Autoimmune Pancreatitis: When to suspect How to Diagnose and How to Treat

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Autoimmune Pancreatitis: When to suspect How to Diagnose and How to Treat"

Transcription

1 Autoimmune Pancreatitis: When to suspect How to Diagnose and How to Treat Suresh T. Chari, MD Head, Pancreas Interest Group Professor, Division of Gastroenterology & Hepatology Mayo Clinic College of Medicine, Rochester, MN AIP may be more than one disease! AIP subtypes: Type 1: Part of a systemic disease Histologic pattern (lymphoplasmacytic sclerosing pancreatitis (LPSP)) Type 2: Pancreas specific Histologic pattern (idiopathic duct centric pancreatitis) Am J GE Sept 2009 Type 1 AIP-Definition AIP is a systemic disease which afflicts not only the pancreas but also a variety of other organs including bile duct, salivary glands, the retroperitoneum and lymph nodes. Organs affected by AIP have lymphoplasmacytic infiltration with abundant IgG4 positive cells. The inflammatory process responds to steroid therapy. 1

2 Some Facts about AIP AIP is uncommon Of 444 consecutive patients with suspected pancreatic disease only 18 (4%) had AIP AIP is a disease of older men: 80% >age 50 years 80% men AIP is a relatively painless disease despite being a form of chronic pancreatitis Unusual for pain of AIP to require long-term narcotics Five Cardinal Features of AIP The HISORt Features Histology: Lymphoplasmacytic sclerosing pancreatitis and a + ve IgG4 immunostain Imaging: Typical (50%) Diffuse sausage-shaped gland enlargement, delayed enhancement Others: Focal enlargement, normal Rare: Low-density mass/dilated pd Serology: Elevated serum IgG4 (75%) Other organ involvement: especially biliary strictures, retroperitoneal fibrosis, salivary gland involvement (50-67%) Response to steroid therapy (~100%) Note of caution re use of serum IgG4 to screen for AIP! 2

3 Scatterplot of Serum IgG4 in Study Groups (n= 467) Am J Gastroenterol 2007;102: If the pre-test probability of AIP is low, the chances are the elevation in IgG4 is a false positive! Look for the other HISORt criteria: If they are present it is more likely to be a true positive. When to suspect AIP? 3

4 Clinical Presentations of AIP Pancreatic Predominantly Extra-pancreatic Acute Post-acute/ Late Pancreatic Presentations Acute Obstructive jaundice/pancreatic mass: Majority (75%) Pancreatitis (25% have elevated enzymes + mild pain, 80% have jaundice/ LFT) Post Acute: Asymptomatic pancreatic mass Steatorrhea with pancreatic atrophy Painless calcific pancreatitis Acute Presentation 67 yo man with 2 week history of obstructive jaundice and 30 lb weight loss. Labs: Glucose 315 mg/dl, CA 19-9 of 350 U/ml EUS: Diffusely hypoechoic gland with?mass in the head, FNA -ve 4

5 Late or Post-acute Presentation 65 yo man, obstructive jaundice 7 months ago, currently asymptomatic after biliary stenting Late or Post-acute Presentation 79 y.o. man with steatorrhea x 9 mo,25 pound weight loss, stool fat: 100 gm/day Pre-dominantly Extra-pancreatic Presentation Biliary strictures resembling those due to Pancreatic cancer Cholangiocarcinoma PSC Interstitial nephritis Retroperitoneal fibrosis Diffuse lymphadenopathy Sjogren s syndrome 5

6 Extra-pancreatic Presentation 70 yo man with steatorrhea and elevated liver enzymes referred for changes of P SC Extra-pancreatic Presentation 58 yo woman with steatorrhea x 2 yrs asymptomatic on enzyme replacement, presents with new renal failure Summary: Suspect AIP if. Patient presents with or has history of or has radiologic evidence of unexplained pancreatic disease Especially obstructive jaundice/pancreatic mass or Extra-pancreatic disease known to be associated with AIP 6

7 When not to suspect AIP Features of cancer: Narcotic requiring pain Marked anorexia/cachexia Dilated pancreatic duct/pancreatic atrophy Recurrent pancreatitis without biliary involvement Very uncommon in AIP Dyspepsia with mildly elevated pancreatic enzymes How to diagnose AIP Challenges to diagnosing AIP Closely mimics other well known diseases So need high index of suspicion! Rare compared to the diseases it mimics 2-3% of those suspected to have pancreatic cancer No single test is diagnostic Histology diagnostic but rarely available in pancreas/bile duct Price of misdiagnosis heavy AIP mistaken for cancer can result in major surgery Cancer mistaken for AIP can result in delay in surgery 7

8 AIP can be diagnosed when patient has Diagnostic Histology (LPSP) post-resection or on core biopsy Typical imaging + serology, OOI or compatible histology Atypical imaging + serology/ooi/ compatible histology + response to steroids Avoid steroids without strong collateral evidence of AIP! A) Making the Diagnosis: Histology A 65 y.o. man with dyspeptic symptoms and weight loss B D S. IgG4:150 mg/dl A EUS guided biopsy + IgG4 stain B 8

