Monthly Archives: June 2012

Consideration

HIV-positive individuals can receive a liver transplant if they meet LT criteria, the CD4 count is > 100 (or > 200 if there is a history of opportunistic complications), the viral load is < 50, AIDS-defining illnesses are absent, and … Continue reading

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Clinical Pearl

Portopulmonary hypertension does not necessarily exclude a patient from liver transplantation, but pulmonary vascular pressures must be successfully lowered before one is deemed a candidate.  To treat, try a phosphodiesterase inhibitor as initial therapy, followed by addition of either inhaled prostacyclin or an … Continue reading

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Pathology: congenital hepatic fibrosis

Congenital hepatic fibrosis is a part of Caroli syndrome (abnormal biliary sacculations).  It is also part of the spectrum of autosomal recessive polycystic kidney disease.  The fibrosis, when advanced, will lead to portal hypertension and its sequelae, including variceal bleeding … Continue reading

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Lecture: tolvaptan for the cirrhotic population

Today’s lecture focused on hyponatremia in the cirrhotic population.  It is recognized that nearly 50% of cirrhotics will experience hyponatremia, but just 2% will have severe hyponatremia (<120).  You must first try to exclude cases of hypovolemic hyponatremia, often seen in the … Continue reading

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The Sunday Chronicles

“Odynophagia? Let me see here…tongue depressor, tongue depressor, where are you?  No tongue depressor, hmm.  Oh! A popsicle!  So tell me, SLURP, how long has this been going on SLURP Mr. Preston? LICK Any nausea with this? Hang on…..braaain freeeeezze!! … Continue reading

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Pathology: Mallory’s hyaline

When we speak of ‘hyaline’ on a liver biopsy, we are usually referring to Mallory’s haline (the ropy, pink substance you see at 6 o’clock in the cytoplasm of the central hepatocyte).  Mallory’s hyaline is very suggestive of alcohol as the etiology … Continue reading

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Pathology: nodular regenerative hyperplasia

Nodular regenerative hyperplasia (NRH) is a common form of non-cirrhotic portal hypertension.  It should be considered whenever stigmata of portal hypertension is present in a patient without liver fibrosis.  Synthetic function is usually preserved. Causes of NRH include medications (azathioprine, … Continue reading

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