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[Pyogenic abscesses of the liver].

Pyogenic abscesses of the liver represent a serious nosologic unit with high morbidity and mortality rates. Their diagnostics is based on ultrasonography, computer tomography or MRI, or positrone emission tomography. The principal treatment procedure includes percutaneous draining of the abscess cavity under the ultrasound or CT control. The authors present a group of 83 subjects hospitalized from 2000 to 2006 for pyogenic abscesses of the liver. Obstruction of the bile ducts, acute cholecystitis and resections of the liver or pancreas for malignancies were recorded as the commonest causes of …

The liver in celiac disease.

Celiac disease is a common (1% prevalence) chronic immune-mediated disorder of the small intestine induced by dietary wheat, barley, and rye. Several hepatic disorders have been described in association with celiac disease. Isolated hypertransaminasemia with nonspecific histologic changes in a liver biopsy is the commonest hepatic presentation of celiac disease. A gluten-free diet normalizes liver enzymes and histologic changes in most patients. Moreover, celiac disease can coexist with autoimmune liver disorders such as autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing c…

Tumors of the liver in children.

In this review we examine the diagnosis and treatment of pediatric liver tumors- both malignant and benign. The two most common malignant tumors are hepatoblastoma and hepatocellular carcinoma. Hepatoblastoma is seen in younger children, hepatocellular carcinoma in older children. Other malignant liver tumors are quite rare and include biliary rhabdomyosarcoma, angiosarcoma, rhabdoid tumor, and undifferentiated sarcoma. The commonly seen benign liver tumors in children are infantile hemangioma, mesenchymal hamartoma, and focal nodular hyperplasia. Rare benign tumors are hepatic adenoma, which …

The Liver in Systemic Illness

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… Biopsy diagnosis of liver disease. Williams & Wilkins; Baltimore: 1992. p. 183. 50. Vyberg M, Ravn V, Anderson B. Pattern of progression of liver injury following jejunoileal bypass for morbid obesity. Liver. 1987;7:271. doi: 10.1111/j.1600-0676.1987.tb00355.x. 51. … Acute liver failure due to lymphoma: a diagnostic concern when considering liver transplantation. Dig Dis Sci. 1994;39:1351. doi: 10.1007/BF02093804. 198. Rowbotham D, Wendon J, Williams R. Acute liver failure secondary to hepatic infiltration: a single center experience of 18 cases. …

MR imaging of the liver.

MR imaging is establishing a role as a primary diagnostic technique, with increasing evidence showing MR imaging to have advantages over CT regarding diagnostic sensitivity and specificity for many pathologies of solid organs, bile and pancreatic ducts, bowel, peritoneum, and retroperitoneum. In addition, there are increasing concerns regarding the risks of radiation and iodinated contrast associated with CT imaging of the abdomen. The incidence of contrast-induced nephropathy associated with iodinated contrast used for CT scanning is difficult to ascertain because reporting is spurious and va

Polycystic disease of the liver.

Autosomal dominant polycystic disease is genetically heterogeneous with mutations in two distinct genes predisposing to the combination of renal and liver cysts (AD-PKD1 and AD-PKD2) and mutations in a third gene yielding isolated liver cysts (the polycystic liver disease gene). Transcription and translation of the PKD1 gene produces polycystin-1, an integral membrane protein that may serve as an extracellular receptor. Mutations occur throughout the PKD1 gene, but more severe disease is associated with N-terminal mutations. The PKD2 gene product, polycystin-2, is an integral membrane protein …

Cysteinyl-leukotrienes and the liver.

Leukotrienes are potent biological mediators implicated in an increasing number of disease processes. This review outlines the basic biology of leukotrienes and discusses recent developments in our understanding of the specific role of cysteinyl-leukotrienes (cLTs) in cholestasis, hepatic inflammation, portal hypertension, and the pathogenesis of the hepatorenal syndrome (HRS).

The liver and the haemeostatic system.

The liver plays a central role in the control of haemostasis being the site of synthesis of most of the coagulation factors and natural anticoagulants, as well as fibrinolytic factors except the main activators of the fibrinolytic system (t-PA and u-PA). The liver also clears many of the activated clotting and fibrinolytic factors, as well as haemostatic activation complexes (TAT and PAP) and end product of fibrin degradation, FDP. Therefore, liver disease results in a complex and multifactorial pattern of defects in haemostatic function in the form of: (i) decreased synthesis of coagulation f…

Isolation perfusion of the liver.

