Hepatitis - ECAB
Hepatitis - ECAB

Author: Abhijit Chowdhury

Publisher: Elsevier Health Sciences

Published: 2009-07-15

Total Pages: 138

ISBN-13: 8131231860

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Hepatitis means inflammation of the liver, which can be classified as acute or chronic depending upon the duration of the condition. Various etiological agents have been correlated with the occurrence of various forms of the disease. The developed countries have a majority of drug-induced and toxic liver injury, while the developing countries like India present with a majority of feco-oral and blood borne transmissions of the disease. Viral hepatitis virtually constitutes a separate etiological group. It causes a set of typical clinical, biochemical, and histological changes with or without icterus resulting from hepatic cell damage. It may be acute or chronic. The acute form causes considerable morbidity and mortality, and the chronic sequelae may prove to be fatal by resulting in liver cirrhosis and hepatocellular carcinoma (HCC). Hepatitis A and E are transmitted feco-orally, while B and C are transmitted only through blood/secretions. Hepatitis D occurs only in association with hepatitis B. Morphological pattern of liver injury in acute hepatitis varies with etiology and severity of insult. The typical lesion in all forms of acute viral hepatitis is panlobular infiltration with mononuclear cells, predominantly lymphocytes, hepatic cell necrosis, and variable degree of cholestasis, Kupffer cell hyperplasia. In fulminant hepatic failure, massive hepatic necrosis results in a soft shrunken liver. All forms of acute viral hepatitis run similar clinical course, which include incubation period after infection during which they are asymptomatic, followed by prodromal, icteric, and convalescent phases. Extrahepatic manifestations of viral hepatitis include renal, neurological, and hematological disorders. Most patients with acute viral hepatitis recover with supportive management. Hospitalization is required only in severe cases as evidenced by prolonged PT, altered sensorium, deep jaundice with ascites. Identification of etiology of acute hepatitis is of prime importance for the treatment of hepatitis. Definitive therapy is needed in drug-induced hepatitis. Most mild forms of viral hepatitis resolve with supportive treatment. Progressive liver failure mandates urgent liver transplantation. Prognostic models (Kings’ College criteria, Clichy’s criteria) have been developed for early identification of patients who would require liver transplant.

Hepatic Encephalopathy - ECAB
Hepatic Encephalopathy - ECAB

Author: Prabha Sawant

Publisher: Elsevier Health Sciences

Published: 2013-06-17

Total Pages: 104

ISBN-13: 8131231836

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Hepatic encephalopathy is the clinical syndrome resulting from increased ammonia levels in blood. The most common cause of HE is chronic liver disease. However, acute liver failure, Reye’s syndrome, or metabolic defects are other causes. The true prevalence of overt HE is difficult to establish because of the considerable heterogeneity in etiology and disease severity. However, HE has been reported to be present in around 50% of patients with cirrhosis or with porto-caval shunts at some time during their illness. It is less common in patients with portosystemic shunts without liver disease. Thirty percent of patients dying of end-stage liver disease experience significant encephalopathy, approaching coma. After TIPS placement, approximately 1/3 of patients will experience overt HE. Minimal HE (MHE) is difficult to diagnose due to lack of standard diagnostic tests. Its clinical significance with regards to progression to overt encephalopathy has however, not been established. Conventional treatment of hepatic encephalopathy relies primarily on reducing the production and absorption of ammonia. Identification and correction of the precipitating factors and general supportive measures are important management steps. There are very few randomized controlled trials (RCT) of therapies and even these are bugged by lack of a control group and small sample sizes.

