Marie L. Borum

Dying with end stage liver disease with cirrhosis: Insights from SUPPORT

OBJECTIVES: To understand patterns of care and end‐of‐life preferences for patients dying with end stage liver disease with cirrhosis (ESLDC).

Fulminant exacerbation of autoimmune hepatitis after the use of ma huang

difficult to determine whether the onset of CMV infection in this case was primary or reactivation, but it cannot be denied that chronic inflammation or immunological perturbation due to Crohn’s disease may have triggered the onset of CMV infection. CMV infection is a more frequent complication of ulcerative colitis than Crohn’s disease (6). However, our case suggests that, even in Crohn’s disease, CMV can influence the clinical course and cause a serious outcome if appropriate therapy is not administered.

Constipation: Evaluation and management

Constipation is a common symptom that can result from several disorders. Most patients with chronic constipation do not have a medical disorder contributing to the constipation and, therefore, require limited evaluation. Initial intervention should include dietary measures and fiber supplements; however, if fiber supplementation is ineffective, other agents can be used. Surgery should be reserved for patients who meet specific clinical criteria.

Gastric sarcoidosis: a case report and review of the literature.

Sarcoidosis is a systemic granulomatous disease of unknown etiology that is characterized by the formation of noncaseating granulomas. Gastrointestinal (GI) tract involvement in sarcoidosis is rare. Gastric sarcoidosis, particularly involving the antrum, affects approximately 10% of patients with systemic disease.1 GI sarcoidosis commonly occurs subclinically, with clinical manifestations present in only 0.1 to 0.9% of patients with the disease. This is a rare case report of an individual with symptomatic gastric sarcoidosis. The patient presented with weight loss, nausea, and early satiety. An EGD and colonoscopy were performed and were grossly normal. However, biopsies of the gastric antrum revealed noncaseating granulomatous inflammation involving the gastric mucosa. Corticosteroid therapy was started and the symptoms abated almost immediately. We also offer a review of the literature.

DOMESTIC VIOLENCE IN WOMEN

Domestic violence is a significant public health issue affecting women. Numerous medical organizations have recommended that routine screening of women be conducted to assist in the prevention, identification, and care for victims of violence. This article examines the scope of domestic violence in women, reviews ways to recognize abuse, examines the potential impact of abuse upon health and discusses the management of victims.

HEPATOBILIARY DISEASES IN WOMEN

Most diseases of the hepatic and biliary systems affect both women and men. There are several disorders, however, that affect women differently than they affect men. Gallstones, primary biliary cirrhosis (PBC), and autoimmune liver disease occur more often in women. The impact of alcohol on the liver is worse in women. Chronic liver disease from any cause can affect fertility. In addition, oral contraceptive use and pregnancy can have specific effects on the liver.

GASTROINTESTINAL DISEASES IN WOMEN

Gastrointestinal disorders are among the most common disorders for which women seek medical attention. Most gastrointestinal diseases in women are not inherently different from those that occur in men. There are several disorders, however, that occur more frequently or manifest themselves differently in women. This article reviews common gastrointestinal disorders affecting women. The pathophysiology, clinical manifestations, management, and gender-specific issues of gastroesophageal reflux disease, peptic ulcer disease, irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD) are discussed.

Fecal bile acid excretion and composition in response to changes in dietary wheat bran, fat and calcium in the rat

The effect and possible interactive influence of different dietary amounts of wheat bran, fat and calcium on the fecal excretion, concentration and composition of bile acids was studied in Fischer-344 rats. The fecal bile acids were analyzed using gas-liquid chromatography. Dietary wheat bran increased both total bile acid excretion and fecal weight without changes in fecal bile acid concentration. The proportion of fecal hyodeoxycholic acid decreased with increasing dietary fiber, whereas that of lithocholic and deoxycholic acids increased significantly with fiber intake. The percent content of fecal chenodeoxycholic acid did not change. Increasing dietary fat led to an increase in bile acid excretion without changes in either fecal weight or bile acid concentration. In contrast, the level of dietary calcium did not affect the total excretion of bile acids. However, since calcium increased the fecal weight, it consequently diluted bile acids and decreased their fecal concentration. Dietary fat and calcium had no influence on fecal bile acid composition. There were no interactive effects of wheat bran, fat and calcium on fecal bile acids. The finding in this study that dietary fiber, fat and calcium induce significant changes in fecal bile acids may be of relevance to the potential of bile acids to promote carcinogenesis.

Colorectal cancer screening

Colorectal cancer causes significant morbidity and mortality in the United States. The incidence of colorectal cancer increases at age 50, approximately. Risk factors that have been identified include a personal history of colorectal cancer or adenomas, a family history of colon cancer or adenomas, inherited colorectal cancer syndromes, and long standing inflammatory bowel disease. Several screening tests have been developed for colorectal cancer prevention. Surveillance strategy is based on an individuals colorectal cancer risk. This article reviews fecal occult blood testing, flexible sigmoidoscopy, colonoscopy, barium enema, and genetic testing.

A case of irreversible alopecia associated with ribavirin and peg-interferon therapy

References 1 Yoshizawa H, Tanaka J, Miyakawa Y. National prevention of hepatocellular carcinoma in Japan based on epidemiology of hepatitis C virus infection in the general population. Intervirology 2006; 49:7–17. 2 Di Bisceglie AM. Hepatitis C and hepatocellular carcinoma. Hepatology 1997; 26:34S–38S. 3 Zeuzem S, Schmidt JM, Lee JH, von Wagner M, Teuber G, Roth WK. Hepatitis C virus dynamics in vivo: effect of ribavirin and interferon alfa on viral turnover. Hepatology 1998; 28:245–252. 4 Enomoto N, Sakuma I, Asahina Y, Kurosaki M, Murakami T, Yamamoto C, et al. Mutations in the nonstructural protein 5A gene and response to interferon in patients with chronic hepatitis C virus 1b infection. N Engl J Med 1996; 334:77–81. 5 Suzuki F, Akuta N, Suzuki Y, Sezaki H, Arase Y, Hosaka T, et al. Predictive factors of virological non-response to interferon-ribavirin combination therapy for patients infected with hepatitis C virus of genotype 1b and high viral load. J Med Virol 2006; 78:83–90. A case of irreversible alopecia associated with ribavirin and peg-interferon therapy