Diagnosing Non-HFE Hereditary Hemochromatosis

A 63-year-old Caucasian female presented for evaluation of abnormal bile duct appearance on ERCP after being diagnosed with gallstone pancreatitis, duodenal ulcers and gastritis at another hospital

The Use of Palliative Performance Score in Patients with End-Stage Liver Disease

● Palliative Care services are often underutilized in patients with End-Stage Liver Disease (ESLD) and often only initiated at the end of life ● The Palliative Performance Score (PPS) is an important tool used in Palliative Care to assess functional status ● PPS has five functional dimensions: ambulation, activity level and evidence of disease, self-care, oral intake, and level of consciousness ● The aim of this study is to determine if there is a correlation between Model for End-Stage Liver Disease (MELD) score and PPS in ESLD patients ● MELD is used to predict mortality and to prioritize liver transplant allocation in ESLD patientshttps://jdc.jefferson.edu/medposters/1011/thumbnail.jp

Helpful or Harmful? A Case Report of Nutritional Supplements Causing Drug-Induced Liver Injury

Herbal supplement-induced liver injury represents a growing concern in the body of drug-induced liver injury (DILI) literature, with recent studies in mainland China, Iceland, and the United States reporting estimated rates of herb/dietary supplement-induced liver injury (HILI) between 1.16-6.38 per 100,000 (Björnsson et al., 2013; Shen et al., 2019; Vega et al., 2017). Notably, a recent 2020 study demonstrated an increasing prevalence of hepatotoxicity secondary to herbal and dietary supplements in the US and worldwide (Zheng et al., 2020). Recognizing the hepatotoxicity of various supplements is crucial, given the increasing usage of dietary and herbal supplements and the lack of regulation of herbal supplements in the United States. HRP-AID is marketed as a twice-daily immune system booster to reduce the intensity and frequency of cold sore outbreaks. The product ingredients include 200 mg ascorbic acid, 20 mcg cholecalciferol, 20 mg a-tocopherol, 10 mg pyridoxine HCl, 50 mcg methylcobalamin, 25 mg zinc citrate, 70 mcg selenium, 250 mg L-lysine, 50 mg Astralagus extract (Astragalus membranaceus), 50 mg Echinacea (Echinacea purpurea), 50 mg garlic powder (Allium salivum), 50 mg natural caffeine (coffee arabica), 50 mg olive leaf extract Oleuropin 20% (Olea Europaea), 50 mg oregano powder (Thymus captatus), 50 mg of elderberry extract (Sambucus nigra) and 50 mg Red Panax ginseng extract (Panax ginseng). A literature review demonstrates that this is the first reported case of DILI secondary to HRP-AID supplementation

Quality Improvement of Diabetic Care at a Resident Clinic

Our objective was to develop a quality improvement project on diabetes mellitus at our internal medicine residency clinic. Residents developed projects aimed at improving an aspect of diabetic care. Continuity of care, achievement of clinical targets, no-show rates, patient knowledge of diabetes, and preventive care were evaluated. Our data was obtained with a questionnaire and a retrospective review of medical records. A different provider was scheduled about every 1.78 visit. The no-show rate was 25.4%. About half of patients identified goal hgbA1c and BPs, and 35% and 60% achieved their hgbA1c and SBP goals respectively. Nearly all of the charts planned for screening exams. We concluded that our clinic needs to improve diabetes education, reaching clinical targets, continuity of care and no-shows. Incorporating a QI project into the clinic with one disease such as diabetes is an efficient way to include practice based learning into an internal medicine residency’s curriculum

Risk Prevention and Health Promotion for Non-Alcoholic Fatty Liver Diseases (NAFLD)

Non-alcoholic fatty liver disease (NAFLD) is a serious clinicopathological condition that is recognized as the most frequent chronic liver disease, affecting 14%-30% of the world’s population. The prevalence of NAFLD has rapidly grown and is correlated with the growth in obesity and type 2 diabetes, among other factors. NAFLD often results in long-term complications including cardiovascular disease, liver cirrhosis, and liver fibrosis. This paper provides an updated overview of NAFLD with a focus on epidemiology, etiology, pathophysiology, screening, complications, and pharmacological therapies to identify effective risk prevention and health promotion

NAFLD and NASH: Cutting Through the Fat

Agenda Introduction Scope of the Problem Noninvasive staging options Current Treatment Emerging Treatmen

