Abnormal Liver Function. Dr William Alazawi MA(Cantab) PhD MRCP Senior Lecturer and Consultant in Hepatology Queen Mary, University of London

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Abnormal Liver Function. Dr William Alazawi MA(Cantab) PhD MRCP Senior Lecturer and Consultant in Hepatology Queen Mary, University of London"

Transcription

1 Abnormal Liver Function Dr William Alazawi MA(Cantab) PhD MRCP Senior Lecturer and Consultant in Hepatology Queen Mary, University of London

2 Does Liver Disease Matter?

3 Mortality in England & Wales

4 Liver-related mortality in under 65s

5 Does Liver Disease Matter? Between 2000 and 2009, deaths from chronic liver disease and cirrhosis in the under 65s increased by around 20% while they fell by the same amount in most EU countries. And all 3 major causes of liver disease - obesity, undiagnosed infection, and, increasingly, harmful drinking - are preventable. Dame Sally Davis Chief Medical Officer

6 Liver Function Tests Bilirubin Aspartate aminotransferase (AST) Alanine aminotransferae (ALT) Alkaline phosphatase Gamma glutamyl transpeptidase (GGT)

7 Liver Function Tests Bilirubin Aspartate aminotransferase (AST) Alanine aminotransferae (ALT) Alkaline phosphatase Gamma glutamyl transpeptidase (GGT)

8 Jaundice Pre-Hepatic Hepatic Post-Hepatic Patients with jaundice should be assessed urgently

9 Liver Tests ALT /AST = hepatatic Alk Phos / γgt = cholestatic

10 Population Study Total for 3 Boroughs n=813,700 White Indian Pakistani Bangladeshi Asian Other Black African Black Caribbean Other How much liver disease is out there? How much has been worked up

11 Study Design Cross sectional study using the east London GP Database 690,683 adults registered in 150 coterminus GP practices LFTs requested in a 2 year period

12 Results 218,032 adults had LFTs tested (31.6%) 31,672 (14.5%) at least 1 abnormal results ALT or AST

13 Risk of Abnormal LFTs Multivariate analysis Alazawi et al, BJGP 2014

14 LFTs - something and nothing?

15 Normal LFTs adults years 8 years follow-ip Kim HC et al. BMJ. 2004;328(7446):983

16 Prevalence of Liver Diagnoses NAFLD Hepatitis B Acute Viral Hepatitis C ALD Inherited Pregnancy-related Autoimmune Venous Thrombosis - 2,000 4,000 6,000 N=690,683 Alazawi et al, 2014

17 Undiagnosed Liver Disease in Primary Care Total Abnormal n=31,672 Undiagnosed Diagnosed n=27,895 n=3,687 88% no liver diagnosis 12,687 (38%) Drugs (including statins) 3,372 (11%) Excess alcohol consumption 6,026 (19%) Safe alcohol & viral tests (negative) 6,300 (20%) No viral tests

18 Abnormal liver function tests and/or ultrasound showing fatty liver Primary Care: Symptoms & comorbidities Detailed drug history Careful family history Alcohol review AUDIT-C Abnormalities resolve AUDIT-C Positive Brief Intervention Repeat tests in 3 months Abnormalities persist Hepatology Metabolic risk factors inc BMI Blood Tests*: Viral hepatitis HBV & HCV FBC, U&E, INR, TFT LFTs inc AST / GGT Lipid profile Ferritin Autoantibodies Immunoglobulins Consider need for ultrasound All patients with clinical jaundice or bilirubin >40 should be referred urgently for assessment *A complete liver screen would additionally include testing for alpha1-antitrypsin, caeruloplasmin and alphafetoprotein. Chronic viral infection should be excluded by testing for hepatitis B virus surface antigen and antibodies against hepatitis C virus. If abnormalities are acute, exclude hepatitis A and hepatitis E virus infection.

19 Abnormal liver function tests and/or ultrasound showing fatty liver Primary Care: Symptoms & comorbidities Detailed drug history Careful family history Alcohol review AUDIT-C Abnormalities resolve AUDIT-C Positive Brief Intervention Repeat tests in 3 months Abnormalities persist Hepatology Metabolic risk factors inc BMI Blood Tests*: Viral hepatitis HBV & HCV Screen Positive or uncertain FBC, U&E, INR, TFT LFTs inc AST / GGT Lipid profile Ferritin Autoantibodies Immunoglobulins Consider need for ultrasound All patients with clinical jaundice or bilirubin >40 should be referred urgently for assessment *A complete liver screen would additionally include testing for alpha1-antitrypsin, caeruloplasmin and alphafetoprotein. Chronic viral infection should be excluded by testing for hepatitis B virus surface antigen and antibodies against hepatitis C virus. If abnormalities are acute, exclude hepatitis A and hepatitis E virus infection.

20 Abnormal liver function tests and/or ultrasound showing fatty liver Primary Care: Symptoms & comorbidities Detailed drug history Careful family history Alcohol review AUDIT-C Metabolic risk factors inc BMI Blood Tests*: Viral hepatitis HBV & HCV FBC, U&E, INR, TFT LFTs inc AST / GGT Lipid profile Ferritin Autoantibodies Immunoglobulins Consider need for ultrasound Abnormalities resolve AUDIT-C Positive Brief Intervention Repeat tests in 3 months Screen Positive or uncertain Negative or Metabolic Risk NAFLD Abnormalities persist Hepatology All patients with clinical jaundice or bilirubin >40 should be referred urgently for assessment *A complete liver screen would additionally include testing for alpha1-antitrypsin, caeruloplasmin and alphafetoprotein. Chronic viral infection should be excluded by testing for hepatitis B virus surface antigen and antibodies against hepatitis C virus. If abnormalities are acute, exclude hepatitis A and hepatitis E virus infection.

