Hepatology Commons^™

Not All That Hurts Is Malignant: A Painful Case Of Focal Nodular Hyperplasia, Zamanali Khakhar, Abdullahi Abdigafar Yunis, Dayib Buthul, Khadija Warfa, Soraiya Manji, Rajiv Patel, Sayed Ali Raza Bukhari

Imaging & Diagnostic Radiology, East Africa

Focal nodular hyperplasia (FNH) is a benign hepatic lesion most often detected incidentally during imaging studies. While typically asymptomatic, a small subset of patients may present with abdominal pain or discomfort. Clinically and radiologically, FNH can mimic malignant liver tumors, occasionally resulting in unnecessary invasive procedures. This case report describes a 45-year-old woman with symptomatic FNH who was placed on routine imaging surveillance and managed conservatively. This case underscores the importance of accurately distinguishing this benign condition from hepatic malignancies. It further highlights the diagnostic challenges associated with achieving a definitive diagnosis.

Telehealth In Emergency Medicine Residency Training: A Model Curriculum, Laura Oh, Rahul Bhat, Michael J Carr, Aditi U Joshi, Bruce M Lo, Ashley C Rider, Lulu Wang, Michael C Wadman, Samuel D Luber

Faculty, Staff and Student Publications

Emergency physicians are well‐positioned to take a leadership role in telehealth, particularly in emerging categories such as triage, direct acute unscheduled care, and virtual observation. However, the growth of telehealth has outpaced curricular development in emergency medicine (EM) residency programs. This manuscript presents a model longitudinal telehealth curriculum, developed by the consensus of education experts, including representatives from the telehealth interest groups from EM's two primary specialty societies: the American College of Emergency Physicians and the Society for Academic Emergency Medicine. The curriculum describes overarching goals and components that may serve as a foundation for individual institutions seeking to train …

Steatotic Mass Secondary To Heterozygous Hemochromatosis, A Rare Case Of Biliary Obstruction, Saddam Zaidi Md, Cheng-Hung Tai, Joanna Gibson Md, Phd, Caroline Loeser

Posters

Heterozygous Hemochromatosis (HH) is a genetic disorder that increases iron absorption. Carriers of the C282Y HFE gene mutation have a higher risk of developing nonalcoholic fatty liver disease (NAFLD). Research indicates a significant association between liver fat accumulation (steatosis) and fibrosis in HH. This case involves a 31-year-old male with HH and an uncommon biliary obstruction caused by focal fat infiltration.

Evaluation Of Liver Fibrosis On Grayscale Ultrasound In A Pediatric Population Using A Cloud-Based Transfer Learning Artificial Intelligence Platform, Amr Mohammed, Aylin Tahmasebi, Sooji Kim, Mostafa Alnoury, Corinne E. Wessner, Tania Siu Xiao, Sharon W. Gould, Lauren A. May, Heidi Kecskemethy, David T. Saul, John R. Eisenbrey

Department of Radiology Faculty Papers

Objectives: The incidence of chronic liver diseases in children is increasing worldwide due to congenital, metabolic, autoimmune and viral diseases. Currently, liver biopsy for fibrosis assessment is considered the gold standard. However, this procedure is invasive, may result in unavoidable complications and is prone to sampling errors. These limitations have led to an increasing demand for noninvasive methods for fibrosis screening. Artificial intelligence integration in ultrasound diagnosis of liver fibrosis has gained interest in clinical research. In the current study we used a cloud-based artificial intelligence platform utilizing transfer learning to evaluate the accuracy of B-mode ultrasound based AI model …

Systemic Inflammatory Markers Of Persistent Cerebral Edema After Aneurysmal Subarachnoid Hemorrhage, Nadia Khan, Magdalena Kurnik-Łucka, Gniewomir Latacz, Krzysztof Gil

Faculty, Staff and Student Publications

In the first part of this article, the role of intestinal epithelial tight junctions (TJs), together with gastrointestinal dopaminergic and renin-angiotensin systems, are narratively reviewed to provide sufficient background. In the second part, the current experimental data on the interplay between gastrointestinal (GI) dopaminergic and renin-angiotensin systems in the regulation of intestinal epithelial permeability are reviewed in a systematic manner using the PRISMA methodology. Experimental data confirmed the copresence of DOPA decarboxylase (DDC) and angiotensin converting enzyme 2 (ACE2) in human and rodent enterocytes. The intestinal barrier structure and integrity can be altered by angiotensin (1-7) and dopamine (DA). Both …