9 A After steroid therapy B D B) Making the Diagnosis: Typical Imaging + Serology 67 yo man, new-onset diabetes, 30 lb weight loss, obstructive jaundice and CA 19-9 of 350 Serum IgG4: 1200 mg/dl Serial Changes in Pancreatic Morphology At presentation 8 weeks later 8 months later 9

10 C) Making the Diagnosis: Steroid Trial 70 yo man referred for P SC Serum IgG4: 870 mg/dl 12 weeks after steroid course 10

11 Word of caution regarding steroid trial It is not to be used as a substitute for a thorough search for etiology Do not use it if there is no objective way to define response Treatment of AIP What do steroids accomplish? Steroids resolve inflammation AIP is a fibro-inflammatory disease, fibrosis may leave a scarred, atrophic organ Rapid decrease in inflammation can be diagnostic and reassuring Confirms that other organ involvement was due to same process Not sure it preserves pancreatic function 11

12 Steroid therapy Initial Treatment Regimen Most common regimen Prednisone 40 mg/day X 4 weeks Taper by 5 mg/week thereafter Rapid taper not helpful in diagnosis or treatment Steroid therapy Follow-up Re-image in 4-6 weeks Serum IgG4, CA 19-9, Liver tests Response rapid Majority can have stents removed by 4-6 weeks CA 19-9 decreases IgG4 decrease with rx of AIP, but so does false +ve IgG4! Response to steroid therapy CT 3.5 weeks after initiating rx 12

13 Steroid Responsiveness Unresectable mass 6 weeks after steroids Resolution of Distal Biliary Stricture 6 weeks After 12 weeks of prednisone 13

14 Relapse Following Steroid Treatment In up to 60%, during steroid taper or after Mostly within 3 years of presentation Could occur in the pancreas or another organ (usually bile duct) Proximal extra-hepatic or intrahepatic strictures predict relapse Normalization of IgG4 after withdrawal of steroids predicts low relapse rate Maintenance Rx Who should receive maintenance rx? Use in all vs wait for one relapse Which drugs can maintain remission? Low-dose steroids (10 mg/day) Azathioprine (2mg/kg) Mycophenalate mofetil (750 mg bid) How long? months Maintenance Rx How to monitor? CBC, liver enzymes every 3 months Relapses 25% on maintenance rx Respond to steroids? Change rx or give another steroid course and remain on same immunosuppression 14

15 Summary AIP is a multisystem disease with protean manifestations HISORt criteria can help diagnose AIP Manifestations respond to steroid therapy Relapses are common, may need long term maintenance rx 15

Autoimmune pancreatitis. Lars Aabakken Oslo University Hospital - Rikshospitalet Oslo, Norway

Autoimmune pancreatitis. Lars Aabakken Oslo University Hospital - Rikshospitalet Oslo, Norway Autoimmune pancreatitis Lars Aabakken Oslo University Hospital - Rikshospitalet Oslo, Norway Autoimmune pancreatitis Concept introduced in 1961 (Sarles) Re-invented in Japan 1995 (Yoshida) Increasingly

More information

A Case of IgG4-Related Disease with Cutaneous Manifestations

A Case of IgG4-Related Disease with Cutaneous Manifestations A Case of IgG4-Related Disease with Cutaneous Manifestations Ashley E. Sutherland 1, Peter J. Green 1, and Thai Yen Ly 2 Division of Clinical Dermatology and Cutaneous Science 1 and Department of Pathology

More information

Chronic pancreatitis Questions and answers. Dr. med. Bruno Strebel

Chronic pancreatitis Questions and answers. Dr. med. Bruno Strebel Chronic pancreatitis Questions and answers Dr. med. Bruno Strebel Question 1: Chronic pancreatitis What is the definition of chronic pancreatitis? Chronic pancreatitis Questions and answers 2 Question

More information

Chronic Pancreatitis

Chronic Pancreatitis Chronic Pancreatitis Dhiraj Yadav, MD MPH Associate Professor Division of Gastroenterology & Hepatology University of Pittsburgh Medical Center August 18, 2013 Acute Pancreatitis Acute Inflammatory condition

More information

Management of Bile Duct Problems Treatment Overview

Management of Bile Duct Problems Treatment Overview Management of Bile Duct Problems Treatment Overview Bile Duct Obstruction Bile duct (or biliary) obstruction occurs for numerous reasons. Causes can include cancerous and non-cancerous processes as well

More information

Liver Cancer What is the liver? What is liver cancer?

Liver Cancer What is the liver? What is liver cancer? Liver Cancer What is the liver? The liver is the largest internal organ in the body and is important in digesting food. The liver performs many other functions, including collecting and filtering blood

More information

Early Colonoscopy in Patients with Acute Diverticulitis Simon Bar-Meir, M.D.