21 Non-Alcoholic Fatty Liver Hepatic fat on biopsy or imaging No other cause for fat including alcohol Metabolic Syndrome

22 Age (continuous) Male <0.001 Diabetes <0.001 Hypertension <0.001 Cardiovascular Disease BMI Category BMI underweight BMI normal (ref) BMI overweight <0.001 BMI obese <0.001 Independent Risk Factors for NAFLD Explanatory Variable Odds 95% CI P value Ratio Ethnic Group Bangladeshi Indian Pakistani White (reference cat) African <0.001 Caribbean <0.001

23 Not the whole story Mean age % not diabetic 48% not obese

24 Non-Alcoholic Fatty Liver Disease

25 How common is NAFLD? Depends on population and definition Histology 20 51% 1,2 US 17 46% 3 MR Spectroscopy 31% 4 ALT 7 11% 3 Overall: NAFLD 20% (6.3 33%) 5 1 Lee J et al. J Hepatol. 2007;47(2):239-44; 2 Marcos A et al. Transplantation. 2000;69: ; 3 Vernon G et al. Aliment Pharmacol Ther Aug;34(3):274-85; 4 Browning JD et al. Hepatology. 2004;40(6): ; 5 Chalasani N et al. Gastroenterology ;142(7):

26 NAFLD is associated with mortality P=0.02

27 Mortality in NAFLD Adams et al 2005

28 Non-Alcoholic Fatty Liver Disease FAT INFLAMMATION

29 NASH and liver mortality NASH - OR 5.71 ( ) 1 NASH + Fibrosis - OR ( ) Survival of 129 / 212 patients with NASH 2 P= Musso Ekstedt Ekstedt 2015

30 NASH vs Fat Retrospective series - biopsies from 1980s N=118 NAFLD Söderberg C et al. Hepatology. 2010;51(2):

31 NAFLD and Liver Cancer 34.8% ALD NAFLD HCV HBV Cirrhotic Non-Cirrhotic 23% of NAFLD are non-cirrhotic Newcastle MDM data Dyson et al 2013 J Hepatol

32 The Prevalence of NASH Brooke Medical Center 12.2% Williams et al, 2011

33 Progression of NAFLD 30% of population has NAFLD 10% of NAFLD develop NASH 25% of NASH develop cirrhosis 10-25% of cirrhosis develop HCC Siegel & Zhu 2009

34 Does SS Progress to NASH? 9-20% NASH progress to cirrhosis 1-3 SS stable over time Olmsted 420 cohort; 7.6 yr follow up No SS deaths 35% NASH died 3 1 Harrison Ong Adams 2005

35 Does SS Progress to NASH? Patients with >1 biopsy Median follow-up 6.6 yr Progressors increase T2DM (65% vs 48%) TOTAL McPherson et al, J Hep 2015

36 Risk Factors for NASH Age / Male Gender? / Hispanic ethnicity Diet Fructose Corn Syrup / Coffee Microbiome Firmicutes -?ethanol-producing Genetics PNPLA3, TM6SF2 steatosis and fibrosis Metabolic syndrome Obesity Diabetes Hyperlipidaemia

37 Liver Biopsy PROs CONs Staging Invasive Grading Cost Diagnosis Sampling Co-Pathology Reluctance Static information 30 % pain / % bleeding Pathologist - dependent 10-30% false negative for cirrhosis

38 Non-Invasive Tests of Fibrosis Blood Tests Elastography Ideally: Accurate Available Stage and Grade Valid (numbers and aetiologies)

39 Non-Invasive Tests of Fibrosis Blood Tests Elastography Ideally: Accurate Available Stage and Grade Valid (numbers and aetiologies)

40 Gressner et al, 2009

41 Assessing risk of fibrosis NAFLD-FS Age / BMI / DM / AST:ALT / Plt / Albumin APRI AST / Plt FIB-4 Age / AST / ALT / Plt BARD BMI / DM / AST:ALT

42 NAFLD fibrosis score 733 patients 480 training, 253 validation Rochester / Newcastle / Sydney / Italy 90% Caucasian BMI 32.2 DM / IFG 69% NPV 88% 60% of patients could avoid biopsy PPV 78% 25% of patients indeterminate

43 Composite Scores Retrospective N= months (3-317) 92% White 36% Diabetic 31% BMI>35 51% Fibrosis ¾ 13% Death or OLT Angulo et al 2013 J Hepatol

44 Abnormal liver function tests and/or ultrasound showing fatty liver Primary Care: Symptoms & comorbidities Detailed drug history Careful family history Alcohol review AUDIT-C Abnormalities resolve AUDIT-C Positive Brief Intervention Repeat tests in 3 months Abnormalities persist Hepatology Metabolic risk factors inc BMI Blood Tests*: Viral hepatitis HBV & HCV FBC, U&E, INR, TFT LFTs inc AST / GGT Lipid profile Ferritin Autoantibodies Immunoglobulins Consider need for ultrasound Screen Positive or uncertain Negative or Metabolic Risk: Likely NAFLD: Calculate NAFLD Fibrosis Score Behaviour / lifestyle advice Alcohol Exercise Diet Cardiovascular risk factors I / H risk Low risk Follow-up in Primary Care Annual review All patients with clinical jaundice or bilirubin >40 should be referred urgently for assessment *A complete liver screen would additionally include testing for alpha1-antitrypsin, caeruloplasmin and alphafetoprotein. Chronic viral infection should be excluded by testing for hepatitis B virus surface antigen and antibodies against hepatitis C virus. If abnormalities are acute, exclude hepatitis A and hepatitis E virus infection. The Diagnostic Liver Clinic will return patients to GP with a diagnosis and advice on future management

45 Treatment in NAFLD? Follow-up metabolic syndrome: Correct hyperlipidaemia Diet Statins monitor change from baseline Glitazones not soundly proven; use if indicated for hyperlipidaemia Other CV risk factors Hypertension Smoking cessation Insulin Resistance

46 Exercise Low/moderate intensity (n=141) 9x more likely to exercise >1hr/week 150 mins / week or increase by >60mins improvement in ALT Metabolic indices (HOMA-IR) Independent of weight loss St George et al, 2009

47 Weight loss improves histology Musso et al, 2009

48 Weight loss improves histology 293 patients with NASH 40% male BMI week lifestyle 750kcal/day deficit 64% fat 22% fat Walk 200 mins / week 8, 16, 24, 32, 40 weeks Vilar-Gomez 2015

49 The NASH pipeline Lomb & Tetri 2015

50 Ongoing work at Barts Health Clinical trials LOXL2 Cenicriviroc Obeticholic acid Observational studies Immune and inflammatory response Diabetes & NAFLD Basic science studies Mechanisms of disease Therapeutic targets

51 Primary Care & Commissioning A pathway for abnormal LFTs? Avoid unnecessary repetition of tests One-stop clinics? Risk stratification Access to behaviour and lifestyle services