Genomes Of Bacteroides Ovatus, B Cellulosilyticus, B Uniformis, Phocaeicola Vulgatus, And P Dorei Isolated From Gut Cavernous Fistulous Tract Micropathologies In Crohn’S Disease, Vaidhvi Singh, Gail West, Claudio Fiocchi, Fabio Cominelli, Caryn E Good, Michael R Jacobs, Alexander Rodriguez-Palacios

Faculty, Staff and Student Publications

Surgically removed bowels from Crohn's disease patients exhibit a novel form of micropathologies known as cavernous fistulous tract microlesions (CavFT), resembling fissures. We announce the genomes/plasmids and antimicrobial resistance genes of six CavFT bacterial isolates representing the Bacteroidota genera Bacteroides and Phocaeicola. Plasmids were identified in Bacteroides cellulosilyticus and Phocaeicola vulgatus.

Retrorectal Hernia: A Rare Cause Of Constipation Diagnosed On Magnetic Resonance (Mr) Defecography, Olanrewaju Ogunleye, Abeer H Abdelhafez, Eduardo Matta, Larry Kramer

Faculty, Staff and Student Publications

Retrorectal herniation of the sigmoid colon is a rare condition characterized by the protrusion of a segment of the colon into the pre-sacral space and posterior to the rectum. This herniation occurs through a defect in the peritoneum, which may have developed secondary to congenital mechanisms, surgery, trauma, or inflammatory processes. Here, a case of retrorectal herniation of the sigmoid colon in an elderly female patient presenting with constipation is reported, with a review of the literature.

Less Contrast, More Clarity, Innovative Visualization Technique For Management Of Multiple Colorectal Liver Metastases Using Microwave Ablation Through A Portal Venous Acces, Kelly Trinh, Muhammad Hamza Shamim, Mohammad Ghasemi-Rad

Faculty, Staff and Students Publications

Colorectal cancer, a leading cause of cancer-related deaths, often results in liver metastases, with about half of patients affected. For those ineligibles for surgery, percutaneous microwave ablation (MWA) offers a viable alternative. Conventionally, visualizing liver lesions prior to MWA demands significant IV contrast, often needing repeated sessions. We introduce a technique using minimal IV contrast to treat multiple metastatic lesions simultaneously. A case of a 47-year-old male with stage 4 colorectal adenocarcinoma and multiple liver metastases is presented. Instead of the typical 100-150 cc of IV contrast, our method used just 25 cc, successfully ablating 6 hepatic metastases in 1 …

The Utility Of Interventional Anesthesia, Kylie Daguio, Kiley Jackson, Samantha Boever, Andrew Chang, James Keane, Leonard B. Goldstein

SOMA Faculty Publications

no abstract

Advancing Virtual At-Home Care For Community Health Center Patients Using Patient Self-Care Tools, Technology, And Education [Letter], Cheryl Modica, Joy H. Lewis, Curtis Bay

SOMA Faculty Publications

Abstract

Introduction

Health centers are community-based, patient directed primary care providers that offer accessible, high-quality primary care within medically underserved communities. Screening for cancer and managing complex chronic conditions such as diabetes, hypertension, obesity, and depression are vital services for the vulnerable populations seen by community health centers. Delivering care for complex chronic conditions and preventive services using virtual models that integrate self-care tools and technology is an important approach to increasing access for hard-to-reach patients served by health centers.

Objective

This study aimed to explore the use of a virtual care model, applied using a systems approach and patient-driven …

Myasthenia Gravis And Numb Chin Syndrome With Lung Carcinoma, Rajesh Kumar Gupta, Ashutosh Gupta, Daniel S Um, Zarrin Khameh Neda

Faculty, Staff and Students Publications

No abstract provided.

