Category Archives: Clinical Pearl

Clinical Pearl

You are screening your cirrhotic patient for varices with an EGD and you detect a long segment of salmon-colored esophageal mucosa.  Instinct tells you to biopsy it and document Barrett’s esophagus.  Careful.  Is there an esophageal varix beneath that tongue … Continue reading

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Clinical Pearl

Remember that kidney failure in the hepatitis C cirrhotic patient might be related to the virus itself! Cryoglobulinemia, membranous glomerulonephritis, MPGN and polyarteritis nodosa are all associated with HCV, and therefore you might entertain a serologic workup that includes a … Continue reading

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Clinical Pearl

When doing a liver biopsy, don’t forget that the costal vasculature runs alongside the bottom edge of the rib.  Therefore the appropriately guided needle should run along the top of the lower rib of your intercostal space.

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Clinical Pearl

Bile duct ischemia has many causes, though we tend to think about it only in the liver transplant setting.  Remember to consider: hepatic artery chemotherapy infusion/embolization/chemoembolization, radiotherapy to the common bile duct, cholecystectomy, hereditary hemorrhagic teleangectasia, systemic vasculitis, AIDS and … Continue reading

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Clinical Pearl

Infliximab infusions can lead to reactivation of hepatitis B virus (HBV) even if pre-treatment viral loads are non-detectable.  For this reason, any patient with a +sAg (or even a +cAb) should be prophylaxed against HBV.

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Clinical Pearl

Drugs can induce ANA positive autoimmune hepatitis.  The ones to be aware of include minocycline, hydralazine, methyldopa, inflixamab, peginterferon and even some statins.

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Clinical Pearl

Use the Lille Score at day 7 of cortiosteroid treatment for severe alcoholic hepatitis to determine whether the treatment is working (and whether to continue steroids).  Don’t have a calculator?  Use the serum bilirubin as a surrogate marker; if it’s … Continue reading

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