Curbside Consultation of the Liver: 49 Clinical Questions by Mitchell Shiffman MD

By Mitchell Shiffman MD

Are you trying to find concise, sensible solutions to questions which are frequently left unanswered by means of conventional liver references? Are you looking short, evidence-based suggestion for classy circumstances or problems? Curbside session of the Liver: forty nine scientific Questions offers fast and direct solutions to the thorny questions usually posed in the course of a “curbside session” among colleagues.

Dr. Mitchell Shiffman has designed this special reference, which bargains professional recommendation, personal tastes, and reviews on difficult scientific questions generally linked to the liver. the original Q&A layout presents easy accessibility to present details on the topic of the liver with the simplicity of a talk among colleagues. a variety of photographs, diagrams, and references are incorporated to augment the textual content and to demonstrate the therapy of the liver.

Curbside session of the Liver: forty nine scientific Questions presents info simple sufficient for citizens whereas additionally incorporating professional suggestion that even high-volume clinicians will take pleasure in. Gastroenterologists, fellows, citizens in education, and scientific scholars will enjoy the undemanding and informal layout and the professional recommendation contained within.

Some of the questions which are answered:
• How frequently may still I persist with a sufferer who had persistent hepatitis C when they accomplished a sustained virologic response?
• should still I cease the HIV drugs in a sufferer who has constructed an elevation in serum liver transaminases?
• What may still I inform my sufferer who's a service for alpha-1-antitrypsin deficiency?
• Which sufferers with fatty liver ailment on an ultrasound exam require a liver biopsy?
• Which sufferers with continual liver sickness should still I display for hepatocellular carcinoma?
• How a lot ascites is secure to take away at any time?


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Adapted from Conjeevaram HS, Fried MW, Jeffers LJ, et al. Peginterferon and ribavirin treatment in African American and Caucasian American patients with hepatitis C genotype 1. Gastroenterology. 2006;131:470-477). ronmental factors, or serum HCV RNA level. Interferon binds to its cell surface receptor equally well in African Americans as in Caucasians. Based upon these data there are basically two strategies that can be utilized to enhance the effectiveness of interferon therapy in African Americans.

6 The use of epoetin alfa in patients whose hemoglobin fell to below 12 mg/dL was associated with a marked improvement in quality of life and enabled 80% of patients to both remain on their starting ribavirin dose and to complete treatment. However, this study failed to assess the impact of epoetin alfa on either virologic response or SVR. 7 In this study, patients were randomly assigned to receive either peginterferon and ribavirin (P+R); peginterferon, ribavirin, and epoetin alfa (P+R+E); peginterferon; or a 200-mg higher dose of ribavirin and epoetin alfa.

Furthermore, the overall cost benefit when a patient with cirrhosis achieves a sustained virologic response (SVR) is enormous, because this reduces future medical costs associated with complications of cirrhosis and liver transplantation. Patients with cirrhosis have been included in nearly all of the large clinical trials designed to evaluate the efficacy of peginterferon with or without ribavirin. A specific study limited to patients with advanced fibrosis and cirrhosis was also conducted with peginterferon alfa-2a.

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