Early Colonoscopy in Patients with Acute Diverticulitis Simon Bar-Meir, M.D. Early Colonoscopy in Patients with Acute Diverticulitis Simon Bar-Meir, M.D. Professor of Medicine Germanis Kaufman Chair of Gastroenterology Director, Dept. of Gastroenterology Chaim Sheba Medical Center,

More information

WHAT S WRONG WITH MY GALL BLADDER? GALL BLADDER POLYPS

WHAT S WRONG WITH MY GALL BLADDER? GALL BLADDER POLYPS WHAT S WRONG WITH MY GALL BLADDER? GALL BLADDER POLYPS This is a patient information booklet providing specific practical information about gall bladder polyps in brief. Its aim is to provide the patient

More information

Bile Duct Diseases and Problems

Bile Duct Diseases and Problems Bile Duct Diseases and Problems Introduction A bile duct is a tube that carries bile between the liver and gallbladder and the intestine. Bile is a substance made by the liver that helps with digestion.

More information

Autoimmune Hepatitis

Autoimmune Hepatitis Autoimmune Hepatitis National Digestive Diseases Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What is autoimmune hepatitis? Autoimmune hepatitis

More information

To Whipple or Not to Whipple, that is the Question: Evaluating the Resectability of Pancreatic Adenocarcinoma

To Whipple or Not to Whipple, that is the Question: Evaluating the Resectability of Pancreatic Adenocarcinoma August 2009 To Whipple or Not to Whipple, that is the Question: Evaluating the Resectability of Pancreatic Adenocarcinoma Christina Ramirez, Harvard Medical School Year III Gillian Lieberman, MD Agenda

More information

EVIDENCE BASED TREATMENT OF CROHN S DISEASE. Dr E Ndabaneze

EVIDENCE BASED TREATMENT OF CROHN S DISEASE. Dr E Ndabaneze EVIDENCE BASED TREATMENT OF CROHN S DISEASE Dr E Ndabaneze PLAN 1. Case presentation 2. Topic on Evidence based Treatment of Crohn s disease - Introduction pathology aetiology - Treatment - concept of

More information

Amylase and Lipase Tests

Amylase and Lipase Tests Amylase and Lipase Tests Also known as: Amy Formal name: Amylase Related tests: Lipase The Test The blood amylase test is ordered, often along with a lipase test, to help diagnose and monitor acute or

More information

Understanding. Pancreatic Cancer

Understanding. Pancreatic Cancer Understanding Pancreatic Cancer Understanding Pancreatic Cancer The Pancreas The pancreas is an organ that is about 6 inches long. It s located deep in your belly between your stomach and backbone. Your

More information

Pancreatic Pseudocysts. Eric Rellinger October 3, 2012 Vanderbilt General Surgery

Pancreatic Pseudocysts. Eric Rellinger October 3, 2012 Vanderbilt General Surgery Pancreatic Pseudocysts Eric Rellinger October 3, 2012 Vanderbilt General Surgery Overview - Pancreatitis (Acute, Necrotizing, Chronic) - Pancreatic Pseudocysts - Clinical Presentation - Diagnostic Evaluation

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

Celiac Disease. Donald Schoch, M.D. Ohio ACP Meeting October 17, 2014

Celiac Disease. Donald Schoch, M.D. Ohio ACP Meeting October 17, 2014 Celiac Disease Donald Schoch, M.D. Ohio ACP Meeting October 17, 2014 None to disclose Conflicts of Interest Format Present a case Do a pretest about the evaluation Review case Discuss the questions & answers

More information

Small Intestine Cancer

Small Intestine Cancer Small Intestine Cancer What is the Small Intestine? The small intestine, also called the small bowel, is part of the body s gastrointestinal tract or digestive system. Its jobs are to: Break down food

More information

Tumour Markers. What are Tumour Markers? How Are Tumour Markers Used?

Tumour Markers. What are Tumour Markers? How Are Tumour Markers Used? Dr. Anthony C.H. YING What are? Tumour markers are substances that can be found in the body when cancer is present. They are usually found in the blood or urine. They can be products of cancer cells or

More information

Clinical management of autoimmune pancreatitis

Clinical management of autoimmune pancreatitis Advances in Medical Sciences Vol. 52 2007 Clinical management of autoimmune pancreatitis 61 Clinical management of autoimmune pancreatitis Kamisawa T 1 *, Satake K 2 1 Department of Internal Medicine,

More information

Teriflunomide (Aubagio) 14mg once daily tablet

Teriflunomide (Aubagio) 14mg once daily tablet Teriflunomide (Aubagio) 14mg once daily tablet Exceptional healthcare, personally delivered Your Consultant Neurologist has suggested that you may benefit from treatment with Teriflunomide. The decision

More information

Pancreatic Cancer Information for patients and their families

Pancreatic Cancer Information for patients and their families Pancreatic Cancer Information for patients and their families This handout answers common questions that are often asked by our patients and families. The information in this booklet is what we talked