52 Abnormal liver function tests and/or ultrasound showing fatty liver Management in Primary Care Referral Primary Care: Abnormalities resolve Diagnosis and Symptoms & Advice comorbidities AUDIT-C Positive Detailed drug history Brief Intervention Careful family history Abnormalities Repeat tests in 3 persist Alcohol review AUDIT-C months Diagnostic Liver Clinic Metabolic risk factors inc Bart s Health Hepatology BMI Screen Blood Tests*: Positive or Viral hepatitis HBV & uncertain HCV Behaviour / FBC, U&E, INR, TFT lifestyle advice Likely NAFLD: LFTs inc AST / GGT Negative Alcohol I / H risk or Calculate Lipid profile Exercise NAFLD Metabolic Ferritin Fibrosis Score Diet Low risk Risk: Cardiovascular Autoantibodies risk factors Immunoglobulins Annual review Consider need for ultrasound All patients with clinical jaundice or bilirubin >40 should be referred urgently for assessment Follow-up in Primary Care *A complete liver screen would additionally include testing for alpha1-antitrypsin, caeruloplasmin and alphafetoprotein. Chronic viral infection should be excluded by testing for hepatitis B virus surface antigen and antibodies against hepatitis C virus. If abnormalities are acute, exclude hepatitis A and hepatitis E virus infection. The Diagnostic Liver Clinic will return patients to GP with a diagnosis and advice on future management

Patterns of abnormal LFTs and their differential diagnosis

Patterns of abnormal LFTs and their differential diagnosis Patterns of abnormal LFTs and their differential diagnosis Professor Matthew Cramp South West Liver Unit and Peninsula Schools of Medicine and Dentistry, Plymouth Summary liver function / liver function

More information

Dr Lee Yin Mei Senior Consultant Gastroenterology NUHS

Dr Lee Yin Mei Senior Consultant Gastroenterology NUHS Dr Lee Yin Mei Senior Consultant Gastroenterology NUHS Simple steatosis (SS), through steatohepatitis Put picture of spectrum Prevalence of NASH 3-25% NASH Progression only occurs in NASH: 27% develop

More information

Abnormal Liver Tests and Fatty Liver Disease

Abnormal Liver Tests and Fatty Liver Disease Abnormal Liver Tests and Fatty Liver Disease Michael D Voigt MD Medical Director Liver Failure and Transplantation, University of Iowa Hospital and Clinics Conflict of interest: I sadly have nothing to

More information

Non-alcoholic fatty liver disease: Prognosis and Treatment

Non-alcoholic fatty liver disease: Prognosis and Treatment Non-alcoholic fatty liver disease: Prognosis and Treatment Zachary Henry, M.D. Assistant Professor UVA Gastroenterology & Hepatology October 28, 2015 Overview Case Presentation Prognosis Effects of fibrosis

More information

Assessment of Fat in the Liver. Gia L. Tyson, MD, MPH Transplant Hepatologist Ochsner Health System New Orleans and Baton Rouge

Assessment of Fat in the Liver. Gia L. Tyson, MD, MPH Transplant Hepatologist Ochsner Health System New Orleans and Baton Rouge Assessment of Fat in the Liver Gia L. Tyson, MD, MPH Transplant Hepatologist Ochsner Health System New Orleans and Baton Rouge Agenda Epidemiology Liver biopsy Laboratory tests Indirect Direct Imaging

More information

脂肪肝的西醫藥治療 Western medicine treatment on fatty liver. Vincent Wong 黃煒燊 Institute of Digestive Disease 消化疾病研究所

脂肪肝的西醫藥治療 Western medicine treatment on fatty liver. Vincent Wong 黃煒燊 Institute of Digestive Disease 消化疾病研究所 脂肪肝的西醫藥治療 Western medicine treatment on fatty liver Vincent Wong 黃煒燊 Institute of Digestive Disease 消化疾病研究所 Disclosures Advisory board member: AbbVie, Gilead, Janssen, Otsuka, Roche Consultancy: Merck,

More information

Non-alcoholic Fatty liver disease in children. Dr.S.Venkatesh Karthik Consultant Paediatric Hepatologist KTP-NUCMI, NUH, Singapore

Non-alcoholic Fatty liver disease in children. Dr.S.Venkatesh Karthik Consultant Paediatric Hepatologist KTP-NUCMI, NUH, Singapore Non-alcoholic Fatty liver disease in children Dr.S.Venkatesh Karthik Consultant Paediatric Hepatologist KTP-NUCMI, NUH, Singapore Relevance Leading cause of chronic liver disease- both adults and children

More information

Fatty Liver Disease Diagnosis & Implications. Dr Matthew Foxton Consultant Hepatologist Chelsea & Westminster Hospital / Kings College Hospital

Fatty Liver Disease Diagnosis & Implications. Dr Matthew Foxton Consultant Hepatologist Chelsea & Westminster Hospital / Kings College Hospital Fatty Liver Disease Diagnosis & Implications Dr Matthew Foxton Consultant Hepatologist Chelsea & Westminster Hospital / Kings College Hospital Intellectuals solve problems Geniuses prevent them The potential

More information

PIERO LUIGI ALMASIO CATTEDRA DI GASTROENTEROLOGIA UNIVERSITA OF PALERMO

PIERO LUIGI ALMASIO CATTEDRA DI GASTROENTEROLOGIA UNIVERSITA OF PALERMO Steatosi e Steatoepatite PIERO LUIGI ALMASIO CATTEDRA DI GASTROENTEROLOGIA UNIVERSITA OF PALERMO Alcoholic liver disease Liver damage resulting from long-term alcohol consumption Histological features:

More information

Fatty Liver in 2016 Update for Primary Physicians. Dr Raymond Kwok Gastroenterologist KTPH

Fatty Liver in 2016 Update for Primary Physicians. Dr Raymond Kwok Gastroenterologist KTPH Fatty Liver in 2016 Update for Primary Physicians Dr Raymond Kwok Gastroenterologist KTPH Lack of awareness in patients Patients in an outpatient diabetes clinic had 70% rate of NAFLD Only 18% of patients

More information

Alcoholic and Non-Alcoholic Fatty Liver Disease

Alcoholic and Non-Alcoholic Fatty Liver Disease Alcoholic and Non-Alcoholic Fatty Liver Disease Thomas W. Faust, M.D., M.B.E. Professor of Clinical Medicine Division of Gastroenterology The University of Pennsylvania Alcoholic Liver Disease Additional

More information

LIVER FUNCTION TESTS AND STATINS

LIVER FUNCTION TESTS AND STATINS LIVER FUNCTION TESTS AND STATINS Philippe J. Zamor and Mark W. Russo Current Opinion in Cardiology 2011,26:338 341 SUMMARY Purpose of review: To discuss recent data on statins in patients with elevated

More information

Managing LFT s in General Practice

Managing LFT s in General Practice Managing LFT s in General Practice Sulleman Moreea FRCP(Edin Edin) ) FRCS(Glasg Glasg) Consultant Gastroenterologist/Hepatologist Bradford Hospitals Trust The normal liver Managing LFT s History and examination

More information

NASH: It is not JUST a Fatty Liver. Karen F. Murray, M.D. Director of Hepatobiliary Program Children s Hospital and Regional Medical Center

NASH: It is not JUST a Fatty Liver. Karen F. Murray, M.D. Director of Hepatobiliary Program Children s Hospital and Regional Medical Center NASH: It is not JUST a Fatty Liver Karen F. Murray, M.D. Director of Hepatobiliary Program Children s Hospital and Regional Medical Center Stages of Fatty Liver Disorders Fatty Liver 16-35% of Western

More information

Need for Biomarker Development in Non-Alcoholic Fatty Liver Disease. Éric Lefebvre, MD Chief Medical Officer Tobira Therapeutics, Inc.

