The Liver in Systemic DiseaseA practical guide for non-hepatologists who encounter abnormal liver test results in patients
The Liver in Systemic Disease is an easy-to-use and authoritative guide for non-hepatologist health care professionals who need guidance on the management of patients with abnormal liver tests. The book provides definitive advice for when further investigation, or changes in management, are indicated.
With a practical focus throughout the text, the editors explore when and how to investigate and manage patients whose primary disease is non-hepatic, but whose liver tests are unexpectedly abnormal. The Liver in Systemic Disease provides substantial flow diagrams and advice on the process, together with updates on the liver diseases non-hepatologists are most likely to encounter.
Take-home primers included in the book shine a light on best practice and recommended procedures when dealing with abnormal liver test results. The book also provides:
- A thorough introduction to evaluate the liver, including serum liver tests, liver imaging, and liver biopsy
- Comprehensive discussions of practical issues in patients with liver abnormalities, including the diagnosis of drug induced liver injury, prescribing in patients with abnormal liver tests, and more
- Practical discussions of the management of patients with unexplained abnormal liver tests in primary care
- In-depth examinations of secondary care management of patients with unexplained abnormal liver tests, including intensive care, and the care of infectious and immunosuppressed patients
The Liver in Systemic Disease is an indispensable resource for non-hepatologist medical practitioners seeking to understand the implications of abnormal liver tests and who wish to know when further investigation or alteration of management is indicated.
Author(s): Gideon M. Hirschfield, Paramjit Gill, James Neuberger
Publisher: Wiley-Blackwell
Year: 2023
Language: English
Pages: 283
City: Hoboken
Cover
Title Page
Copyright Page
Contents
List of Contributors
Preface
Section 1 Introduction
Chapter 1 Liver Tests
Introduction
The Reference Range
The Standard Liver Function Tests
Albumin
Aspartate and Alanine Amino Transferase
Alkaline Phosphatase
Gamma-Glutamyl Transferase
Bilirubin
Prothrombin Time
Other Analytes in Liver Disease
Kidney Blood Tests
Hematologic Analytes
Markers of Malignancy
Hepatitis Viral Markers
Assessment of Hepatic Fibrosis
Imaging
Assessment of Liver Fat
Assessment of Alcohol Use
Functional Tests of Liver Function
Liver Biopsy
Models Assessing Prognosis in Liver Disease
References
Further Reading
Section 2 Take-Home Primers: Managing Unexplained Abnormal Liver Tests
Chapter 2 Primary Care
Introduction
Liver Disease in the UK
Isolated Raised Liver Transaminase in a Healthy Individuals
Non-alcoholic Fatty Liver Disease
Alcohol and Liver Disease
Chronic Infections of the Liver
Hepatitis B Virus
Hepatitis C Virus
Hyperbilirubinemia
Unconjugated Hyperbilirubinemia
Conjugated Hyperbilirubinemia
Neonatal Jaundice
Physiological and Prolonged Jaundice
Pathological Jaundice
References
Chapter 3 Global Perspective
Introduction
Indian Perspective
Patterns of Specific Liver Disorders in the Indian Context
Viral Hepatitis
Hepatitis A Infection
Hepatitis B Infection
Hepatitis C
Hepatitis D
Hepatitis E
Alcohol-Related Liver Disease
Non-alcoholic Fatty Liver Disease
Autoimmune Hepatitis
Primary Biliary Cholangitis
Wilson’s Disease
Drug-Induced Liver Injury
Other Cholestatic Diseases
Hemochromatosis
Gilbert’s Syndrome
Non-hepatic Causes of Liver Enzymes Elevation
Isolated Raised Alkaline Phosphatase
Conclusions
Far East Perspective
Africa Perspective
Why Liver Disease in Primary Care?