More information

Systemic Lupus Erythematosus

Systemic Lupus Erythematosus Harvard-MIT Division of Health Sciences and Technology HST.021: Musculoskeletal Pathophysiology, IAP 2006 Course Director: Dr. Dwight R. Robinson Systemic Lupus Erythematosus A multi-system autoimmune

More information

Rheumatology Labs for Primary Care Providers. Robert Monger, M.D., F.A.C.P. 2015 Frontiers in Medicine

Rheumatology Labs for Primary Care Providers. Robert Monger, M.D., F.A.C.P. 2015 Frontiers in Medicine Rheumatology Labs for Primary Care Providers Robert Monger, M.D., F.A.C.P. 2015 Frontiers in Medicine Objectives Review the Indications for and Interpretation of lab testing for the following diseases:

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

IMMUNOLOGICAL AND DIABETOLOGICAL FEATURES OF CHRONIC PANCREATITIS. Ph.D. Thesis. Viktória Terzin, M.D.

IMMUNOLOGICAL AND DIABETOLOGICAL FEATURES OF CHRONIC PANCREATITIS. Ph.D. Thesis. Viktória Terzin, M.D. IMMUNOLOGICAL AND DIABETOLOGICAL FEATURES OF CHRONIC PANCREATITIS Ph.D. Thesis Viktória Terzin, M.D. First Department of Medicine, University of Szeged Szeged, Hungary 2012 1 CONTENTS ABBREVIATIONS...

More information

1. What is the prostate-specific antigen (PSA) test?

1. What is the prostate-specific antigen (PSA) test? 1. What is the prostate-specific antigen (PSA) test? Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. The PSA test measures the level of PSA in the blood. The doctor

More information

Nicole Kounalakis, MD

Nicole Kounalakis, MD Breast Disease: Diagnosis and Management Nicole Kounalakis, MD Assistant Professor of Surgery Goal of Breast Evaluation The goal of breast evaluation is to classify findings as: normal physiologic variations

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

UCLA Asian Liver Program

UCLA Asian Liver Program CLA Program Update Program Faculty Myron J. Tong, PhD, MD Professor of Medicine Hepatology Director, Asian Liver Program Surgery Ronald W. Busuttil, MD, PhD Executive Chair Department of Surgery Director,

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

ELEMENTS FOR A PUBLIC SUMMARY. Overview of disease epidemiology. Summary of treatment benefits

ELEMENTS FOR A PUBLIC SUMMARY. Overview of disease epidemiology. Summary of treatment benefits VI: 2 ELEMENTS FOR A PUBLIC SUMMARY Bicalutamide (CASODEX 1 ) is a hormonal therapy anticancer agent, used for the treatment of prostate cancer. Hormones are chemical messengers that help to control the

More information

800-475-6473. www.sjogrens.org. www.sjogrens.org

800-475-6473. www.sjogrens.org. www.sjogrens.org S j ö g r e n s F a s t F a c t s l The hallmark symptoms of Sjögren s syndrome are dry eyes and dry mouth. l Sjögren s is one of the most prevalent autoimmune disorders, striking as many as 4,000,000

More information

Pancreatic Cancer. The Killer that must be discovered early. Dr Alfred Kow Wei Chieh

Pancreatic Cancer. The Killer that must be discovered early. Dr Alfred Kow Wei Chieh Pancreatic Cancer The Killer that must be discovered early 27 th June 2015 Dr Alfred Kow Wei Chieh Consultant Department of Surgery Division of HPB Surgery & Liver Transplantation & Assistant Dean (Education)

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

SARCOIDOSIS. Signs and symptoms associated with specific organ involvement can include the following:

SARCOIDOSIS. Signs and symptoms associated with specific organ involvement can include the following: SARCOIDOSIS Sarcoidosis is a disease that occurs when areas of inflammation develop in different organs of the body. Very small clusters of inflammation, called granulomas, are seen with sarcoidosis. They

More information

Gallbladder cancer is a disease in which malignant (cancer) cells form in the tissues of the gallbladder.

Gallbladder cancer is a disease in which malignant (cancer) cells form in the tissues of the gallbladder. Gallbladder cancer Gallbladder cancer is a disease in which malignant (cancer) cells form in the tissues of the gallbladder. Gallbladder cancer is a rare disease in which malignant (cancer) cells are found

More information

Pancreatic Cancer Understanding your diagnosis

Pancreatic Cancer Understanding your diagnosis Pancreatic Cancer Understanding your diagnosis Let s Make Cancer History 1 888 939-3333 cancer.ca Pancreatic Cancer Understanding your diagnosis When you first hear that you have cancer you may feel alone

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 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

Renovascular Hypertension

Renovascular Hypertension Renovascular Hypertension Philip Stockwell, MD Assistant Professor of Medicine (Clinical) Warren Alpert School of Medicine Cardiology for the Primary Care Provider September 28, 201 Renovascular Hypertension

More information

and Helicobacter pylori

and Helicobacter pylori Family Practice Oncology Network Upper Gastrointestinal Cancer (Suspected) Part 2 External Review Effective Date: TBD SCOPE: Part 2 of this guideline outlines recommendations for the prevention, screening,

More information

Pancreatitis: scope workshop discussions Group 1 Date: 14 June 2016

Pancreatitis: scope workshop discussions Group 1 Date: 14 June 2016 Pancreatitis: scope workshop discussions Group 1 1.1. Who is the focus: The DH remit is for the diagnosis and management of Paediatrics: Very rare instances of chronic pancreatitis as the child would not

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

Sjögren s Fast Facts.

