Curbside Consultation of the Liver: 49 Clinical Questions

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Mitchell L. Shiffman
SLACK Incorporated, 2008 - Medical - 245 pages
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Are you looking for concise, practical answers to questions that are often left unanswered by traditional liver references? Are you seeking brief, evidence-based advice for complicated cases or complications? Curbside Consultation of the Liver: 49 Clinical Questions provides quick and direct answers to the thorny questions commonly posed during a “curbside consultation” between colleagues.

Dr. Mitchell Shiffman has designed this unique reference, which offers expert advice, preferences, and opinions on tough clinical questions commonly associated with the liver. The unique Q&A format provides quick access to current information related to the liver with the simplicity of a conversation between two colleagues. Numerous images, diagrams, and references are included to enhance the text and to illustrate the treatment of the liver.

Curbside Consultation of the Liver: 49 Clinical Questions provides information basic enough for residents while also incorporating expert advice that even high-volume clinicians will appreciate. Gastroenterologists, fellows, residents in training, and medical students will benefit from the user-friendly and casual format and the expert advice contained within.

Some of the questions that are answered:
• How often should I follow a patient who had chronic hepatitis C after they achieved a sustained virologic response?
• Should I stop the HIV medications in a patient who has developed an elevation in serum liver transaminases?
• What should I tell my patient who is a carrier for alpha-1-antitrypsin deficiency?
• Which patients with fatty liver disease on an ultrasound examination require a liver biopsy?
• Which patients with chronic liver disease should I screen for hepatocellular carcinoma?
• How much ascites is safe to remove at any time?

 
 

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Contents

WHAT Is THE LIKELIHOOD THAT MY PATIENT WITH CHRONIC HEPATITIS C WILL DEVELOP CIRRHOSIS HEPATOCELLULAR CARCI...
3
HOW SHOULD A PATIENT WHO TESTS POSITIVE FOR CHRONIC HEPATITIS C BUT HAS PERSISTENTLY NORMAL SERUM AMINOTRA...
7
DO ALL PATIENTS WITH CHRONIC HEPATITIS C VIRUS REQUIRE A LIVER BIOPSY?
11
HOW OFTEN SHOULD I MEASURE CHRONIC HEPATITIS C RNA WHILE TREATING A PATIENT WITH PEGINTERFERON AND RIBAVIRI...
17
WHEN A PATIENT RECEIVING PEGINTERFERON AND RIBAVIRIN THERAPY DEVELOPS ANEMIA SHOULD I PRESCRIBE EPOETIN ALF...
21
Is THERE ANYTHING I CAN DO TO IMPROVE THE CHANCE THAT AN AFRICAN AMERICAN WITH CHRONIC HEPATITIS C WILL RESP...
27
Is IT SAFE TO TREAT PATIENTS WITH CHRONIC HEPATITIS C AND CIRRHOSIS WITH PEGINTERFERON AND RIBAVIRIN?
31
HOW OFTEN SHOULD I FOLLOW A PATIENT WHO HAD CHRONIC HEPATITIS C AFTER HE ACHIEVED A SUSTAINED VIROLOGIC RES...
35
AN OBESE PATIENT WITH HYPERCHOLESTEROLEMIA WAS RECENTLY STARTED ON A STATIN AND IS NOW FOUND TO HAVE ELE...
137
WHAT Is THE BEST TREATMENT TO UTILIZE IN A PATIENT WITH FATTY LIVER DISEASE AND TYPE 2 DIABETES MELLITUS?
141
MY PATIENT WITH CHRONIC HEPATITIS C ALSO HAS EVIDENCE OF NONALCOHOLIC STEATOHEPATITIS ON HIS LIVER BIOPSY WH...
147
CAN A PATIENT OF NORMAL BODY WEIGHT A NORMAL SERUM CHOLESTEROL LEVEL AND No HISTORY OF DIABETES HAVE FAT...
151
WHEN SHOULD I INITIATE TREATMENT WITH URSODEOXYCHOLIC ACID AND WHAT DOSE SHOULD I UTILIZE IN MY PATIENT WI...
157
WHAT TYPE OF TESTING DOES MY PATIENT WITH PRIMARY BILIARY CIRRHOSIS REQUIRE?
161
IS URSODEOXYCHOLIC ACID EFFECTIVE FOR THE TREATMENT OF PRIMARY SCLEROSING CHOLANGITIS?
167
SHOULD I BE SCREENING MY PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS FOR CHOLANGIOCARCINOMA?
171

