Nov 262013
 
Related Articles

Metal storage disorders: Wilson disease and hemochromatosis.

Med Clin North Am. 2014 Jan;98(1):87-102

Authors: Kanwar P, Kowdley KV

Abstract
Hereditary hemochromatosis and Wilson disease are autosomal recessive storage disorders of iron and copper overload, respectively. These metals are involved in multiple redox reactions, and their abnormal accumulation can cause significant injury in the liver and other organs. Over the last few decades clinicians have developed a much better understanding of these metals and their mechanism of action. Moreover, sophisticated molecular genetic testing techniques that make diagnostic testing less invasive are now available. This article updates and discusses the pathogenesis, diagnosis, and management of these metal storage disorders.

PMID: 24266916 [PubMed - in process]

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Nov 262013
 
Related Articles

Management of End-stage Liver Disease.

Med Clin North Am. 2014 Jan;98(1):119-52

Authors: Liou IW

Abstract
Major complications of cirrhosis include the development of ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, variceal hemorrhage, hepatic encephalopathy, and hepatocellular carcinoma. Careful evaluation and management of ascites and varices with judicious use of prophylactic therapy can improve survival. Diagnosis of hepatic encephalopathy can lead to appropriate intervention without protein restriction. Patients should undergo hepatocellular carcinoma surveillance routinely every 6 months. The development of any decompensating event should prompt referral to a liver transplant center.

PMID: 24266918 [PubMed - in process]

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Nov 262013
 
Related Articles

Management of End-stage Liver Disease.

Med Clin North Am. 2014 Jan;98(1):119-52

Authors: Liou IW

Abstract
Major complications of cirrhosis include the development of ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, variceal hemorrhage, hepatic encephalopathy, and hepatocellular carcinoma. Careful evaluation and management of ascites and varices with judicious use of prophylactic therapy can improve survival. Diagnosis of hepatic encephalopathy can lead to appropriate intervention without protein restriction. Patients should undergo hepatocellular carcinoma surveillance routinely every 6 months. The development of any decompensating event should prompt referral to a liver transplant center.

PMID: 24266918 [PubMed - in process]

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Nov 262013
 
Related Articles

Cholestatic liver disease.

Med Clin North Am. 2014 Jan;98(1):73-85

Authors: Gossard AA, Talwalkar JA

Abstract
Cholestatic liver disease may involve both extrahepatic and intrahepatic bile ducts, or may be limited to one or the other. Cholestasis may be due primary bile duct disease or secondary causes such as stones or tumors. Care of the patient with cholestasis depends on identifying the probable cause, initiating appropriate treatment or intervention, and the recognition and management of potential complications.

PMID: 24266915 [PubMed - in process]

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Nov 052013
 
Related Articles

Patients with chronic kidney disease.

Med Clin North Am. 2013 Nov;97(6):1109-22

Authors: Kalamas AG, Niemann CU

Abstract
Chronic kidney disease (CKD) is a major public health problem worldwide. Roughly 1 in 10 adult Americans has CKD. These patients are at significant risk for excessive morbidity and mortality during the perioperative period. Given the health and cost burden of end-stage renal disease (ESRD), preventing or avoiding progression of CKD to ESRD is critical. Therefore, identifying risk factors and implementing risk mitigation strategies to prevent further deterioration of renal function during the perioperative period is of paramount importance. This article reviews patient risk stratification, preoperative evaluation and management, and perioperative interventions for renal protection.

PMID: 24182722 [PubMed - in process]

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Nov 052013
 
Related Articles

Patients with disorders of thrombosis and hemostasis.

Med Clin North Am. 2013 Nov;97(6):1161-80

Authors: Orfanakis A, Deloughery T

Abstract
Surgery, by definition, is a challenge to the hemostatic system. In addition, a surgical procedure may provoke inappropriate venous or arterial thrombosis, such as is suggested historically by Virchow's Triad. For these reasons, proper functioning of the hematologic system is integral in a successful and safe perioperative period. Patients with a disorder of either coagulation or hemostasis, therefore, present an exciting challenge to the preoperative physician. Diagnosis of a hematologic disorder may be more or less occult. A proper bleeding and clotting history can serve to elucidate such a disorder and is therefore paramount to the preoperative workup. For those patients with a previously diagnosed disorder of the hematologic system, appropriate laboratory investigation and a concise therapeutic plan for the day of surgery can help to minimize risks in the perioperative period.

PMID: 24182725 [PubMed - in process]

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