Sjögren s Fast Facts. Sjögren s Fast Facts l Sjögren s is pronounced SHOW-grins. l The hallmark symptoms of Sjögren s syndrome are dry eyes, dry mouth, fatigue and joint pain, but the disease is systemic, affecting the entire

More information

LYMPHOMA IN DOGS. Diagnosis/Initial evaluation. Treatment and Prognosis

LYMPHOMA IN DOGS. Diagnosis/Initial evaluation. Treatment and Prognosis LYMPHOMA IN DOGS Lymphoma is a relatively common cancer in dogs. It is a cancer of lymphocytes (a type of white blood cell) and lymphoid tissues. Lymphoid tissue is normally present in many places in the

More information

CHAPTER 11 DISEASES OF THE DIGESTIVE SYSTEM (K00-K95) April MVP Health Care, Inc.

CHAPTER 11 DISEASES OF THE DIGESTIVE SYSTEM (K00-K95) April MVP Health Care, Inc. DISEASES OF THE DIGESTIVE SYSTEM (K00-K95) April 2014 2014 MVP Health Care, Inc. CHAPTER SPECIFIC CATEGORY CODE BLOCKS K00-K14 Diseases of oral cavity and salivary glands K20-K31 Diseases of esophagus,

More information

Thymus Cancer. This reference summary will help you better understand what thymus cancer is and what treatment options are available.

Thymus Cancer. This reference summary will help you better understand what thymus cancer is and what treatment options are available. Thymus Cancer Introduction Thymus cancer is a rare cancer. It starts in the small organ that lies in the upper chest under the breastbone. The thymus makes white blood cells that protect the body against

More information

An overview of CLL care and treatment. Dr Dean Smith Haematology Consultant City Hospital Nottingham

An overview of CLL care and treatment. Dr Dean Smith Haematology Consultant City Hospital Nottingham An overview of CLL care and treatment Dr Dean Smith Haematology Consultant City Hospital Nottingham What is CLL? CLL (Chronic Lymphocytic Leukaemia) is a type of cancer in which the bone marrow makes too

More information

Hodgkin Lymphoma Disease Specific Biology and Treatment Options. John Kuruvilla

Hodgkin Lymphoma Disease Specific Biology and Treatment Options. John Kuruvilla Hodgkin Lymphoma Disease Specific Biology and Treatment Options John Kuruvilla My Disclaimer This is where I work Objectives Pathobiology what makes HL different Diagnosis Staging Treatment Philosophy

More information

Autoimmune pancreatitis (AIP) is an unique form

Autoimmune pancreatitis (AIP) is an unique form Original Article / Pancreas Hepatobiliary & Pancreatic Diseases International Diagnosis and treatment of autoimmune pancreatitis: experience with 100 patients Lei Xin, Yuan-Xiang He, Xiao-Fei Zhu, Qun-Hua

More information

Sybile Val, MD Department of Surgery. October 29, 2009

Sybile Val, MD Department of Surgery. October 29, 2009 Soft Tissue Tumors Sybile Val, MD Department of Surgery SUNY Downstate Medical Center October 29, 2009 Case Presentation 52 YOM presented to ED on 7/22 with 52 YOM presented to ED on 7/22 with abdominal

More information

Benign Breast Disorders

Benign Breast Disorders Benign Breast Disorders Valerie Swiatkowski, MD Medical Student Lecture Introduction 16% of women ages 40-69 will seek advice from their physician regarding breast complaints over 10 years. Failure to

More information

Geir Folvik, MD Division of Gastroenterology Department of Medicine, Haukeland University Hospital Bergen, Norway 30.11.2015

Geir Folvik, MD Division of Gastroenterology Department of Medicine, Haukeland University Hospital Bergen, Norway 30.11.2015 Benign liver diseases Geir Folvik, MD Division of Gastroenterology Department of Medicine, Haukeland University Hospital Bergen, Norway 30.11.2015 1 Agenda Benign focal liver lesions Fatty liver disease

More information

Update on Hepatitis C. Sally Williams MD

Update on Hepatitis C. Sally Williams MD Update on Hepatitis C Sally Williams MD Hep C is Everywhere! Hepatitis C Magnitude of the Infection Probably 8 to 10 million people in the U.S. are infected with Hep C 30,000 new cases are diagnosed annually;