Need for Biomarker Development in Non-Alcoholic Fatty Liver Disease. Éric Lefebvre, MD Chief Medical Officer Tobira Therapeutics, Inc. International Workshop on NASH Biomarkers Need for Biomarker Development in Non-Alcoholic Fatty Liver Disease Éric Lefebvre, MD Chief Medical Officer Tobira Therapeutics, Inc. Disclosure International

More information

Non-alcoholic Fatty Liver Disease. Christi Matteoni, MD GI Consultants

Non-alcoholic Fatty Liver Disease. Christi Matteoni, MD GI Consultants Non-alcoholic Fatty Liver Disease Christi Matteoni, MD GI Consultants Definition of NAFLD Evidence of hepatic steatosis by imaging or histology No causes for secondary hepatic fat accumulation Significant

More information

Revised Newcastle, North Tyneside and Northumberland Guidelines for the Management of Adults with Asymptomatic Liver Function Abnormalities.

Revised Newcastle, North Tyneside and Northumberland Guidelines for the Management of Adults with Asymptomatic Liver Function Abnormalities. Clinical Guidelines Revised Newcastle, North Tyneside and Northumberland Guidelines for the Management of Adults with Asymptomatic Liver Function Abnormalities. August 2014 Dr Mark Hudson Dr Stuart McPherson

More information

Alanine aminotransferase (serum, plasma)

Alanine aminotransferase (serum, plasma) Alanine aminotransferase (serum, plasma) 1 Name and description of analyte 1.1 Name of analyte Alanine aminotransferase (ALT) 1.2 Alternative names Systematic name L alanine:2 oxoglutarate aminotransferase

More information

Work up of the Asymptomatic Patient with Liver Enzyme Abnormalities

Work up of the Asymptomatic Patient with Liver Enzyme Abnormalities Work up of the Asymptomatic Patient with Liver Enzyme Abnormalities G.Y. Minuk Professor of Medicine and Pharmacology University of Manitoba Head, Section of Hepatology Health Sciences Centre 2014 NDAFP

More information

What to Do with the Patient With Abnormal Liver Enzymes? Nizar N. Zein, M.D. The Cleveland Clinic

What to Do with the Patient With Abnormal Liver Enzymes? Nizar N. Zein, M.D. The Cleveland Clinic What to Do with the Patient With Abnormal Liver Enzymes? Nizar N. Zein, M.D. The Cleveland Clinic Introduction Elevated liver enzymes is often not a clinical problem by itself. However it is a warning

More information

NICE guideline Published: 6 July 2016 nice.org.uk/guidance/ng49

NICE guideline Published: 6 July 2016 nice.org.uk/guidance/ng49 Non-alcoholic fatty liver disease (NAFLD): assessment and management NICE guideline Published: 6 July 2016 nice.org.uk/guidance/ng49 NICE 2016. All rights reserved. Your responsibility The recommendations

More information

NP/PA Clinical Hepatology Fellowship Summary of Year-Long Curriculum

NP/PA Clinical Hepatology Fellowship Summary of Year-Long Curriculum OVERVIEW OF THE FELLOWSHIP The goal of the AASLD NP/PA Fellowship is to provide a 1-year postgraduate hepatology training program for nurse practitioners and physician assistants in a clinical outpatient

More information

Evaluation of Liver Function tests in Primary Care. Abid Suddle Institute of Liver Studies, KCH

Evaluation of Liver Function tests in Primary Care. Abid Suddle Institute of Liver Studies, KCH Evaluation of Liver Function tests in Primary Care Abid Suddle Institute of Liver Studies, KCH Liver Function tests Markers of hepatocellular damage Cholestasis Liver synthetic function Markers of Hepatocellular

More information

Primary Care Guidance Program: Non-Alcohol related Fatty Liver Disease (NAFLD) Guidance on Management in Primary Care

Primary Care Guidance Program: Non-Alcohol related Fatty Liver Disease (NAFLD) Guidance on Management in Primary Care Primary Care Guidance Program: Non-Alcohol related Fatty Liver Disease (NAFLD) Guidance on Management in Primary Care This advice has been developed to help GPs with shared care of patients with Non- Alcohol

More information

Fatty Liver What to do? michael herman d.o. Borland-groover clinic Jacksonville, florida

Fatty Liver What to do? michael herman d.o. Borland-groover clinic Jacksonville, florida Fatty Liver What to do? michael herman d.o. Borland-groover clinic Jacksonville, florida Liver Enzymes Liver enzymes are not liver function tests! True liver function tests Albumin INR Bilirubin The patient

More information

2.1 AST can be measured in heparin plasma or serum. 3 Summary of clinical applications and limitations of measurements

2.1 AST can be measured in heparin plasma or serum. 3 Summary of clinical applications and limitations of measurements Aspartate aminotransferase (serum, plasma) 1 Name and description of analyte 1.1 Name of analyte Aspartate aminotransferase (AST) 1.2 Alternative names Systematic name L aspartate:2 oxoglutarate aminotransferase

More information

BURDEN OF LIVER DISEASE IN BRAZIL

BURDEN OF LIVER DISEASE IN BRAZIL BURDEN OF LIVER DISEASE IN BRAZIL Burden of Liver Disease in Europe Blachier et al. J Hepatol 58:593, 2013 Review of 260 epidemiologic studies of the 5 previous years Cirrhosis is responsible for 170.000

More information

BACKGROUND MEDIA INFORMATION Fast facts about liver disease

BACKGROUND MEDIA INFORMATION Fast facts about liver disease BACKGROUND MEDIA INFORMATION Fast facts about liver disease Liver, or hepatic, disease comprises a wide range of complex conditions that affect the liver. Liver diseases are extremely costly in terms of

More information

Abnormal LFT s in Asymptomatic Patients

Abnormal LFT s in Asymptomatic Patients Abnormal LFT s in Asymptomatic Patients FV Liver Care Pathway Pete Bramley Hepatology/Gastroenterology Forth Valley WSW Event 5 th and 7 th March 2013 Overview Liver disease in UK and Scotland Liver function