Liver Enzymes
Common Causes of Raised Enzymes
What to Do When a Patient Has Unexplained Liver Enzymes
Clinical Features
Relevant Investigations
When to Refer
Infections
Liver Cirrhosis
Drugs
Issues to Note in Africa
Conclusion/Take Home Message
References
Section 3 Take-Home Primers: Managing Unexplained Abnormal Serum Liver Tests in Secondary Care
Chapter 4 Intensive Care
Classification and Prevalence
Patterns of Liver Test Abnormalities
Hepatocellular Pattern of Liver Injury
Principal Causes of Hepatocellular Liver Injury
Cholestatic Pattern of Liver Injury
Assessment of Severity of Liver Injury
International Normalized Ratio
Lactate
Ammonia
Albumin
Sequential Clinical Assessment
Approach to Supportive Care
Discussion with a Specialist Liver Unit
References
Chapter 5 Infections Affecting the Liver in the Immunosuppressed
Introduction
Viral Infections
Hepatitis A
Hepatitis E
Hepatitis B
Hepatitis C
Yellow Fever
Dengue
Epstein–Barr Virus
Cytomegalovirus
Herpes Simplex Virus
Other Viral Infections
Bacterial and Parasitic Infections
Enteric Fever
Brucellosis
Leptospirosis
Syphilis
Lyme Disease, Q Fever, Rocky Mountain Spotted Fever
Tuberculosis
Schistosomiasis
Malaria
Fungal Infections
Candida
Aspergillosis
Histoplasmosis
Blastomycosis
Cryptococcosis
Conclusion
Reference
Further Reading
Chapter 6 The Postoperative Patient
Introduction
Common Liver Problems Associated with the Postoperative Patient
Common Postoperative Causes of a Predominant Hepatocellular Injury
Common Postoperative Causes of a Predominantly Cholestatic Injury
Unmasking Underlying Chronic Liver Conditions
Approach to Abnormal Liver Function Tests in the Postoperative Patient
Imaging the Liver When Liver Function Tests are Deranged Postoperatively
When Postoperative Abnormal Liver Function Tests are Unrelated to a Primary Liver Pathology
References
Chapter 7 Pregnancy
Introduction
Normal Pregnancy
History
Investigations
Alkaline Phosphatase in Normal Pregnancy
Abnormal Liver Tests Attributable to Pregnancy-Related Disease
Hyperemesis Gravidarum
Acute Fatty Liver of Pregnancy
Hypertensive Disorders of Pregnancy
HELLP Syndrome
Distinguishing HELLP from Acute Fatty Liver of Pregnancy
Intrahepatic Cholestasis of Pregnancy
Ischemic Hepatitis
Pre-existing Liver Disease
Non-alcoholic Fatty Liver Disease
Cirrhosis
Liver Transplant
Gall Bladder Disease
Primary Biliary Cholangitis
Primary Sclerosing Cholangitis
Hereditary Hemochromatosis
Wilson’s Disease
Acquired Non-Pregnancy-Related Disease
Budd–Chiari Syndrome
Drug-Induced Liver Injury
Autoimmune Hepatitis
Viral Hepatitis
References
Further Reading
Chapter 8 Endocrinology and Metabolic Diseases (Including Diabetes)
Introduction
The Liver: Crossroads of Nutrient Homeostasis
When Will the Endocrinologist See Unexplained Abnormal Liver Function Tests?
Workup for Excluding Alternative Causes
Abnormal Liver Function Tests in Patients with Known Endocrinology Disease
Type 2 Diabetes Mellitus
Thyroid Diseases
Dyslipidemia
Adrenal Diseases and the Liver
When to Refer to a Liver Specialist
References
Further Reading
Chapter 9 Abnormal Serum Liver Tests in Cardiac Disease
Introduction
Liver Disease Causing Heart Disease
Cirrhotic Cardiomyopathy
Heart Disease Causing Liver Disease
Right-Sided Heart Failure and Hepatic Congestion
Acute Heart Failure
Atrial Fibrillation
Left-Ventricular Assist Devices and Cardiac Support Devices
Liver Disease in Congenital Heart Disease
Heart and Liver Disease Caused by a Common Disorder
Infections
Inflammatory Diseases
Metabolic Diseases
Liver Disease Unrelated to Heart Disease
Drug-Induced Liver Injury
References
Further Reading
Chapter 10 Respiratory Disease
Lung Problems Due to Unexpected Liver Issues
Arterial Hypoxemia
Pulmonary Hypertension
Pleural Effusions
Liver–Lung Problems as Part of a “Systemic” Presentation
Genetic Lung Abnormalities with Associated Abnormal Liver Tests
Immunologic/Inflammatory Lung Disorders with Liver Manifestations
References
Chapter 11 Gastroenterology
Abnormal Liver Tests in Gastroenterological Disease
Pancreatobiliary Conditions
Luminal Conditions
Liver Diseases that may Mimic Gastroenterological Diseases
Primary Sclerosing Cholangitis
Liver Diseases Associated with Gastroenterological Diseases
When to Refer
Primary Sclerosing Cholangitis: Inflammatory Bowel Disease
Secondary Sclerosing Cholangitis/Secondary Biliary Cirrhosis
Take-Home Messages
Unexplained Abnormal Liver Tests in Patients with Known Gastroenterological Diseases
Take-Home Messages
Monitoring Liver Blood Tests in Gastroenterology
Liver Screen
Further Reading
Chapter 12 Renal Medicine
Introduction
Renal Impairment in Patients with Liver Disease
Measurement of Renal Function in Patients with Cirrhosis
Acute Kidney Injury in Patients with Liver Cirrhosis
Chronic Kidney Disease in Patients with Liver Cirrhosis
Renal Impairment in Patients with Acute Liver Failure
Renal Impairment in Liver Transplant Recipients
Abnormal Liver Enzymes in Patients with Kidney Disease
Abnormal Liver Enzymes in Patients with Acute Kidney Injury
Abnormal Liver Enzymes in Patients with Chronic Kidney Disease
Dialysis
Liver Disease in Kidney Transplant Recipients
Viral Hepatitis in Kidney Transplant Recipients
References
Chapter 13 Dermatology
Introduction
Dermatological Drugs and Liver Function Tests
Methotrexate
Retinoids
Azathioprine
Cyclosporin
Antifungal Medication
Chinese Herbal Medication
When is Further Investigation Required?