More information

Kidney Cancer OVERVIEW

Kidney Cancer OVERVIEW Kidney Cancer OVERVIEW Kidney cancer is the third most common genitourinary cancer in adults. There are approximately 54,000 new cancer cases each year in the United States, and the incidence of kidney

More information

INITIATING ORAL AUBAGIO (teriflunomide) THERAPY

INITIATING ORAL AUBAGIO (teriflunomide) THERAPY FOR YOUR PATIENTS WITH RELAPSING FORMS OF MS INITIATING ORAL AUBAGIO (teriflunomide) THERAPY WARNING: HEPATOTOXICITY AND RISK OF TERATOGENICITY Severe liver injury including fatal liver failure has been

More information

Regional Health Care Education Presentation Topics

Regional Health Care Education Presentation Topics Division of Gastroenterology and Hepatology Mayo Clinic, Rochester, MN Regional Health Care Education Presentation Topics Contact: For more information and to plan a presentation, please contact Joyce

More information

Hepatitis E virus and chronic hepatitis in organ-transplant recipients

Hepatitis E virus and chronic hepatitis in organ-transplant recipients Hepatitis E virus and chronic hepatitis in organ-transplant recipients Nassim Kamar MD, PhD Department of Nephrology, Dialysis and Multi-Organ Transplantation Toulouse University Hospital Antwerp, 13/3/2009

More information

ON NOT Associated with MS

ON NOT Associated with MS ON NOT Associated with MS Neuromyelitis optica (NMO, Devic s disease) Acute disseminated encephalomyelitis (ADEM) Chronic relapsing inflammatory optic neuropathy (CRION) Post-vaccination-associated optic

More information

Autoimmune Hepatitis/ Autoimmune Pancreatitis. Edmund Krasinski, Jr., D.O. F.A.C.G.

Autoimmune Hepatitis/ Autoimmune Pancreatitis. Edmund Krasinski, Jr., D.O. F.A.C.G. Autoimmune Hepatitis/ Autoimmune Pancreatitis Edmund Krasinski, Jr., D.O. F.A.C.G. Assessment of Liver Function Which of the following is not a good biochemical assessor of hepatic function? A) Serum bilirubin

More information

Salivary Gland Disorders

Salivary Gland Disorders Salivary Gland Disorders Introduction Located in your mouth and throat, the salivary glands make saliva. Saliva is the watery fluid in the mouth. There are many problems that can affect the salivary glands.

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

Pancreatic Cancer Basics. Meghan McGurk, PA-C, MMSc Physician Assistant Department of Medical Oncology Yale Cancer Center

Pancreatic Cancer Basics. Meghan McGurk, PA-C, MMSc Physician Assistant Department of Medical Oncology Yale Cancer Center Pancreatic Cancer Basics Meghan McGurk, PA-C, MMSc Physician Assistant Department of Medical Oncology Yale Cancer Center Case Study Mr.T is a 36 yo male who presented in the fall of 2003, at the age of

More information

Pathway for the Management of Acute Gallstone Diseases

Pathway for the Management of Acute Gallstone Diseases Pathway for the Management of Acute Gallstone Diseases What s in this document? Pathways to encourage safer, faster and more cost effective management of acute gallstone (GS) disease by stratification

More information

Renal Cancer: Symptoms, diagnosis, pathology & prognosis

Renal Cancer: Symptoms, diagnosis, pathology & prognosis Renal Cancer: Symptoms, diagnosis, pathology & prognosis Mark Johnson Consultant Urological Surgeon Newcastle upon Tyne Hospitals NHS Foundation Trust Plan for today: How renal tumours present What investigations

More information

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Multiple Technology Appraisal

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Multiple Technology Appraisal NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Multiple Technology Appraisal Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional

More information

Alcoholic Hepatitis (Teacher s Guide)

Alcoholic Hepatitis (Teacher s Guide) Thomas Ormiston, M.D. Updated 5/5/15 2007-2015, SCVMC Alcoholic Hepatitis (Teacher s Guide) (30 minutes) I. Objectives Recognize the signs and symptoms of alcoholic hepatitis Understand the treatment options

More information

Liver Diseases. An Essential Guide for Nurses and Health Care Professionals

Liver Diseases. An Essential Guide for Nurses and Health Care Professionals Brochure More information from http://www.researchandmarkets.com/reports/1047385/ Liver Diseases. An Essential Guide for Nurses and Health Care Professionals Description: Liver disease is a rapidly growing

More information

Jaundice. Michael Ornes

Jaundice. Michael Ornes Jaundice Michael Ornes Definitions Jaundice: hyperbilirubinemia leading to yellow discoloration of the skin Icterus: hyperbilirubinemia leading to yellow discoloration of the sclera Usually undetectable

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

Signs and symptoms of pancreatic cancer factsheet

Signs and symptoms of pancreatic cancer factsheet 1 Signs and symptoms of pancreatic cancer factsheet This fact sheet is for anyone who would like to find out more about the signs and symptoms of pancreatic. It contains information on the common symptoms