More information

Managing Abnormal Liver Tests in Primary Care Summary guideline August 2015

Managing Abnormal Liver Tests in Primary Care Summary guideline August 2015 Managing Abnormal Liver Tests in Primary Care Summary guideline August 2015 Main objectives for liver guidance 1. Identify patients at risk of chronic liver disease 2. In people with abnormal LFTs increase

More information

Approach to Abnormal Liver Tests

Approach to Abnormal Liver Tests Approach to Abnormal Liver Tests Naga P. Chalasani, MD, FACG Professor of Medicine and Cellular & Integrative Physiology Director, Division of Gastroenterology and Hepatology Indiana University School

More information

NAFLD/NASH: Criteri diagnostici e prognostici

NAFLD/NASH: Criteri diagnostici e prognostici Monotematica AISF Personalizzazione della Cura in Epatologia NAFLD/NASH: Criteri diagnostici e prognostici Pisa 17-19 ottobre 2013 Elisabetta Bugianesi MD, PhD Division of Gastro-Hepatology, University

More information

Non Invasive Assessment of Liver Fibrosis Serum Surrogate Markers

Non Invasive Assessment of Liver Fibrosis Serum Surrogate Markers Falk Symposium 162, Dresden, Saturday, Oct 13th Non Invasive Assessment of Liver Fibrosis Serum Surrogate Markers Dominique Thabut Hôpital Pitié-Salpêtrière Paris, France Limitations of Liver Biopsy Morbidity

More information

HBV & HCV induced. Liver Cirrhosis Iradj Maleki MD Gut & Liver Research Center Mazandaran University of Medical Sciences

HBV & HCV induced. Liver Cirrhosis Iradj Maleki MD Gut & Liver Research Center Mazandaran University of Medical Sciences HBV & HCV induced Liver Cirrhosis Iradj Maleki MD Gut & Liver Research Center Mazandaran University of Medical Sciences Definition of Cirrhosis Final pathway for a wide variety of chronic liver diseases

More information

Evaluation of abnormal LFT in the asymptomatic patient. Son Do, M.D. Advanced Gastroenterology Vancouver, WA

Evaluation of abnormal LFT in the asymptomatic patient. Son Do, M.D. Advanced Gastroenterology Vancouver, WA Evaluation of abnormal LFT in the asymptomatic patient Son Do, M.D. Advanced Gastroenterology Vancouver, WA Definition of chronic, abnormally elevated LFT Elevation of one or more of the following for

More information

and I think the rest of the day truly will give you further details into some of these additional disease

and I think the rest of the day truly will give you further details into some of these additional disease KAPIL CHOPRA, MD 1 So I'm going to kickoff this course with the topic of abnormal liver function tests. To be very honest this is a huge topic. I think to do justice I'm going to try and touch on some

More information

Patient information: Nonalcoholic steatohepatitis (NASH)

Patient information: Nonalcoholic steatohepatitis (NASH) Official reprint from UpToDate www.uptodate.com 2011 UpToDate The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek

More information

Elevated Liver Enzymes Workup, When to Worry, When to Refer

Elevated Liver Enzymes Workup, When to Worry, When to Refer Elevated Liver Enzymes Workup, When to Worry, When to Refer Ontario College of Family Physicians Annual Scientific Assembly Barry Lumb No disclosures Liver Biochemistry Bilirubin Hepatocellular - AST,

More information

Recommendations for the Identification of Chronic Hepatitis C virus infection Among Persons Born During 1945-1965

Recommendations for the Identification of Chronic Hepatitis C virus infection Among Persons Born During 1945-1965 Recommendations for the Identification of Chronic Hepatitis C virus infection Among Persons Born During 1945-1965 MMWR August 17, 2012 Prepared by : The National Viral Hepatitis Technical Assistance Center

More information

After the Cure: Long-Term Management of HCV Liver Disease Norah A. Terrault, MD, MPH

After the Cure: Long-Term Management of HCV Liver Disease Norah A. Terrault, MD, MPH After the Cure: Long-Term Management of HCV Liver Disease Norah A. Terrault, MD, MPH Professor of Medicine Department of Gastroenterology Director, Viral Hepatitis Center University of California San Francisco

More information

New IDSA/AASLD Guidelines for Hepatitis C

New IDSA/AASLD Guidelines for Hepatitis C NORTHWEST AIDS EDUCATION AND TRAINING CENTER New IDSA/AASLD Guidelines for Hepatitis C John Scott, MD, MSc Associate Professor, UW SoM Asst Director, Liver Clinic, Harborview Medical Center Presentation

More information

Viral Hepatitis Case Report

Viral Hepatitis Case Report Page 1 of 9 Viral Hepatitis Case Report Perinatal Hepatitis B Virus Infection Michigan Department of Community Health Communicable Disease Division Investigation Information Investigation ID Onset Date

More information

The Skinny On Non Alcoholic Fatty Liver Disease

The Skinny On Non Alcoholic Fatty Liver Disease The Skinny On Non Alcoholic Fatty Liver Disease UCSF Advances in Internal Medicine Monika Sarkar, MD, MAS UCSF Division of GI/Hepatology May 20 th, 2015 Non Alcoholic Fatty Liver Disease: Outline Pathogenesis

More information

Non-alcoholic Fatty Liver Disease (NAFLD) Nissa Erickson, MD June 13, 2014

Non-alcoholic Fatty Liver Disease (NAFLD) Nissa Erickson, MD June 13, 2014 Non-alcoholic Fatty Liver Disease (NAFLD) Nissa Erickson, MD June 13, 2014 I have no financial relationships to disclose Case 12 yo hispanic male presents to clinic after incidental finding of increased

More information

Albumin. Prothrombin time. Total protein

Albumin. Prothrombin time. Total protein Hepatitis C Fact Sheet February 2016 www.hepatitis.va.gov Laboratory Tests and Hepatitis If you have hepatitis C, your doctor will use laboratory tests to about learn more about your individual hepatitis

More information

Nonalcoholic Steatohepatitis

Nonalcoholic Steatohepatitis Nonalcoholic Steatohepatitis National Digestive Diseases Information Clearinghouse National Institute of Diabetes and Digestive and Kidney Diseases NATIONAL INSTITUTES OF HEALTH Nonalcoholic steatohepatitis

More information

Hepatology Guidelines for Primary Care November 2011

Hepatology Guidelines for Primary Care November 2011 Common requests for hepatology opinion/advice 1. Abnormal LFTs (is this fatty liver?) 2. Fatty Liver Disease (is this serious liver disease?) 3. Abnormal liver ultrasound 4. Alcohol related liver disease

More information

Transmission of HCV in the United States (CDC estimate)

Transmission of HCV in the United States (CDC estimate) Transmission of HCV in the United States (CDC estimate) Past and Future US Incidence and Prevalence of HCV Infection Decline among IDUs Overall incidence Overall prevalence Infected 20+ years Armstrong

More information

Hepatitis C. David Mutimer Queen Elizabeth Hospital Liver Unit Birmingham. Substance Misuse Treatment in the West Midlands. How can we reduce harm?

