Category Archives: The Tion

In the absence of high risk factors for hepatitis B recurrence post transplant (high pre-transplant viral load; HBsAg+), the recipient can discontinue HBIG after several months.  In such a case, long term treatment with antivirals (single or in combination) can be … Continue reading →

Immune (ie. T cell) exhaustion is implicated in the setting of a defiant viral infection, as in the case of hepatitis B.  This helps to explain the permissiveness of viral replication over many years of infection.

MELD exception points for hepatocellular carcinoma began at 29 and have been reduced on two occasions since.  Experts in the field still believe 22 points is excessive, and HCC patients are given an unfair advantage over ESLD patients.

Although variceal band ligation is considered to be equivalent to beta blockade for the primary prophylaxis of bleeding, in meta-analyses, it is a few percentage points superior to beta blockade.

An elevated alkaline phosphatase (and GGT) is your clue to an infiltrative liver disease, like lymphoma or sarcoid, particularly when elevated in isolation.

Autoimmune pancreatitis is a misnomer of sorts, for it affect many organs other than the pancreas, including the bile ducts.  A hallmark of this disorder is deposition of immunoglobulin G, subclass 4 (ie. IgG4) which leads to a reversible stricturing … Continue reading →

Obesity is a proinflammatory state; adipokines promote multiorgan disease.

Two scenarios that call for the administration of IV N-acetylcysteine (NAC): 1) acute acetaminophen hepatotoxicity, and 2) acute liver failure NOS with moderate to advanced hepatic encephalopathy.

When the bile duct is obstructed there is retention of bile acids in the hepatocyte, leading to necrosis and apoptosis.  A portion of the bile acids are modified by sulfation, and both sulfated and unsulfated bile acids are regurgitated into … Continue reading →

Vitamin K antagonists (ie. warfarin) allows complete recanalization in about 40-75% of acute, partial portal vein thromboses (and is less effective for complete thromboses).  Extension of clot despite anticoagulation occurs in about 10%.  Bleeding complications are rare (2/75 cases, no … Continue reading →