WHICH PATIENTS WITH CHRONIC HEPATITIS B REQUIRE A LIVER BIOPSY?
41
HOW DO I DECIDE WHICH MEDICATION TO UTILIZE IN A PATIENT WITH HEPATITIS B VIRUS?
47
CAN I EVER STOP TREATMENT IN A PATIENT WITH CHRONIC HEPATITIS B RECEIVING AN ORAL ANTIVIRAL AGENT?
53
HOW DO I KNOW WHEN A PATIENT RECEIVING AN ORAL ANTIVIRAL AGENT HAS DEVELOPED RESISTANCE AND WHAT Do I Do ...
59
HOW DO I TREAT A PATIENT WHO IS COINFECTED WITH CHRONIC HEPATITIS B AND C VIRUSES?
65
HOW DOES HAVING HIV AFFECT THE LIKELIHOOD THAT MY PATIENT WITH CHRONIC HEPATITIS C WILL DEVELOP CIRRHOSIS?
71
WHICH PATIENTS WITH CHRONIC HEPATITIS C AND HIV COINFECTION SHOULD BE TREATED WITH PEGINTERFERON AND RIBAVI...
75
IS THERE A SIMPLE WAY TO TREAT A PATIENT WHO IS COINFECTED WITH HEPATITIS B VIRUS AND HIV?
81
WHAT THINGS COULD CAUSE MY PATIENT WITH HIV TO DEVELOP JAUNDICE?
89
SHOULD I STOP HIV MEDICATIONS IN A PATIENT WHO HAS DEVELOPED AN ELEVATION IN SERUM TRANSAMINASES?
93
WHAT IS THE BEST SCREENING TEST FOR GENETIC HEMOCHROMATOSIS?
99
QUESTION 20 HOW FREQUENTLY SHOULD I HAVE A PATIENT WITH GENETIC HEMOCHROMATOSIS UNDERGO PHLEBOTOMY?
105
WHAT IS THE BEST SCREENING TEST FOR WILSONS DISEASE?
109
WHAT SHOULD I TELL MY PATIENT WHO IS A CARRIER FOR ALPHA1ANTITRYPSIN DEFICIENCY?
113
DO ALL PATIENTS WITH AUTOIMMUNE HEPATITIS REQUIRE IMMUNE SUPPRESSIVE MEDICATIONS?
119
MY PATIENT WITH AUTOIMMUNE HEPATITIS CANNOT TAKE CORTICOSTEROIDS ARE THERE OTHER MEDICATIONS I COULD USE?
123
DO I NEED TO PERFORM A LIVER BIOPSY IN ALL PATIENTS WITH AUTOIMMUNE HEPATITIS PRIOR TO INITIATING STEROIDS?
127
WHICH PATIENTS WITH FATTY LIVER DISEASE ON ULTRASOUND REQUIRE A LIVER BIOPSY?
133
SHOULD ALL PATIENTS WITH SUSPECTED PRIMARY SCLEROSING CHOLANGITIS UNDERGO AN ENDOSCOPIC RETROGRADE CHOL...
175
MY PATIENT WITH ULCERATIVE COLITIS RECENTLY UNDERWENT A TOTAL COLECTOMY FOR SEVERE DYSPLASIA DOES THIS RE...
179
WHICH ASYMPTOMATIC PATIENTS WITH CIRRHOSIS SHOULD UNDERGO AN UPPER ENDOSCOPY TO DETERMINE WHETHER THEY ...
183
I JUST BANDED ACTIVELY BLEEDING VARICES IN A PATIENT WITH KNOWN CIRRHOSIS THE PATIENT IS NOW HEMODYNAMICAL...
187
WHICH PATIENTS WITH CHRONIC LIVER DISEASE SHOULD I SCREEN FOR HEPATOCELLULAR CARCINOMA?
191
SHOULD I VACCINATE MY PATIENTS WITH CIRRHOSIS FOR HEPATITIS A AND B?
195
A HEALTHY PATIENT NOT KNOWN TO HAVE CHRONIC LIVER DISEASE WITH NORMAL LIVER CHEMISTRIES AND LIVER FUNCTIO...
199
I WAS ASKED TO SEE A PATIENT WITH TENSE ASCITES How MUCH ASCITES IS SAFE TO REMOVE AT ANY ONE TIME?
203
I HAVE BEEN INCREASING THE DOSE OF DIURETICS IN MY PATIENT WITH ASCITES OVER SEVERAL WEEKS HE STILL HAS ASCITE...
207
MY PATIENT WITH CRYPTOGENIC CIRRHOSIS WAS RECENTLY HOSPITALIZED WITH SPONTANEOUS BACTERIAL PERITONITIS How...
211
MY PATIENT WITH CIRRHOSIS HAS AN ELEVATED SERUM AMMONIA BUT No SYMPTOMS OF HEPATIC ENCEPHALOPATHY HOW M...
215
MY PATIENT WITH HEPATIC ENCEPHALOPATHY CONTINUES TO BE MILDLY CONFUSED DESPITE TAKING LACTULOSE TWICE DAI...
219
MY PATIENT WITH CIRRHOSIS SUFFERS FROM SEVERE FATIGUE BUT HAS NORMAL LIVER FUNCTION AND HAS NEVER HAD A MAJ...
223
WHAT SHOULD I RECOMMEND FOR MY PATIENT WITH CIRRHOSIS WHO WAS RECENTLY FOUND TO HAVE A NEW 2CENTIMETER ...
227
I HAVE BEEN ASKED TO SEE A PATIENT WHO HAD A LIVER TRANSPLANT 5 YEARS AGO IN ANOTHER STATE HE HAS NOT BEEN S...
233
INDEX
237
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About the author (2008)

\Mitchell L. Shiffman, MD received his MD degree from the State University of New York, Upstate Medical Center in Syracuse, NY. He then completed internship and residency training in Internal Medicine at the Medical College of Virginia (now the Virginia Commonwealth University Medical Center) in Richmond, VA. He remained at this institution for fellowship training in Gastroenterology and Hepatology, which included two years of research training funded by a National Institutes of Health training grant. After completing his training, Dr. Shiffman joined the faculty of the Virginia Commonwealth University as an Assistant Professor of Medicine and has remained at this institution throughout his academic career. He is currently a Professor of Medicine, and has been the Chief of the Hepatology Section and Medical Director of the Liver Transplant Program at the VCU Medical Center for over a decade. Dr. Shiffman has authored or coauthored over 200 original articles, editorials, reviews, and/or book chapters. His clinical research has focused on improving our understanding and developing better treatments for viral hepatitis B and C. He is a member of the Board of Trustees of the American College of Gastroenterology, and has served on numerous NIH grant review committees and is a member of the Editorial Boards of Liver Transplantation and Liver International.

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