Hepatitis C. David Mutimer Queen Elizabeth Hospital Liver Unit Birmingham. Substance Misuse Treatment in the West Midlands. How can we reduce harm? Hepatitis C David Mutimer Queen Elizabeth Hospital Liver Unit Birmingham Substance Misuse Treatment in the West Midlands. How can we reduce harm? Birmingham October 19 th 2007 infection HCV Natural History

More information

The child with abnormal liver function tests

The child with abnormal liver function tests The child with abnormal liver function tests Dr Jane Hartley Consultant Paediatric Hepatologist Birmingham Children s Hospital, UK 1 st Global Congress CIP, Paris 2011 Contents Over view of liver anatomy,

More information

Drugs and Alcohol in Primary Care Steve Brinksman Clinical Lead SMMGP

Drugs and Alcohol in Primary Care Steve Brinksman Clinical Lead SMMGP Drugs and Alcohol in Primary Care Steve Brinksman Clinical Lead SMMGP Habit is habit, and not to be flung out of the window by any man, but coaxed down-stairs one step at a time. Samuel Langhorne Clemens

More information

Non-invasive evaluation of liver fibrosis: current clinical use and next perspectives (chronic hepatitis C)

Non-invasive evaluation of liver fibrosis: current clinical use and next perspectives (chronic hepatitis C) Non-invasive evaluation of liver fibrosis: current clinical use and next perspectives (chronic hepatitis C) Paul Calès Liver and Gastroenterology department, University hospital & HIFIH laboratory, Angers

More information

Non Alcoholic Steato-Hepatitis (NASH)

Non Alcoholic Steato-Hepatitis (NASH) Non Alcoholic Steato-Hepatitis (NASH) DISCLAIMER NEITHER THE PUBLISHER NOR THE AUTHORS ASSUME ANY LIABILITY FOR ANY INJURY AND OR DAMAGE TO PERSONS OR PROPERTY ARISING FROM THIS WEBSITE AND ITS CONTENT.

More information

Indications in Hepatology and Liver Diseases

Indications in Hepatology and Liver Diseases exclusively working in Health Care sananet GmbH Tilo Stolzke Breite Str. 6-8 23562 Lübeck Germany Telefon : +49 451 400 8301 Telefax : +49 451 400 8302 E-Mail : stolzke@sananet.com Internet : www.sananet.com

More information

Hepatitis C. Laboratory Tests and Hepatitis C

Hepatitis C. Laboratory Tests and Hepatitis C Hepatitis C Laboratory Tests and Hepatitis C If you have hepatitis C, your doctor will use laboratory tests to check your health. This handout will help you understand what the major tests are and what

More information

Epidemiology of Hepatitis C Infection. Pablo Barreiro Service of Infectious Diseases Hospital Carlos III, Madrid

Epidemiology of Hepatitis C Infection. Pablo Barreiro Service of Infectious Diseases Hospital Carlos III, Madrid Epidemiology of Hepatitis C Infection Pablo Barreiro Service of Infectious Diseases Hospital Carlos III, Madrid Worldwide Prevalence of Hepatitis C 10% No data available WHO.

More information

What to do with abnormal LFTs? Andrew M Smith Hepatobiliary Surgeon

What to do with abnormal LFTs? Andrew M Smith Hepatobiliary Surgeon What to do with abnormal LFTs? Andrew M Smith Hepatobiliary Surgeon "it looks like there's something wrong.with your television set. Matt Groenig, creator of The Simpsons Probability of an abnormal screening

More information

Surveillance for Hepatocellular Carcinoma

Surveillance for Hepatocellular Carcinoma Surveillance for Hepatocellular Carcinoma Marion G. Peters, MD John V. Carbone, MD, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California San Francisco Recorded on April

More information

2015 Outpatient Chronic Hepatitis B Management

2015 Outpatient Chronic Hepatitis B Management 2015 Outpatient Chronic Hepatitis B Management Hepatitis B Hepatitis B Info 70% of acute infections are subclinical More severe symptoms when in addition to other liver disease Fulminant Hepatitis

More information

disease going forward for the next 10 years and I'm sure all of you will see more and more of these

disease going forward for the next 10 years and I'm sure all of you will see more and more of these MANAGEMENT, JAIDEEP BEHARI, MD 1 So moving on from the viral hepatitis in the morning to what I think will be the most important liver disease going forward for the next 10 years and I'm sure all of you

More information

Identify presence of elevated liver enzymes in otherwise healthy patients in outpatient medicine

Identify presence of elevated liver enzymes in otherwise healthy patients in outpatient medicine Patrick Louis Brine September 27 th Associate Program Director SEHC IM Residency Assistant Professor Northeast Ohio Medical University Clinical Adjunct Professor Lake Erie College of Osteopathic Medicine

More information

Intracellular fat deposition

Intracellular fat deposition Who Gets Alcoholic Liver Disease? Chris Day Newcastle University Alcoholic Fatty Liver (Steatosis) Fatty hepatocytes Intracellular fat deposition Alcoholic SteatoHepatitis (ASH) Fat deposits Inflammation

More information

Southern Derbyshire. Shared Care Pathology Guidelines. Abnormal Liver Function Tests (LFTs) in Adults

Southern Derbyshire. Shared Care Pathology Guidelines. Abnormal Liver Function Tests (LFTs) in Adults Southern Derbyshire Shared Care Pathology Guidelines Abnormal Liver Function Tests (LFTs) in Adults Purpose of Guideline The management of patients with abnormal liver function test results Scope This

More information

HCC: Risk factors, surveillance and the importance of a multidisciplinary team

HCC: Risk factors, surveillance and the importance of a multidisciplinary team HCC: Risk factors, surveillance and the importance of a multidisciplinary team Anjana Pillai MD Assistant Professor of Medicine Director, Emory University Hospital Liver Tumor Clinic Division of Digestive

More information

Evaluation and Prognosis of Patients with Cirrhosis

Evaluation and Prognosis of Patients with Cirrhosis Evaluation and Prognosis of Patients with Cirrhosis Marion G. Peters, MD John V. Carbone, MD, Endowed Chair Professor of Medicine Chief of Hepatology Research University of California San Francisco Recorded

More information

Management of hepatitis C: pre- and post-liver transplantation. Piyawat Komolmit Bangkok

Management of hepatitis C: pre- and post-liver transplantation. Piyawat Komolmit Bangkok Management of hepatitis C: pre- and post-liver transplantation Piyawat Komolmit Bangkok Liver transplantation and CHC Cirrhosis secondary to HCV is the leading cause of liver transplantation in the US

More information

OMG my LFT s! How to Interpret and Use Them. OMG my LFT s! OMG my LFT s!