Exosome Shedding Is Concordant With Objective Treatment Response Rate And Stratifies Time To Progression In Treatment Naïve, Non-Resectable Hepatocellular Carcinoma, Kelley G. Núñez, Dorota Wyczechowska, Mina Hibino, Tyler Sandow, Juan Gimenez, Ali R. Koksal, Yucel Aydin, Srikanta Dash, Ari J. Cohen, Paul T. Thevenot

School of Medicine Faculty Publications

Translational strategies to characterize and monitor extracellular vesicles such as exosome (EX) shedding and the clinical impact of this data within hepatocellular carcinoma (HCC) remains unclear. In this study, EX shedding was assessed in early-stage HCC and evaluated as a stratification factor for time to progression (TTP) following first-cycle liver-directed therapy (LDT). Plasma EXs were isolated from HCC patients undergoing LDT using ultracentrifugation. Purified EXs were stained using markers CD9 and CD63 and quantified using an ImageStreamX flow cytometer. Circulating EXs expressing CD9 were isolated at 10-fold higher levels compared to CD63. The intensity of CD9+ EX shedding following LDT …

A Method Using Longitudinal Laboratory Data To Predict Future Intestinal Complication In Patients With Crohn's Disease, James Irwin, Anton Lord, Emma Ferguson, Lisa A Simms, Katherine Hanigan, Carlos A Montoya, Graham Radford-Smith

Faculty, Staff and Student Publications

Background

Stenosis, fistulization, and perforation of the bowel are severe outcomes which can occur in patients with Crohn’s disease. Accurate prediction of these events may enable clinicians to alter treatment strategies and avoid these outcomes.

Aims

To study the correlation between longitudinal laboratory testing and subsequent intestinal complications in patients with Crohn’s disease.

Methods

An observational cohort of patients with Crohn’s disease at a single center were analyzed between 01/01/1994 and 06/30/2016. A complication was defined as the development of an intestinal fistula, stenosis, or perforation. Exploratory analysis using Cox regression was performed to select the best statistical method to …

Renal Cell Carcinoma Presenting With Upper Gastrointestinal Bleeding: A Case Report, James Mega, Rene Roberts, Mohamed M Shahin, Ahmed Kamel Abdel Aal

Faculty, Staff and Student Publications

Renal cell carcinoma (RCC) is increasing in incidence as more cross sectional imaging is performed with approximately 20%-30% of cases presenting with metastasis at the time of diagnosis. Small bowel metastatic disease is rare, with RCC to the small bowel being exceptionally rare. We present a case report of metastatic RCC that initially presented as upper gastrointestinal bleeding at time of diagnosis. We also provide a brief discussion of small bowel metastatic RCC disease and literature review.

Synergic Effect Of Cai And Lii On Ionic Conductivity Of Solution-Based Synthesized Li7p3s11 Solid Electrolyte, Binoy Yohannan, Allen C Omo-Ogboi, Varaha S Tammisetti, Adan Rios

Faculty, Staff and Student Publications

Autoimmune hepatitis (AIH) is a rare immune-mediated disease predominantly seen in women and triggered by various environmental factors. Rarely, AIH can be triggered by an underlying malignancy. We report a woman in her 60s who presented with markedly abnormal liver biochemical tests. Serology was positive for anti-smooth muscle antibodies and a liver biopsy confirmed AIH. During the hospital course, she developed sepsis and acute renal failure requiring dialysis support. Serum protein electrophoresis (SPEP) showed a monoclonal IgG kappa protein of 1.92 g/dL and a bone marrow biopsy revealed 7% clonal plasma cells. She had lytic lesions on skeletal survey confirming …

Surgical And Oncological Outcomes Of Hepatic Resection For Hepatocellular Carcinoma: Report From A Low Volume Centre In A Developing Country, Muhammad Rizwan Khan, Saleema Begum, Muhammad Tayyab Ul Hasan Siddiqui

Section of General Surgery

Objective: To review the surgical and oncological outcomes of patients who underwent hepatic resection for hepatocellular carcinoma (HCC).
Study design: Cohort study.
Place and duration of study: Department of Surgery of the Aga Khan University Hospital Karachi, from 2008 to 2019.
Methodology: Consecutive patients who underwent hepatic resection for HCC at the Hospital were included. The data were collected and analysed on aspects including demographics, liver function status, tumour characteristics, perioperative management, and surgical and oncological outcomes. Survival analyses were performed using the Kaplan-Meier method, and log-rank test was applied to determine the influence of variables on overall and disease-free …