Acute Pancreatitis - ECAB
Acute Pancreatitis - ECAB

Author: Pramod Kumar Garg

Publisher: Elsevier Health Sciences

Published: 2013-05-24

Total Pages: 282

ISBN-13: 8131231895

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Acute pancreatitis is defined as an acute inflammatory process of the pancreas that may also involve peripancreatic tissues and/or remote organ systems. It typically presents with sudden deep, boring pain that starts in the epigastrium and radiates to the back, which usually worsens on intake of food. It may be of varying severity ranging from mild to severe. Mild disease, if managed promptly and adequately resolves with minimal or no sequelae and seldom leads to extended morbidity or mortality. However Severe Acute Pancreatitis has a longer course of resolution, usually requires hospitalization and has a greater propensity to lead to adverse outcomes. As a thumb rule, it has greater morbidity and mortality rates as compared to Mild Acute Pancreatitis. Understandably, the management protocol for the severe acute pancreatitis is more invasive and emergent, and may require intensive care management. Hence understanding and assessment of the condition in the first 48 hours is a critical step in deciding the outcome. The various assessment criteria that are used to prognosticate and plan the management for this disease have been discussed in this clinical update. Previously, the condition was thought to be caused by infection, but now it is an established fact that it is an acute inflammation of the pancreatic gland with activation of the pancreatic enzymes within the gland leading to its autodigestion. Previously, acute pancreatitis was considered to be mostly associated with chronic alcohol abuse or acute bouts of binge drinking. With the availability of data from recent studies in India and the Asian subcontinent, Biliary disease is emerging as the commonest etiological agent. Extensive genetic analysis and mapping have helped put a cause to the erstwhile "idiopathic" cases. Newer diagnostic modalities and minimal invasive procedures have made the conventional surgeries nearly obsolete now. The rationale and use of antimicrobial treatment in the medical management of the condition has also undergone a change. This clinical update has been designed to update the readers on the important aspects of Acute Pancreatitis. The book has stressed upon various aspects of the condition like the etiology, pathogenesis, diagnosis and evaluation along with an insight into the management approach of the patient including the supportive and nutritional management. Overall, the book presents to the readers an excellent compilation of clinically applicable literature sourced from the most acclaimed physicians in the country.

Non-Alcoholic Fatty Liver Disease - ECAB
Non-Alcoholic Fatty Liver Disease - ECAB

Author: Sudeep Khanna

Publisher: Elsevier Health Sciences

Published: 2013-04-15

Total Pages: 142

ISBN-13: 8131231909

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Non-alcoholic fatty liver disease is a common cause of chronic liver disease, and its incidence is rising worldwide. Understanding its pathogenesis, biochemical parameters, histological grading and staging, and its management is a vital issue in today’s clinical practice. It appears to be linked directly to the growing epidemic of obesity in adults as well as in children. Thus, in a sense, NAFLD is a self-inflicted liver disease, much like alcoholic liver disease. The exact causes responsible for the development of NAFLD have not been established yet. However, some researchers consider that cluster of disorders that increases the risk of developing heart disease, diabetes, and stroke may be the factor behind development of NAFLD. Most patients with NAFLD have no symptoms or signs of liver disease at the time of diagnosis. In these patients, abnormal liver function tests are often discovered incidentally. Non-alcoholic steatohepatitis (NASH) is that stage of the spectrum that involves fat accumulation (steatosis), inflammation (hepatitis), and scarring (fibrosis) in the liver. Those who have fatty liver or hepatic steatosis with non-specific inflammation as fatty liver with non-specific inflammation generally have a benign longterm prognosis, whereas those who have NASH can progress to cirrhosis. NASH-related cirrhosis may have similar prognosis as cirrhosis from other causes. Hepatocellular carcinoma (HCC) is part of the spectrum of NAFLD, and screening for HCC seems reasonable in patients who have NASH-related cirrhosis. No established treatment is available for NAFLD. Some empiric treatment strategies have been suggested. Presumably, weight loss through exercise and diet modification along with insulinsensitizing agents will help reverse fatty infiltration of the liver. Its incidence is reportedly on the rise the world over as well as in India. Realizing its significance, there is now greater understanding of its etiology, pathogenesis, and management. The efforts of Elsevier have been directed toward addressing these aspects. Elsevier has thus pooled its existing resources with those of the internationally acclaimed Gastroenterologists of India who have chosen to share their rich clinical knowledge, experience, and expertize to serve the practitioners and patient community.