OMG my LFT s! How to Interpret and Use Them. OMG my LFT s! OMG my LFT s! How to Interpret and Use Them René Romero, M.D. Clinical Director, Pediatric Hepatology CPG Gastroenterology, Hepatology and Nutrition Emory University School of Medicine Objectives Understand the anatomy

More information

PREVENTION OF HCC BY HEPATITIS C TREATMENT. Morris Sherman University of Toronto

PREVENTION OF HCC BY HEPATITIS C TREATMENT. Morris Sherman University of Toronto PREVENTION OF HCC BY HEPATITIS C TREATMENT Morris Sherman University of Toronto Pathogenesis of HCC in chronic hepatitis C Injury cirrhosis HCC Injury cirrhosis HCC Time The Ideal Study Prospective randomized

More information

Boehringer Ingelheim- sponsored Satellite Symposium. HCV Beyond the Liver

Boehringer Ingelheim- sponsored Satellite Symposium. HCV Beyond the Liver Boehringer Ingelheim- sponsored Satellite Symposium HCV Beyond the Liver HCV AS A METABOLIC MODIFIER: STEATOSIS AND INSULIN RESISTANCE Francesco Negro University Hospital of Geneva Switzerland Clinical

More information

Prevalence of alcohol consumption among Rheumatoid Arthritis patients on Methotrexate and impact on liver function tests

Prevalence of alcohol consumption among Rheumatoid Arthritis patients on Methotrexate and impact on liver function tests Prevalence of alcohol consumption among Rheumatoid Arthritis patients on Methotrexate and impact on liver function tests Christine Iannaccone, MPH, Michelle Frits, Jing Cui, PhD, Michael Weinblatt MD,

More information

IS VITAMIN E SAFE TO USE?

IS VITAMIN E SAFE TO USE? Vitamin E & Fatty Liver IS VITAMIN E SAFE TO USE? Nonalcoholic Fatty Liver Disease (NAFLD) & Nonalcoholic Steatohepatitis (NASH) Prevalence: 5.7-16.5% 57 5 in US Usually diagnosed in 40-60 y/o s Non-significant

More information

Liver Transplantation for Hepatocellular Carcinoma. John P. Roberts, MD Chief, Division of Transplant Service University of California, San Francisco

Liver Transplantation for Hepatocellular Carcinoma. John P. Roberts, MD Chief, Division of Transplant Service University of California, San Francisco Liver Transplantation for Hepatocellular Carcinoma John P. Roberts, MD Chief, Division of Transplant Service University of California, San Francisco Hepatocellular Carcinoma HCC is the 5th most common

More information

GT-020 Phase 1 Clinical Trial: Results of Second Cohort

GT-020 Phase 1 Clinical Trial: Results of Second Cohort GT-020 Phase 1 Clinical Trial: Results of Second Cohort July 29, 2014 NASDAQ: GALT www.galectintherapeutics.com 2014 Galectin Therapeutics inc. Forward-Looking Statement This presentation contains, in

More information

NAFLD Risk Factors. Classifications of Fatty Liver. Non Alcoholic Fatty Liver Disease (NAFLD) Definitions. Other Causes of hepatic steatosis 8/14/2016

NAFLD Risk Factors. Classifications of Fatty Liver. Non Alcoholic Fatty Liver Disease (NAFLD) Definitions. Other Causes of hepatic steatosis 8/14/2016 Beyond Obesity: The Spectrum of Nonalcoholic Fatty Liver Disease Normal Liver NAFLD Spectrum Fatty liver (Steatosis) Jamie Wolosin, MD Division of Gastroenterology Sharp Rees Stealy Medical Group Financial

More information

How can we best use MELD and Child-Pugh scores to assess the liver at baseline and during treatment of CHC and NASH?

How can we best use MELD and Child-Pugh scores to assess the liver at baseline and during treatment of CHC and NASH? How can we best use MELD and Child-Pugh scores to assess the liver at baseline and during treatment of CHC and NASH? Patrick S. Kamath, MD Division of Gastroenterology and Hepatology Mayo Clinic, College

More information

Cirrhosis and HCV. Jonathan Israel M.D.

Cirrhosis and HCV. Jonathan Israel M.D. Cirrhosis and HCV Jonathan Israel M.D. Outline Relationship of fibrosis and cirrhosisprevalence and epidemiology. Sequelae of cirrhosis Diagnosis of cirrhosis Effect of cirrhosis on efficacy of treatment

More information

Cirrhosis. An information guide

Cirrhosis. An information guide TO PROVIDE THE VERY BEST CARE FOR EACH PATIENT ON EVERY OCCASION Cirrhosis An information guide Cirrhosis What is cirrhosis? Cirrhosis is the result of long term, continuous damage to the liver and may

More information

Lamivudine for Patients with hronic Hepatitis B and Advanced Liver Disease. From : New England Journal of Medicine

Lamivudine for Patients with hronic Hepatitis B and Advanced Liver Disease. From : New England Journal of Medicine Lamivudine for Patients with hronic Hepatitis B and Advanced Liver Disease From : New England Journal of Medicine Volume 351:1521-1531, Number 15, Oct 7, 2004 馬 偕 紀 念 醫 院 一 般 內 科, 肝 膽 腸 胃 科 新 竹 分 院 陳 重

More information

Update on hepatitis C: treatment and care and future directions

Update on hepatitis C: treatment and care and future directions Update on hepatitis C: treatment and care and future directions Professor Greg Dore Viral Hepatitis Clinical Research Program, National Centre in HIV Epidemiology and Clinical Research, University of New

More information

Comparative Levels of ALT, AST, ALP and GGT in Liver associated Diseases

Comparative Levels of ALT, AST, ALP and GGT in Liver associated Diseases Available online at wwwpelagiaresearchlibrarycom European Journal of Experimental Biology, 2013, 3(2):280-284 ISSN: 2248 9215 CODEN (USA): EJEBAU Comparative Levels of ALT, AST, ALP and GGT in Liver associated

More information

Liver Enzymes. AST and ALT (Transaminases)

Liver Enzymes. AST and ALT (Transaminases) Liver Enzymes Four separate liver enzymes are included on most routine laboratory tests. They are- aspartate aminotransferase (AST or SGOT) and alanine aminotransferase (ALT or SGPT), which are known together

More information

Executive summary of recommendations

Executive summary of recommendations MOH CLINICAL PRACTICE GUIDELINES 2/2011 Chronic Hepatitis B Infection College of Family Physicians, Singapore Academy of Medicine, Singapore Singapore Medical Association Executive summary of recommendations

More information

Review: How to work up your patient with Hepatitis C

Review: How to work up your patient with Hepatitis C Review: How to work up your patient with Hepatitis C You screened your patient, and now the HCV antibody test is positive. What do you do next? The antibody test only means they have been exposed to HCV.

