Monthly Archives: June 2011

Definition: acute cellular rejection

Posted on June 30, 2011 by thebileflow

Acute cellular rejection (ACR) can occur anytime in the lifespan of a donor allograft, though is most common in the first year post-transplant when the level of immunosuppression is low.  It is diagnosed on biopsy with the triad of cholangiolitis, endothelialitis and … Continue reading →

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Pathology: levamisole vasculitis

Posted on June 29, 2011 by thebileflow

A young cocaine + male with HCV was admitted with an apparent cutaneous vasculitis and acute renal failure. Suspicion was high for cryoglobulinemia, but the cryocrit was normal.  Skin biopsy was performed, showing a leukocytoclastic vasculitis, with positive stains for … Continue reading →

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Clinical Pearl

Posted on June 28, 2011 by thebileflow

If a liver transplant patient presents to the clinic with leukopenia and diarrhea…think about cytomegalovirus (CMV).  This likelihood is greatest if the liver donor was CMV+ and the recipient was CMV- , though any combination can lead to this infection … Continue reading →

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Hepatorenal syndrome

Posted on June 27, 2011 by thebileflow

Question: You are confronted with a very sick 41 year old Puerto Rican male with HCV and EtOH cirrhosis, MELD score of 36, hyponatremia, large ascites and jaundice.  His creatinine is rising and is now 2.3.  Which of the following … Continue reading →

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The Sunday Chronicles

Posted on June 26, 2011 by thebileflow

“Excuse me, bartender?  I thought I said no salt. Doctor’s orders.”

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Haiku: Cryoglobulinemia

Posted on June 24, 2011 by thebileflow

Cryoglobulins Kidney and skin deposits Will Rituxan work?

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Pathology: dilated sinusoids

Posted on June 23, 2011 by thebileflow

The hepatic sinusoid is the smallest caliber blood vessel in the liver, and much of end stage liver disease is based on sinusoidal pressures.  Portal hypertension can be divided into pre-sinusoidal (portal vein thrombosis), sinusoidal (hepatic fibrosis) and post-sinusoidal conditions … Continue reading →

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Clinical Pearl

Posted on June 22, 2011 by thebileflow

Palmar erythema is the manifestation of spider teleangectasias on the palm.  Because the skin of the palm is so thick, the radial extensions are dulled and a general erythema appears instead.  This is all part of the dilated periphery of the hyperdynamic circulatory … Continue reading →

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Cholangiocarcinoma

Posted on June 21, 2011 by thebileflow

Question: A 47 year old female with biopsy-proven cholangiocarcinoma, measuring 3.3 cm, is sent to you for treatment. What do you recommend? A. transplant evaluation B. refer to surgeon and oncologist C. there is no treatment D. send to IR … Continue reading →

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Definition: ischemic hepatitis

Posted on June 20, 2011 by thebileflow

Ischemic hepatitis often presents in an intensive care setting, whereby the liver is transiently hypoperfused due to a low-flow state such as shock or cardiac dysrhythmia.  Transaminases often rise > 1,000 and fall soon thereafter; the kidney may also show … Continue reading →

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