Host Gut Resistome In Gulf War Chronic Multisymptom Illness Correlates With Persistent Inflammation, Dipro Bose, Somdatta Chatterjee, Ethan Older, Ratanesh Seth, Patricia Janulewicz, Punnag Saha, Ayan Mondal, Jeffrey M Carlson, Alan W Decho, Kimberly Sullivan, Nancy Klimas, Stephen Lasley, Jie Li, Saurabh Chatterjee

Faculty, Staff and Student Publications

Chronic multisymptom illness (CMI) affects a subsection of elderly and war Veterans and is associated with systemic inflammation. Here, using a mouse model of CMI and a group of Gulf War (GW) Veterans' with CMI we show the presence of an altered host resistome. Results show that antibiotic resistance genes (ARGs) are significantly altered in the CMI group in both mice and GW Veterans when compared to control. Fecal samples from GW Veterans with persistent CMI show a significant increase of resistance to a wide class of antibiotics and exhibited an array of mobile genetic elements (MGEs) distinct from normal …

Interventional Treatment With The Transjugular Intrahepatic Portosystemic Shunt (Tips) Procedure May Offer A Preferable Alternative To Systemic Anticoagulation In Patients With Cirrhosis And Portal Vein Thrombosis, Molly N. Pantelic

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising:

Wang Z, Jiang MS, Zhang HL, et al. Is post-tips anticoagulation therapy necessary in patients with cirrhosis and portal vein thrombosis? A randomized controlled trial. Radiology. 2016;279(3):943-951. https://doi.org/10.1148/radiol.2015150369

for a patient with cryptogenic cirrhosis, gastroesophageal varices, pancreatic cancer, and portal vein thrombosis.

Parallel Transjugular Intrahepatic Portosystemic Shunt With Viatorr® Stents For Primary Tips Insufficiency: Case Series And Review Of Literature, Driss Raissi, Qian Yu, Michael Nisiewicz, Steven Krohmer

Radiology Faculty Publications

BACKGROUND

Transjugular intrahepatic portosystemic shunts (TIPS) can alleviate complications of portal hypertension such as ascites and variceal bleeding by decreasing the portosystemic gradient. In limited clinical situations, parallel TIPS may be only solution to alleviate either variceal bleeding or ascites secondary to portal hypertension when the primary TIPS fails to do so. Data specifically addressing the use of this partially polytetrafluoroethylene covered nitinol stent (Viatorr^®) is largely lacking despite Viatorr^® being the current gold standard for modern TIPS placement.

CASE SUMMARY

All three patients had portal hypertension and already had a primary Viatorr^® TIPS placed previously. …

Delayed Hepatic Rupture Post Ultrasound-Guided Percutaneous Liver Biopsy: A Case Report., Jia-Yan Huang, Qiang Lu, Ji-Bin Liu

Department of Radiology Faculty Papers

RATIONALE: Hemorrhage, one of complications after liver biopsy, is often identified immediately after the procedure while delayed liver rupture is relatively rare.

PATIENT CONCERNS: A 45-year-old woman was diagnosed with undetermined liver cirrhosis and abnormal liver function. To determine the etiology and severity of liver cirrhosis, ultrasound-guided liver biopsy was arranged. The patients did not complain any pain during the procedure. Ultrasound examination on postoperative day1 (POD 1) and MRI on POD 3 showed no evidence of hematoma and ascites. On POD 7, however, the patient was taken to the hospital with a sudden onset of pain in the right …

Intrahepatic Cholangiocarcinoma Presenting As Li-Rads 5 "Hcc", Raja K. Dhanekula, Md, Donald Mitchell, Md, John Farber, Md, Ashwin R. Sama, Md, Jesse M. Civan, Md

Division of Gastroenterology and Hepatology Posters

Background

• Hepatocellular Carcinoma (HCC), if within Milan Criteria, is an indication for liver transplantation.

• In contrast, intrahepatic cholangiocarcinoma (IHCC) is a contra-indication to liver transplantation due to high rates of recurrence.