More information

Assessment of some biochemical tests in liver diseases

Assessment of some biochemical tests in liver diseases Assessment of some biochemical tests in liver diseases By Prof. Mohamed Sharaf-Eldin Prof. of Hepatology & Gastroenterology Faculty of Medicine Tanta University, Egypt. Significant liver damage may occur

More information

The economic cost and health burden of liver diseases in Australia. The Gastroenterological Society of Australia/Australian Liver Association

The economic cost and health burden of liver diseases in Australia. The Gastroenterological Society of Australia/Australian Liver Association The economic cost and health burden of liver diseases in Australia The Gastroenterological Society of Australia/Australian Liver Association January 2013 Contents Glossary of acronyms... i Executive summary...

More information

Liver Cancer and Clinical Trials

Liver Cancer and Clinical Trials Liver Cancer and Clinical Trials Abby Siegel MD, MS Medical Director, Hepatobiliary Oncology Columbia University Medical Center Tony Wang MD Assistant Professor, Radiation Oncology, Columbia University

More information

Hepatitis C Infections in Oregon September 2014

Hepatitis C Infections in Oregon September 2014 Public Health Division Hepatitis C Infections in Oregon September 214 Chronic HCV in Oregon Since 25, when positive laboratory results for HCV infection became reportable in Oregon, 47,252 persons with

More information

HIV and Hepatitis Co-infection. Martin Fisher Brighton and Sussex University Hospitals, UK

HIV and Hepatitis Co-infection. Martin Fisher Brighton and Sussex University Hospitals, UK HIV and Hepatitis Co-infection Martin Fisher Brighton and Sussex University Hospitals, UK Useful References British HIV Association 2010 http://www.bhiva.org/documents/guidelines/hepbc/2010/ hiv_781.pdf

More information

2014 Fatty Liver Disease

2014 Fatty Liver Disease 2014 Fatty Liver Disease Fatty Liver Disease Fatty liver disease happens when there is a buildup of extra fat cells in the liver. A liver is fatty when fat makes up 5-10% of the liver. Simple fatty liver

More information

The following should be current within the past 6 months:

The following should be current within the past 6 months: EVALUATION Baseline Labs Obtain at time or prior to initial evaluation CBC with diff PT/INR CMP HCV Genotype (obtained PRIOR TO consult visit) HCV RNA (obtained PRIOR TO consult visit) Hep A IgG Hep BsAg,

More information

Central Florida Research Update

Central Florida Research Update Central Florida Research Update Ayala, Julio, PhD, Sanford-Burnham Medical Research Institute, Orlando, Florida Anorectic Mechanisms of Glp1r Agonists Obesity Jan 1, 2014 Dec 31, 2018 Integrated Physiology,

More information

Determinants of Abnormal Liver Function Tests in Diabetes Patients in Myanmar

Determinants of Abnormal Liver Function Tests in Diabetes Patients in Myanmar International Journal of Diabetes Research 2012, 1(3): 36-41 DOI: 10.5923/j.diabetes.20120103.02 Determinants of Abnormal Liver Function Tests in Diabetes Patients in Myanmar Han Ni 1,*, Htoo Htoo Kyaw

More information

A 55 year old man with cirrhosis due to chronic hepatitis C (CHC) genotype 3a is referred for liver transplantation.

A 55 year old man with cirrhosis due to chronic hepatitis C (CHC) genotype 3a is referred for liver transplantation. A 55 year old man with cirrhosis due to chronic hepatitis C (CHC) genotype 3a is referred for liver transplantation. Three years ago he was treated with 24 weeks of peginterferon alfa-2a (180 µg/wk, PEGIFN)

More information

What's the Best Approach to Evaluate the Liver Mass?

What's the Best Approach to Evaluate the Liver Mass? WHAT IS THE BEST WAY TO EVALUATE THE LIVER MASS? Mitchell L Shiffman, MD Chief, Hepatology Section Virginia Commonwealth University Medical Center Richmond, VA LIVER MASSES DISCOVERY AND SIGNIFICANCE Incidental

More information

Gall Bladder Disease CP1 Handout

Gall Bladder Disease CP1 Handout Gall Bladder Disease CP1 Handout List the common types of gallstones and describe the pathophysiology involved in their formation. 1. 2. 3. Pathophysiology available from osmosis youtube gallstone google

More information

HEPATOLOGY CLERKSHIP

HEPATOLOGY CLERKSHIP College of Osteopathic Medicine HEPATOLOGY CLERKSHIP Office for Clinical Affairs 515-271-1629 FAX 515-271-1727 Elective Rotation General Description This elective rotation is a four (4) week introductory,

More information

Case Finding for Hepatitis B and Hepatitis C

Case Finding for Hepatitis B and Hepatitis C Case Finding for Hepatitis B and Hepatitis C John W. Ward, M.D. Division of Viral Hepatitis Centers for Disease Control and Prevention Atlanta, Georgia, USA Division of Viral Hepatitis National Center

More information

Liver function. coffee & health topics. Contents. Please see for recent updates on this topic. Page.

Liver function. coffee & health topics. Contents. Please see  for recent updates on this topic. Page. Contents coffee & health topics Intended for professional audiences Page 1 Summary 2 2 in Europe 2 3 Coffee consumption and liver function 3 4 Potential mechanisms 4 5 Conclusion 4 6 References 5 Please

More information

Abnormal Liver Test! by! George Vagujhelyi M.D.!

Abnormal Liver Test! by! George Vagujhelyi M.D.! Abnormal Liver Test! by! George Vagujhelyi M.D.! 1! Liver Enzymes! AST asparate aminotransferase! ALT alanine aminotransferase! Alkaline phosphatase! GGT Gamma-glytamyl transpeptidase! 5 -nucleosidase!

More information

Conveners: S. Bruno, C.M. Mastroianni

Conveners: S. Bruno, C.M. Mastroianni SESSIONE 2 Oral communications based on selected abstracts Conveners: S. Bruno, C.M. Mastroianni PNPLA3 variant is an independent predictor of severe steatosis in patients with chronic hepatitis C and

More information