Thousands of patients die annually from unresectable metastatic or primary hepatic cancers confined to liver. Isolated hepatic perfusion (IHP) is a regional treatment strategy in which the vascular supply to the liver is isolated and perfused with a therapeutic regimen using an extracorporeal circuit consisting of a reservoir, heat exchanger, and oxygenator. Drug doses that would cause severe toxicities if delivered systemically can be confined to the liver by isolated hepatic perfusion, resulting in the ability to intensify treatment to the cancer-burdened region of the body. Agents and mecha…

The fatty liver in AIDS.

Steatosis or fatty liver in individuals with human immunodeficiency virus (HIV) may result from HIV itself, the use of nucleoside analogues, concurrent infection with hepatitis B or C, alcohol use, diabetes mellitus, obesity, or combinations of these factors. Nucleoside analogues have been the focus of increasing concern, because several fatal cases of severe macrosteatosis, lactic acidosis, and hepatomegaly have been linked to the use of nucleoside analogues. Other classes of antiretroviral drugs, as well as opportunistic infections, can also cause hepatic injury without steatosis. The additi…

Inflammatory disease of the liver.

Imaging and imaging guided intervention have revolutionized the management of hepatic inflammatory diseases. Pyogenic abscess is preferentially treated percutaneously. Radiologic techniques are crucial for the diagnosis of amebic liver abscess and infectious conditions of the liver in immunocompromised patients.

Liver disease in the elderly.

Despite several morphologic and functional changes that have been described in the aging liver, most relevant studies fail to identify a significant age-related deficit in liver function in humans. One of the important age-related changes is a decrease in regenerative capacity, which may partly explain the impaired recovery after severe viral and toxic injury in the elderly. Nevertheless, livers from older subjects are used successfully for transplantation. Substantial morbidity and mortality in the elderly is attributable to liver diseases, and the number of patients older than 65 years of ag…

[Diabetes mellitus and the liver].

Liver diseases are frequently associated with disorders of the carbohydrate metabolism--impaired glucose tolerance, hyperinsulinaemia, insulin resistance. Impaired glucose tolerance is due in particular to impaired glucose uptake in the splanchnic area and periphery. Glucose production by the liver is normal, similarly as insulin secretion. Its reduced clearance leads to hyperinsulinaemia with subsequent down regulation of insulin receptors and the development of insulin resistance. In diabetic subjects hepatomegaly is frequent, most frequently associated with steatosis of the liver. It correl…

Paracetamol, alcohol and the liver.

It is claimed that chronic alcoholics are at increased risk of paracetamol (acetaminophen) hepatotoxicity not only following overdosage but also with its therapeutic use. Increased susceptibility is supposed to be due to induction of liver microsomal enzymes by ethanol with increased formation of the toxic metabolite of paracetamol. However, the clinical evidence in support of these claims is anecdotal and the same liver damage after overdosage occurs in patients who are not chronic alcoholics. Many alcoholic patients reported to have liver damage after taking paracetamol with 'therapeutic int…

The liver in choledochal cyst.

BACKGROUND/PURPOSE: Hepatic changes due to choledochal cyst have not been given due emphasis in the published literature. In this study the gross and microscopic appearance of the liver in patients with choledochal cyst have been correlated with clinical features, liver function tests and postoperative complications. METHODS: A retrospective evaluation of patients treated for choledochal cysts between January 1989-December 1998 was undertaken. The case records were reviewed and liver biopsies taken at surgery were analysed. RESULTS: The case records of 22 patients were reviewed (16 girls, 6 …

Pregnancy and cirrhosis of the liver.

Pregnancy in patients with cirrhosis of the liver is uncommon. We reviewed 9 pregnancies in 7 patients with cirrhosis. One patient conceived within 1 month of diagnosis and in another the disease was diagnosed during the index pregnancy. Four patients has associated portal hypertension and 1 of them conceived after lienorenal shunt. Complications associated with these pregnancies were jaundice (1) jaundice plus ascites (2) and gastrointestinal bleeding (1). In 2 patients endoscopic sclerotherapy was done during the index pregnancy. The incidence of preterm delivery was 50% (4 of 8) and the maj…