Monthly Archives: May 2012

Paraneoplastic syndromes

Question: Which of the following paraneoplastic syndromes has a relationship to hepatocellular carcinoma? A. polycythemia B. Trousseau sign C. Cushing syndrome D. acanthosis nigricans   Answer: Paraneoplastic syndromes are not frequently attributed to primary cancers of the liver, like hepatocellular … Continue reading

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Clinical Pearl

Sometimes we’re not sure of an elevated INR is related to liver synthetic dysfunction or to vitamin K deficiency (ie. poor nutrition, recent antibiotic use).  By giving supplemental vitamin K, the INR will not reverse in a patient with synthetic dysfunction, but should … Continue reading

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Definition: drug induced liver injury (DILI)

Drug induced liver injury, or DILI, can be divided into idiosyncratic reactions (unpredictable, ie. antibiotics) and hepatotoxic reactions (dose dependent, ie. acetaminophen >4 g/d; methotrexate) and can be associated with jaundice (10%) or even acute liver failure.  The classes of … Continue reading

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Why do the women among us get intoxicated faster at the Memorial Day backyard barbecues?  Their relative deficiency of gastric alcohol dehydrogenase of course means more unmetabolized ethanol reaches the hepatic circulation.

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The Sunday Chronicles

Caleb knew the feeding tube was best for his nutritional health, but he wasn’t sold on the color of the tube itself.  He yearned for something edgier, something in the mauve family.

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Pathology: rash from telaprevir

More than 90% of these rashes are mild or moderate, but rash will show up in about half of patients on triple therapy (with or without pruritus).  In clinical trials, 6% require discontinuation of therapy due to rash, and Stevens-Johnson … Continue reading

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Definition: Rotor syndrome

Rotor syndrome is an autosomal recessive condition usually discovered in childhood that is associated with conjugated hyperbilirubinemia and 40-65% coproporphyrin in the urine.  Unlike in Dubin-Johnson syndrome, Rotor syndrome does not have a black pigmentation seen on histology.

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