i C h a p te r Hepatology at a Glance This title is also available as an e‐book. For more details, please see www.wiley.com/buy/9781118759394 or scan this QR code: Hepatology at a Glance Deepak Joshi Consultant Hepatologist King’s College Hospital London, UK Geri Keane Clinical Research Fellow Institute for Liver and Digestive Health University College London London, UK Alison Brind Consultant Gastroenterologist with interest in Hepatology University Hospital of North Midlands, Stoke on Trent, UK This edition first published 2015 © 2015 by John Wiley & Sons, Ltd. 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Cover image: iStock/ © Eraxion Set in 9.5/11.5pt Minion by SPi Publisher Services, Pondicherry, India 1 2015 Contents Preface vii Acknowledgements viii List of abbreviations ix How to use your revision guide xii Part 1 Basics 1 1 Liver and biliary anatomy and structure 2 2 Liver metabolism and function 4 3 Coagulation in liver disease 6 4 Liver fibrosis 8 Part 2 Evaluation of liver disease 11 5 Clinical history 12 6 Liver examination 14 7 Liver function tests 16 8 Radiology in liver disease 18 9 Liver biopsy 20 10 Non‐invasive markers of fibrosis 22 Part 3 Clinical scenarios 25 11 Asymptomatic abnormal LFTs 26 12 Jaundice 28 13 Portal hypertension 30 14 Variceal bleeding 32 15 Ascites 34 16 Management of complications of ascites 36 17 Renal dysfunction in cirrhosis 38 18 Cardiopulmonary complications 40 19 Hepatic encephalopathy 42 20 Acute liver failure 44 21 Liver disease in pregnancy 46 22 Indications for liver transplantation 48 23 Drug‐induced liver injury 50 24 Focal liver lesions 52 Part 4 Diseases 55 25 Alcohol‐related liver disease 56 26 Management of alcohol misuse 58 27 Fatty liver disease 60 28 Hepatitis A and hepatitis E viruses 62 29 Hepatitis B virus and delta hepatitis 64 v 30 Hepatitis C virus 67 31 Autoimmune hepatitis 70 32 Primary biliary cirrhosis 72 33 Sclerosing cholangiopathies 74 34 Overlap syndromes 76 35 Haemochromatosis and iron overload 78 36 Wilson’s disease 80 37 Metabolic disorders 82 38 Multisystemic diseases 84 39 Vascular disorders 86 40 Hepatocellular carcinoma 88 41 Cholangiocarcinoma 90 42 Surgical procedures 92 43 Biliary disorders 94 44 Pancreatic disorders 96 45 Post‐liver transplantation: general considerations 98 46 Post‐liver transplantation: disease recurrence 100 47 Tropical liver disease: parenchymal 102 48 Tropical liver disease: hepatobiliary 104 49 Nutrition and liver disease 106 Further reading 108 Index 109 vi Preface Hepatology is a rapidly growing specialty with increasing self‐assessment MCQs are designed as a single best response in keep emphasis within the medical curriculum requiring an ‘at a ing with the specialty certificate examination in gastroenterology. Glance’ of its own. We have integrated core principles of basic The publishers of ‘at Glance’ approached the education com science, pathophysiology, treatments and management algorithms mittee of the British Society of Gastroenterology (BSG) who into a single easy‐to‐use text. As such, it can be used by medical selected the authors. We should like to thank the BSG for their students throughout their training, junior doctors entering the support and the opportunity to contribute to the literature with field of hepatology and also by allied health care professionals with this innovative publication. In addition, we would like to thank all an interest in hepatology. our colleagues who took the time to review each chapter and As with other at a Glance publications, Hepatology at a Glance ensure the content was of the highest standard. We also thank the is based around a two‐page spread for each main topic, with colour staff at Wiley Blackwell, without whom we would not have been figures and text complementing each other to give an overview of able to produce this new and exciting first edition. a topic. Case studies based on some of the most commonly encoun tered presentations in hepatology are included. The book covers Deepak Joshi all the core elements of hepatology and its major diseases; fur Geri Keane ther reading suggestions are included for more in‐depth study. The Alison Brind vii Acknowledgements Dr Kosh Agarwal, King’s College Hospital, London Dooley JS, Lok A, Burroughs AK, Heathcote J (eds) Sherlock’s Diseases of Dr Ahmir Ahmad, Imperial College, London the Liver and Biliary System, 12th edn. Blackwell Publishing, 2011. Professor