Liver Disease that Mimics Dermatological Diseases
Primary Biliary Cholangitis
Alcohol-Related Liver Disease
Hepatitis C
Hemochromatosis
Liver Disease Associated with Dermatological Disease
Psoriasis
Sarcoidosis
Lichen Planus
Dermatitis Herpetiformis
Mastocytosis
Dermatological Malignancies
Neurofibromatosis
Other Dermatology Conditions
Unexplained Abnormal Liver Function Tests in Patients with Known Dermatological Disease
References
Chapter 14 Oncology
Liver Diseases That May Mimic Oncologic Diseases
Liver Diseases Associated with Oncologic Diseases
Liver Enzyme Elevations
Chemotherapy-Associated Steatohepatitis
Hepatic Sinusoidal Injury
Nodular Regenerative Hyperplasia
Immune-Mediated Hepatitis
Radiation-Associated Liver Injury
Hepatitis B Virus Reactivation
Unexplained Abnormal Liver Tests in Patients with Known Oncologic Disease
At Diagnosis
During Therapy
After Therapy
Summary
References
Chapter 15 Hematology
Introduction
Unexplained Abnormal Liver Tests in Patients with Known Hematologic Disease
References
Chapter 16 Mental Health and Neurology
Introduction
Unexplained Abnormal Liver Function Tests in Mental Health and Neurology Settings
Antidepressants
Antipsychotics
Liver Diseases that May Mimic Psychiatric Conditions
Liver Diseases Associated with Psychiatric Disease
Unexplained Abnormal Liver Function Tests in Patients with Known Psychiatric Disease
Chapter 17 Non-Alcoholic Fatty Liver Disease
Introduction
Definition
Epidemiology
Pathophysiology
Risk Factors
Natural History/Prognosis
Clinical Features and Diagnosis
Non-Invasive Assessment
Steatosis Assessment
Fibrosis Assessment
Treatment
Conclusion
References
Section 4 Practical Issues in Patients with Liver Abnormalities
Chapter 18 Prescribing in Patients with Abnormal Liver Tests or Liver Disease: A Pragmatic Approach
Introduction
Abnormal Liver Tests
Drug Licensing for Patients with Liver Disease and Prescribing Guidance
Prescribing Hepatotoxic Medication and Drug-Induced Liver Injury
Idiosyncratic Drug-Induced Liver Injury
Dose-Dependent Drug-Induced Liver Injury
“First Principles” to Consider in Prescribing for Patients with Liver Disease
Absorption
Distribution
Elimination
Metabolism
Prescribing in the Context of Liver Disease
Liver Fibrosis
Cholestatic Liver Disease
Compensated Cirrhosis
Decompensated Cirrhosis
Cytochrome P450 Enzyme System
Preserving Renal Function
Summary
Reference
Further Reading
Chapter 19 Invasive Procedures in Patients with Liver Disease
Introduction
Coagulation Testing in Patients with Liver Disease
Platelet Count in Patients with Liver Disease
Which Patients with Liver Disease are at Increased Risk of Bleeding?
Use of Blood Products in Patients with Liver Disease Requiring Invasive Procedures
Additional Treatments Used to Reduce Procedural Bleeding in Patients with Liver Disease
Medication History
Learning Points
References
Further Reading
Chapter 20 Diagnosing Drug-Induced Liver Injury
Challenges in the Diagnostic Approach
Be Aware of the Base Rates
Raised Liver Enzymes
Jaundice
Acute Liver Failure
Consider Drug-Induced Liver Injury
Probe for Information on Medications
Look for Features of Hypersensitivity
Identify the Pattern of Liver Injury
Consider Alternative Explanations
Hypoxic Hepatitis
Rule Out Biliary Obstruction
Evaluate Causality Systematically
Perform Liver Biopsy
Use Genetic Tests
Importance of the Diagnosis
References
Index
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