulmonary Syndrome
Background
Diagnosis
Investigations
Treatment
Porto-pulmonary Hypertension
Background
Diagnosis
Treatment
Schistosomiasis
Background
Diagnosis
Treatment
Wilson’s Disease
Background
Diagnosis
Hepatic Parenchymal Copper Concentration
Treatment
Prognosis
References
Index