GP Aithal, Queens Medical Centre, Nottingham EASL–EORTC Clinical Practice Guidelines: Management of Dr Zahir Amin, University College London Hospitals, London hepatocellular carcinoma. European Journal of Cancer 2012;48: Dr Quentin Anstee, Freeman Hospital, Newcastle 599–641. Friedman SL. Mechanisms of disease: Mechanisms of hepatic fibrosis Dr Adrian Bateman, Southampton General Hospital, Southampton and therapeutic implications. Nature Clinical Practice Dr Mike Brown, University College London Hospitals, and Gastroenterology and Hepatology 2004;1:98–105. Hospital for Tropical Diseases, London Friedman SL. Mechanisms of hepatic fibrogenesis. Gastroenterology Dr Mike Chapman, University College London Hospitals, London 2008;134(6):1655–669. Professor Anil Dhawan, King’s College Hospital, London García‐Martinez R, Córdoba J. Acute‐on‐chronic liver failure: the Dr Catherine Edwards, Torbay Hospital, Torquay brain. Current Opinion in Critical Care 2011;17:177–83. Dr Michael Heneghan, King’s College Hospital, London Gleeson D, Heneghan MA. British Society of Gastroenterology (BSG) Dr Gavin Johnson, University College London Hospitals, London guidelines for management of autoimmune hepatitis. Gut Dr TuVinh Luong, Royal Free Hospital, London 2011;60:1611–29. Professor John O’Grady, King’s College Hospital, London Goossens N, Joshi D, O’Grady J. Image of the month. Digital clubbing Dr Steve Pereira, University College London Hospitals, London in association with hepatopulmonary syndrome. Hepatology 2010;53(1):365–6. Professor Massimo Pinzani, UCL Institute for Liver and Digestive Hajarizadeh B, Grebely J, Dore GJ. Epidemiology and natural history Health, London of HCV infection. Nature Clinical Practice Gastroenterology and Dr Samantha Read, University College London Hospitals, London Hepatology 2013;10(9):553–62. Dr Andrew Rochford, Barts Health, London Joshi D, Belgaumkar A, Ratnayake V, Quaglia A, Austin D. A case of Dr Debbie Shawcross, King’s College Hospital, London hepatomegaly. Postgraduate Medical Journal 2007;83(984):e2. Dr Nick Sheron, University Hospital, Southampton Keane MG, Marlow NJ, Pereira SP. Novel endoscopic approaches in Dr Douglas Thorburn, Royal Free Hospital, London the diagnosis and management of biliary strictures. Prime Reports Dr Paul Trembling, Royal Free Hospital, London 2014;32(5):570–8. Dr Manolis Tsochatzis, Royal Free Hospital, London Keane MG, Pereira SP. Improving the detection and treatment of liver Dr Sumita Verma, Brighton and Sussex Medical School, Brighton cancer. The Practitioner 2013;257:21–6. Keshav S, Bailey A. The Gastrointestinal System at a Glance, 2nd edn. Dr George Webster, University College London Hospitals, London. John Wiley & Sons Ltd, 2013. Mieli‐Vergani G, Vergani D. Autoimmune hepatitis. Nature Reviews Gastroenterology and Hepatology 2011;8:320–7. Figure sources Papastergiou V, Tsochatzis E, Burroughs A. Non‐invasive assessment Anstee QM, Targer G, Day CP. Progression of NAFLD to diabetes mel- of liver fibrosis. Annals of Gastroenterology 2012;25:218–31. litus, cardiovascular disease or cirrhosis. Nature Reviews Skipworth JRA, Keane MG, Pereira SP. Update on the management of Gastroenterology and Hepatology 2013;10:330–44. cholangiocarcinoma. Digestive Diseases 2014;32(5):570–8. Babor TF, Higgins‐Biddle JC, Saunders JB, Monteiro JG. AUDIT: Utzschneider KM, Kowdley KV. Hereditary hemochromatosis and Guidelines for Use in Primary Care, 2nd edn. WHO, 2001. diabetes mellitus: implications for clinical practice. Nature Reviews Beeching N, Gill G (eds) Lecture Notes: Tropical Medicine, 7th edn. in Endocrinology 2010;6:26–33. Wiley Blackwell, 2014. Watt KDS, Pedersen RA, Kremers WK, Heimbach JK, Charlton MR. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Evolution of causes and risk factors for mortality post‐liver trans- Quality Initiative workgroup. Acute renal failure – definition, out- plant: results of the NIDDK long‐term follow‐up study. American come measures, animal models, fluid therapy and information Journal of Transplantation 2010:6;1420–7. technology needs: the Second International Consensus Conference Zarrinpar A, Busuttil RW. Liver transplantation: past, present and of the Acute Dialysis Quality Initiative (ADQI) Group. Critical future. Nature Clinical Practice Gastroenterology and Hepatology Care 2004;8(4):R204–12. 2013;10:434–40. viii
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