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

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

Clinical Images: Colorectal Foreign Body

Case Presentation A 42 year-old male was admitted to the hospitalwith a known retained foreign body. A can ofshaving cream was inserted into the patient’srectum several days prior to presentation. Onadmission, an abdominal radiograph (Figure1) was taken to confirm the position of theforeign body and the absence of free air inthe abdomen. The patient was taken to theoperating room and under local anesthesiaunderwent successful transanal removal ofthe aerosol can using tenaculum forceps.There was no evidence of bowel perforation.The patient was transferred to the recoveryroom in stable condition

Hematuria Leads to a New Diagnosis of Cirrhosis.

A known consequence of portal hypertension is the development of varices, which are described as ectopic when located at unusual sites in the abdomen. Ectopic varices carry a mortality rate as high as 40% after initial hemorrhagic episode. We report a patient who presented with hematuria secondary to bladder varices as the presenting symptom for a new diagnosis of cirrhosis. Cross-sectional imaging, early recognition of this rare event, combined with multidisciplinary management was essential for this patient to have a successful outcome

Enteral Nutrition Support for a Sarcopenia in End-Stage Liver Disease

Introduction Weight loss with muscle wasting, also known as sarcopenia, commonly occurs in patients with end-stage liver disease (ESLD). A robust association between sarcopenia and mortality in cirrhotic and post-liver transplant patients has been reported. This is a report of a patient with severe sarcopenia and ESLD who was provided enteral nutrition using a Dobhoff tube (DHT) pre-liver transplant resulting in successful bridging to transplant

Listing practices for Morbidly Obese Patients at Liver Transplant Centers in the United States

Introduction Obesity affects more than one third of Americans. Morbid obesity (body mass index (BMI) \u3e35 kg/m2) has been associated with multiple co-morbidities and perioperative complications. The effect of morbid obesity on liver transplant outcomes has yielded mixed results