More information

Prostate Cancer Screening

Prostate Cancer Screening Prostate Cancer Screening Bruce L. Houghton, MD Associate Professor of Medicine Division of General Medicine Department of Internal Medicine Creighton University School of Medicine http://en.wikipedia.org/wiki/image:prostatelead.jpg

More information

Presumptive Cancers Due to Agent Orange Exposure & Cholangiocarcinoma (Bile Duct - Liver Fluke Cancer)

Presumptive Cancers Due to Agent Orange Exposure & Cholangiocarcinoma (Bile Duct - Liver Fluke Cancer) Presumptive Cancers Due to Agent Orange Exposure & Cholangiocarcinoma (Bile Duct - Liver Fluke Cancer) Presumptive Cancers Due to Agent Orange Exposure Prostate Cancer - Cancer of the prostate; one of

More information

GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER

GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER GUIDELINES FOR THE MANAGEMENT OF LUNG CANCER BY Ali Shamseddine, MD (Coordinator); as04@aub.edu.lb Fady Geara, MD Bassem Shabb, MD Ghassan Jamaleddine, MD CLINICAL PRACTICE GUIDELINES FOR THE TREATMENT

More information

Acute Pancreatitis. Questionnaire. if yes: amount (cigarettes/day): since when (year): Drug consumption: yes / no if yes: type of drug:. amount:.

Acute Pancreatitis. Questionnaire. if yes: amount (cigarettes/day): since when (year): Drug consumption: yes / no if yes: type of drug:. amount:. The physical examination has to be done AT ADMISSION! The blood for laboratory parameters has to be drawn AT ADMISSION! This form has to be filled AT ADMISSION! Questionnaire Country: 1. Patient personal

More information

Diagnosis and Prognosis of Pancreatic Cancer

Diagnosis and Prognosis of Pancreatic Cancer Main Page Risk Factors Reducing Your Risk Screening Symptoms Diagnosis Treatment Overview Chemotherapy Radiation Therapy Surgical Procedures Lifestyle Changes Managing Side Effects Talking to Your Doctor

More information

BILIARY TRACT DISORDERS, GALLBLADDER DISORDERS AND GALLSTONE PANCREATITIS

BILIARY TRACT DISORDERS, GALLBLADDER DISORDERS AND GALLSTONE PANCREATITIS BILIARY TRACT DISORDERS, GALLBLADDER DISORDERS AND GALLSTONE PANCREATITIS By Young Choi, M.D. & William B. Silverman, M.D. FACG Division of Gastroenterology / Hepatology University of Iowa Hospitals and

More information

Jaundice, icterus, hyperbilirubinemia Jaundice

Jaundice, icterus, hyperbilirubinemia Jaundice 1333 Plaza Blvd, Suite E, Central Point, OR 97502 * www.mountainview.net Jaundice, icterus, hyperbilirubinemia Jaundice Affected Animals: Any dog can develop jaundice. It is very unusual, however, to see

More information

LOCAL PRIMARY CARE GUIDELINES USE OF FAECAL CALPROTECTIN IN THE ASSESSMENT OF PATIENTS WITH LOWER GASTROINTESTINAL SYMPTOMS

LOCAL PRIMARY CARE GUIDELINES USE OF FAECAL CALPROTECTIN IN THE ASSESSMENT OF PATIENTS WITH LOWER GASTROINTESTINAL SYMPTOMS LOCAL PRIMARY CARE GUIDELINES USE OF FAECAL CALPROTECTIN IN THE ASSESSMENT OF PATIENTS WITH LOWER GASTROINTESTINAL SYMPTOMS Dr. James Turvill (MD FRCP) James Turvill, York NHSFT Page 1 14/01/2014 Directive

More information

Surgical Treatment of Various GI Tract Cancers

Surgical Treatment of Various GI Tract Cancers Surgical Treatment of Various GI Tract Cancers By James Ouellette, DO, FACS, Surgical Oncology, Hepatobiliary Surgery Surgical treatment for most gastrointestinal (GI) cancers requires multidisciplinary

More information

Open the Flood Gates Urinary Obstruction and Kidney Stones. Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke

Open the Flood Gates Urinary Obstruction and Kidney Stones. Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke Open the Flood Gates Urinary Obstruction and Kidney Stones Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke Nephrology vs. Urology Nephrologist a physician who has been trained in the diagnosis

More information

TransplantUpdate. A Report from the Annette C. and Harold C. Simmons Transplant Institute Volume 3 Number 2

TransplantUpdate. A Report from the Annette C. and Harold C. Simmons Transplant Institute Volume 3 Number 2 TransplantUpdate A Report from the Annette C. and Harold C. Simmons Transplant Institute Volume 3 Number 2 Recurrence of Hepatocellular Carcinoma Decreases in Last Decade 2 The recurrence of hepatocellular

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

Introduction Breast cancer is cancer that starts in the cells of the breast. Breast cancer happens mainly in women. But men can get it too.

