Clinical Liver Disease

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Ectopic varices - Shiv Kumar Sarin and Chandan K. N. Kumar – Article Reading Jul 07, 2013

Show notes

Ectopic varices represent a clinical challenge because they are difficult to localize, and at present, there are no clear guidelines on the management of ectopic varices due to the diversity of presentation and absence of randomized controlled trials. Drs. Sarin and Kumar review etiology, prevalence, clinical presentation, and management strategies.

Primary prophylaxis of esophageal variceal bleeding - Douglas A. Simonetto and Vijay H. Shah – Article Reading Jul 07, 2013

Show notes

: Portal hypertension is a common complication of cirrhosis and is the result of increased intrahepatic resistance and splanchnic and systemic hemodynamic changes. Elevated portal pressure leads to the formation of portosystemic laterals, which comprise gastroesophageal varices. Once varices have developed, they tend to enlarge and may eventually bleed. Drs. Simonetto and Shah discuss the important and much-debated topic of the management of esophageal varices.

Approach to the management of portal hypertensive gastropathy and gastric antral vascular ectasia - Bezawit D. Tekola and Stephen Caldwell – Article Reading Jul 07, 2013

Show notes

Gastric antral vascular ectasia (GAVE) and portal hypertensive gastropathy (PHG) are distinct entities with some overlapping properties that have both challenged medical, endoscopic, and surgical therapies owing to the lack of a complete understanding of their respective pathophysiology. Each patient with chronic gastrointestinal bleeding and suspected lesions should be categorized in the appropriate group, because the management is significantly different. Drs. Tekola and Caldwell address the clinical characteristics and management approach for each.

Management of gastric varices - Louis M. Wong Kee Song – Article Reading Jul 07, 2013

Show notes

Gastric varices (GV) are present in approximately 20% of patients with portal hypertension. While GVs bleed less frequently than esophageal varices (EV), bleeding is more severe and mortality is higher. Dr. Wong Kee Song reviews the latest recommendations for endoscopic, radiologic, and surgical interventions and comments on potential approaches for prevention.

Drugs used in therapy of portal hypertension - Dhiraj Tripathi – Article Reading Jul 07, 2013

Show notes

For portal hypertension, drug therapy with nonselective beta-blockers (NSBBs) is considered by many to be first line for primary and secondary prevention of variceal hemorrhage. In this brief and practical review, Dr. Tripathi outlines the benefits and drawbacks of the range of potential drug therapies.

Transjugular intrahepatic portosystemic shunt: An overview - Harjit K. Bhogal and Arun J. Sanyal – Article Reading Jul 07, 2013

Show notes

Transhepatic intrahepatic portosystemic shunt (TIPS) stent placement is a minimally invasive procedure that, given the risk associated with surgical decompression, is preferred for the management of portal decompression. Drs. Bhogal and Sanyal discuss the procedure. .

Assessment and management of comorbidities (including cardiovascular disease) in patients with nonalcoholic fatty liver disease - Kathleen E. Corey and Raj Vuppalanchi – Article Reading Jul 07, 2013

Show notes

NAFLD is associated with an increased risk of cardiovascular disease (CVD) and is frequently associated with metabolic syndrome. This creates a pressing need for the diagnosis and management of the comorbidities of NAFLD, including CVD. Drs. Corey and Vuppalanci guide clinicians in the assessment and management of metabolic disease and CVD in patients with NAFLD.

Management of nonalcoholic fatty liver disease in children – Jean P. Molleston – Article Reading Jul 07, 2013

Show notes

In the context of limited data and controversial approaches to screening, management of pediatric NAFLD presents many challenges for healthcare providers. Dr. Molleston outlines the reviews the best available evidence, recommends management approaches, identifies limitations in the current evidence base, and highlights other important aspects in the care of children with chronic liver disease, such as immunization against hepatitis A and B and counseling to avoid potential hepatotoxins such as alcohol.

Nonalcoholic fatty liver disease: Indications for liver biopsy and noninvasive biomarkers - Mazen Noureddin and Rohit Loomba – Article Reading Jul 07, 2013

Show notes

Liver biopsy is the gold standard to confirm NASH, a progressive form of NAFLD. Biomarkers and clinical prediction rules for refining the management paradigm of NAFLD are emerging. Drs. Noureddin and Loomba discuss the noninvasive biomarkers that may be useful and indications for performing liver biopsy in patients with NAFLD.

Treatment of nonalcoholic fatty liver disease: Role of dietary modification and exercise - Angelo H. Paredes, Dawn M. Torres and Stephen A. Harrison – Article Reading Jul 07, 2013

Show notes

The treatment of NAFLD is a patient-centered process that requires a patient to accept responsibility for lifestyle modifications. Evidence is emerging that allows physicians to guide patients better with diet and exercise counseling. Drs. Paredes, Torres, and Harrison explain..

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