• LI-RADS 5 classification (synonymous with OPTN-5) carries a near 100% positive predictive value for HCC, allowing prioritization of patients for liver transplantation without histological confirmation.

• The “LI-RADS M” classification indicates the presence of malignancy not meeting diagnostic criteria for HCC. In theory, IHCC lesions should be identified as LI-RADS M and not LI-RADS 5.

Voxel-Level Absorbed Dose Calculations With A Deterministic Grid-Based Boltzmann Solver For Nuclear Medicine And The Clinical Value Of Voxel-Level Calculations, Justin Mikell

Dissertations and Theses (Open Access)

Voxel-level absorbed dose (VLAD) is rarely calculated for nuclear medicine (NM) procedures involving unsealed sources or 90Y microspheres (YM). The current standard of practice for absorbed dose calculations in NM utilizes MIRD S-values, which 1) assume a uniform distribution in organs, 2) do not use patient specific geometry, and 3) lack a tumor model. VLADs overcome these limitations. One reason VLADs are not routinely performed is the difficulty in obtaining accurate absorbed doses in a clinically acceptable time. The deterministic grid-based Boltzmann solver (GBBS) was recently applied to radiation oncology where it was reported as fast and accurate for both …

A Prospective Analysis Of Factors Associated With Decreased Physical Activity In Patients With Cirrhosis Undergoing Transplant Evaluation, Anna Christina Dela Cruz, Valery Vilchez, Sooyeon Kim, Benjamin Barnes, Abhishek Ravinuthala, Anthony Zanni, Roberto Galuppo, Achuthan Sourianarayanane, Trushar Patel, Erin Colleen Maynard, Malay B. Shah, Michael F. Daily, Timothy L. Uhl, Karyn A. Esser, Roberto Gedaly

Internal Medicine Faculty Publications

BACKGROUND: Physical activity has been associated with improved recovery time after transplantation. Handgrip strength has been related to post-transplant outcomes.

AIM: To evaluate predictors of physical activity and grip strength in cirrhotic patients undergoing liver transplant evaluation.

METHODS: Single center, prospective analysis.

RESULTS: A hundred patients were evaluated (54% male, mean age 53 ± 9). Common etiologies of liver disease were non-alcoholic hepatitis (27%), hepatitis C (22%), and alcoholic liver disease (21%). Mean MELD score was 13.5. Forty one percent had a history of smoking. Ninety-three patients completed the International Physical Activity Questionnaire. The median total physical activity score of …

Triphasic Computed Tomography (Ct) Scan In Focal Tumoral Liver Lesions, Saima Hafeez, Muhammad Shahbaz Alam, Zafar Sajjad, Zahid Anwar Khan, Waseem Akhter, Fatima Mubarak

Department of Radiology

OBJECTIVE: To assess the diagnostic accuracy of triphasic spiral CT in differentiating benign from malignant focal tumoral liver lesions.

METHODS: The study was conducted in Department of Radiology of Aga Khan University Hospital and Sind Institute of Urology and Transplantation, Karachi from Feb 2006 to Feb 2007. By convenient sampling, 45 patients found to have focal tumoral liver lesions were recruited for one year period and their triphasic CT scans findings were evaluated and later correlated with histopathology. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of triphasic CT scan were calculated.

RESULTS: Among 45 patients, 136 …

Prevalence Of Fatty Liver In Japanese Children Ages 4 To 12 Years Old : Relationship To Obesity : An Epidemiological Ultrasonographic Survey, Kunihiko Tominaga

Loma Linda University Electronic Theses, Dissertations & Projects

The prevalence of fatty liver disease in children is not well established and its relationship to childhood obesity is poorly defined. The present study of 810 northern Japanese school-aged children (4-12 years old), determined the prevalence of fatty liver and its relationship to gender and degree of obesity. Diagnosis of fatty liver was assessed by real-time ultrasonography.

RESULTS: 1. The overall prevalence of fatty liver is 2.6 %. 2. Fatty liver prevalence is higher for boys (3.4 %) than for girls (1.8 %), although not statistically significant (P = 0.15). 3. Fatty liver occurs in children as young as 6 …