The Use Of Statins In Liver Disease: Risk Versus Benefit

Introduction The National Cholesterol Education Program periodicallyproduces Adult Treatment Panel (ATP) updates as warranted bycurrent clinical scientific research in cholesterol management.1Each of the guideline reports, ATP I, II, and III, has a major rolein guiding physicians how to treat abnormal cholesterol levels.Recent clinical trials demonstrate that LDL-lowering therapywith statins (HMG-CoA inhibitors) reduces total mortality,coronary mortality, major coronary events, coronary proceduresand strokes in patients with established coronary heart disease.1However, the ATP III has cited active or chronic liver disease as anabsolute contraindication to the use of statins. The reason for thiscontraindication goes back to the initial clinical trials of Lipitor(atorvastatin), which demonstrated that persistent elevations (\u3e 3times the upper limit of normal) in serum transaminases occurredin 0.7% of patients who received atorvastatin. The incidence ofthese abnormalities was 0.2%, 0.2%, 0.6% and 2.3% for 10, 20, 40and 80 mg atorvastatin, respectively.2 Based on this information,the recommendation held that liver function tests should beperformed before the initiation of treatment with statins, followingeach dosage increase, and periodically thereafter

Vitamins: Friend or Foe

Case Presentation A 39 year-old male presented to the emergency department withgeneralized body aches after a recent fall. The patient underwenturgent trauma evaluation and incidentally was found to havemultiple medications in his right colon on radiography (Figures1 and 2). The patient was immediately screened for a drugoverdose, but he admitted to taking a large amount of Ultra-Startvitamins that he purchased on the internet. Due to suspicionfor possible drug overdose, a nasogastric tube was placed, andpolyethylene glycol was administered to help the patient pass thepills from his bowels. Despite the large ingestion of vitamins, thepatient remained asymptomatic throughout his hospitalization

A Case Report of Gemcitabine-Induced Steatohepatitis Associated with Adjuvant Monotherapy for Pancreatic Adenocarcinoma

Introduction: Drug induced liver injury [DILI] is the most common cause of fulminant liver failure in the Western hemisphere. There are databases logging the myriad of herbs, supplements and medications that can cause DILI. Gemcitabine, a cytotoxic chemotherapy used most commonly in lung and pancreaticobiliary malignancy, has been well described as causing cholestatic liver injury. There are several case reports remarking on fatal hepatic failure with gemcitabine. This case describes steatohepatitis, a pattern of liver injury not previously described with gemcitabine. Case Presentation: This case involves a 51-year-old healthy Caucasian female who presented to her primary care physician with jaundice and was found to have a 3 cm pancreatic head mass. She underwent surgical resection and was found to have 2 of 17 lymph nodes positive for adenocarcinoma. Her postoperative course was uncomplicated, and eight weeks later she was started on adjuvant chemotherapy with single agent gemcitabine for stage IIB pancreatic adenocarcinoma. Imaging studies before beginning chemotherapy revealed two arterially enhancing lesions in the liver consistent with focal nodular hyperplasia [FNH]. The patient had a reported history of Gilbert syndrome. She underwent genetic testing which confirmed homozygosity of UDP- gluconyltrasnsferase1A1* 28 (UGT) allele which is associated with Gilbert’s syndrome. The patient completed six 28-day cycles of standard dose gemcitabine, specifically, 1000 mg/m2 on days 1, 8, and 15 of each cycle. Routine surveillance CT imaging obtained at the start of cycle 3 revealed new hepatic steatosis. The patient was continued on gemcitabine and repeat surveillance imaging obtained at the end of cycle 4 revealed severe diffuse hepatic steatosis

Primary Pancreatic Lymphoma Presenting as Acute Pancreatitis.

Primary pancreatic lymphoma (PPL) is a rare extranodal manifestation of any histopathologic subtype of non-Hodgkin lymphoma that predominantly involves the pancreas. Fewer than 2% of extranodal malignant lymphomas and 0.5% of all pancreatic masses constitute PPL.1 Common clinical manifestations include abdominal pain, jaundice, acute pancreatitis, small bowel obstruction, and diarrhea. The clinical and radiologic findings are not pathognomonic, and the diagnosis is established only after histopathologic and cytopathologic examination with confirmatory molecular testing. Although rare, this particular neoplasm is amenable to treatment even in very advanced stages