Alcoholic Liver Disease - ECAB
Alcoholic Liver Disease - ECAB

Author: Philip Abraham

Publisher: Elsevier Health Sciences

Published: 2009-09-15

Total Pages: 168

ISBN-13: 8131231844

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Alcoholic liver disease involves an acute or chronic inflammation of liver occurring as a consequence of alcohol abuse. The pathological changes occur in 3 stages namely, fatty liver, alcoholic liver disease and cirrhosis, with the final stage traditionally considered to be irreversible. Alcoholic liver disease is responsible for a significant number of premature deaths per annum all around the globe. There is an urgent need to educate the masses about the hazards of alcohol abuse. An efficient system to encourage and prolong the period of alcohol abstinence is the need of the hour. The importance of lifestyle modifications like weight reduction and cessation of smoking in the progression of liver disease needs to be communicated to the patients and the medical community as well. Moreover, realization of the role of nutrition in the management and recovery of ALD would enhance the treatment strategies for this condition. This book has been designed to update the readers on the important aspects of ALD and is a step forward to enable the society in combating the social and economic losses that occur as a result of alcohol abuse. The book has stressed upon various aspects of ALD like the role of nutrition, epidemiology and pathogenesis, and the possible therapeutic strategies involved. Supportive case scenarios have also been incorporated with relevance to the topics covered under the book. Overall, the book presents to the readers an excellent compilation of clinically applicable literature sourced from the most acclaimed physicians in the country.

Chronic Pancreatitis - ECAB
Chronic Pancreatitis - ECAB

Author: Pramod Kumar Garg

Publisher: Elsevier Health Sciences

Published: 2013-06-17

Total Pages: 222

ISBN-13: 8131231887

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Chronic pancreatitis (CP) is defined as a continuous or recurrent inflammatory disease of the pancreas characterized by progressive and irreversible morphological changes. It typically causes pain and permanent impairment of pancreatic function. In chronic pancreatitis, areas of focal necrosis are typically associated with perilobular and intralobular fibrosis of the parenchyma, by stone formation in the pancreatic duct, and by the development of pseudocysts. Late in the course of the disease a progressive loss of endocrine and exocrine function occurs. In the past, chronic pancreatitis was considered to be mostly associated with chronic alcohol abuse. During the past 2 decades idiopathic chronic pancreatitis and, moreover, hereditary pancreatitis have been recognized as distinct disease entities. Usually the diagnosis is made by a combination of imaging procedures such as ultrasound and endoscopic retrograde cholangiopancreatography, and exocrine and endocrine function tests. Therapy is presently restricted to symptom control for the lack of a causal treatment strategy. Thirty to sixty percent of all patients develop disease-associated complications such as persistent pain, strictures of the common bile duct, or pancreatic duct stones that may require either endoscopic or surgical treatment. Chronic pancreatitis is a difficult condition to live with as well as to treat. Optimal care needs to be carried out in a multidisciplinary environment that can address both the physical and psychological aspects of the disease. It is commonly seen in alcohol-dependent individuals, but many other groups of individuals suffer with irreversible inflammatory destruction of the pancreas. Abdominal pain is the predominant feature and pain specialists are an important part of any pancreatic team. Exocrine and endocrine failure are addressed by appropriate nutrition with supplements and insulin, whilst the complications that are seen over time, may require a combination of endoscopic and surgical treatment. This clinical update has been designed to update the readers on the important aspects of CP. The book has stressed upon various aspects of the condition like the etiology, pathogenesis, diagnosis and evaluation along with an insight into the management approach of the patient. Supportive case scenarios have also been incorporated with relevance to the topics covered under the book. Overall, the book presents to the readers an excellent compilation of clinically applicable literature sourced from the most acclaimed physicians in the country.