Introduction Breast cancer is cancer that starts in the cells of the breast. Breast cancer happens mainly in women. But men can get it too. Male Breast Cancer Introduction Breast cancer is cancer that starts in the cells of the breast. Breast cancer happens mainly in women. But men can get it too. Many people do not know that men can get breast

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

Bone Basics National Osteoporosis Foundation 2013

Bone Basics National Osteoporosis Foundation 2013 When you have osteoporosis, your bones become weak and are more likely to break (fracture). You can have osteoporosis without any symptoms. Because it can be prevented and treated, an early diagnosis is

More information

BILE ACID SYNTHESIS AND METABOLISM DEFECTS

BILE ACID SYNTHESIS AND METABOLISM DEFECTS The Childhood Liver Disease Research Network strives to provide information and support to individuals and families affected by liver disease through its many research programs. BILE ACID SYNTHESIS AND

More information

Cystic Fibrosis. Cystic fibrosis affects various systems in children and young adults, including the following:

Cystic Fibrosis. Cystic fibrosis affects various systems in children and young adults, including the following: Cystic Fibrosis What is cystic fibrosis? Cystic fibrosis (CF) is an inherited disease characterized by an abnormality in the glands that produce sweat and mucus. It is chronic, progressive, and is usually

More information

Guideline for the Imaging of Patients Presenting with Breast Symptoms incorporating the guideline for the use of MRI in breast cancer

Guideline for the Imaging of Patients Presenting with Breast Symptoms incorporating the guideline for the use of MRI in breast cancer Guideline for the Imaging of Patients Presenting with Breast Symptoms incorporating the guideline for the use of MRI in breast cancer Version History Version Date Summary of Change/Process 0.1 09.01.11

More information

5.07.09. Aubagio. Aubagio (teriflunomide) Description

5.07.09. Aubagio. Aubagio (teriflunomide) Description Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.07.09 Subject: Aubagio Page: 1 of 6 Last Review Date: December 5, 2014 Aubagio Description Aubagio (teriflunomide)

More information

Many people with non-hodgkin lymphoma have found an educational support group helpful. Support

Many people with non-hodgkin lymphoma have found an educational support group helpful. Support Track 2: Treatment Options [Narrator] Many people with non-hodgkin lymphoma have found an educational support group helpful. Support groups take many forms: some meet the needs of people with all kinds

More information

Evidence of Crohn s Disease. Case Presentation

Evidence of Crohn s Disease. Case Presentation Witt Wait to Treat tutiled Until Endoscopic Evidence of Crohn s Disease Raymond Cross, MD, MS, AGAF Associate Professor of Medicine Director, IBD Program University of Maryland School of Medicine Co-Director,

More information

Greater Manchester and Cheshire HPB Unit Guidelines for the Assessment & Management of Hepatobiliary and Pancreatic Disease Chapter 4

Greater Manchester and Cheshire HPB Unit Guidelines for the Assessment & Management of Hepatobiliary and Pancreatic Disease Chapter 4 Greater Manchester and Cheshire HPB Unit Guidelines for the Assessment & Management of Hepatobiliary and Pancreatic Disease Chapter 4 Contents 4. Manchester Cancer Pathways 32 4.1. Manchester Cancer 33

More information

Less stress for you and your pet

Less stress for you and your pet Less stress for you and your pet Canine hyperadrenocorticism Category: Canine Cushing s disease, Cushing s syndrome Affected Animals: Although dogs of almost every age have been reported to have Cushing

More information

190.25 - Alpha-fetoprotein

190.25 - Alpha-fetoprotein Other Names/Abbreviations AFP 190.25 - Alpha-fetoprotein Alpha-fetoprotein (AFP) is a polysaccharide found in some carcinomas. It is effective as a biochemical marker for monitoring the response of certain

More information

Guide to Understanding Breast Cancer

Guide to Understanding Breast Cancer An estimated 220,000 women in the United States are diagnosed with breast cancer each year, and one in eight will be diagnosed during their lifetime. While breast cancer is a serious disease, most patients

More information

Hepatitis C Glossary of Terms

Hepatitis C Glossary of Terms Acute Hepatitis C A short-term illness that usually occurs within the first six months after someone is exposed to the hepatitis C virus (HCV). 1 Antibodies Proteins produced as part of the body s immune

More information

CME Test for AMDA Clinical Practice Guideline. Diabetes Mellitus

CME Test for AMDA Clinical Practice Guideline. Diabetes Mellitus CME Test for AMDA Clinical Practice Guideline Diabetes Mellitus Part I: 1. Which one of the following statements about type 2 diabetes is not accurate? a. Diabetics are at increased risk of experiencing

More information

Chronic Prostatitis: Patient information

Chronic Prostatitis: Patient information Chronic Prostatitis: Patient information There are two main types of chronic prostatitis - chronic bacterial prostatitis (caused by chronic bacterial infection) and chronic prostatitis/chronic pelvic pain

More information