Gastroenterology Commons^™

Cecal Bascule After Colonoscopy - Case Report And Review Of Literature, Nihar Shah Md, Hiren Patel Md, Varun Patel Md, Robert Spira

Gastroenterology

Cecal bascule is a rare disease variant of a cecal volvulus. It consists of upward and anterior folding of the ascending colon, forming a flap valve, and occluding the bowel lumen resulting in proximal cecal dilatation. Herein, we present a case of a patient who developed persistent abdominal pain few hours after a colonoscopy. CT scan of the abdomen revealed an upward and anterior folding of the cecum. Subsequently the patient was taken to the operating room for a right hemi-colectomy. This case emphasizes the importance to consider cecal bascule as a differential diagnosis in patients with persistent abdominal pain …

Role Of Non-Selective Beta Blockers In Hepatocellular Carcinoma: An Analysis In Patients With Cirrhosis And Portal Hypertension, Hiren Patel, Abhishek Kumar, Nihar Shah Md, Ela Eris, Michael Maroules, Walid J. Baddoura, Vincent A. Debari

Gastroenterology

There are many different biochemical processes responsible for the hepatocelluar carcinoma (HCC) development that can be targeted for the prevention or halt progression of the HCC. Non-selective betablockers (NSBB) affects a multitude of intracellular biochemical and signaling pathways involved in carcinogenesis. Aim: To determine if NSBB may be protective for HCC in patients with cirrhosis and portal hypertension. Methods: We retrospectively enrolled 200 patients from medical records diagnosed with cirrhosis and portal hypertension between January 2001 and December 2013. Eighteen patients were excluded (taking selective beta-blocker and/or unavailable medical records). The etiology of cirrhosis, use of NSBB, demographics and the …

An Unusual Initial Presentation Of Hepatocellular Carcinoma As A Sellar Mass, Nihar Shah Md, Yana Cavanagh, Hamid Shaaban, Beth Stein, Sohail N. Shaikh, Dharmesh H. Kaswala, Walid Baddoura

Gastroenterology

Sellar masses are frequently adenomatous pituitary tumors. Metastatic disease is unusual, often mimicking the presentations of adenomas. Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy but unusual to have a pituitary metastasis (PM). A 65-year-old man presented with headache, diplopia, ptosis, decreased vision in the right eye and unintentional weight loss of 32lbs. Preliminary out-patient work-up revealed a mass in the pituitary region. Cranial imaging showed 3.1 cm × 3.2 cm × 4.4 cm lesion. Abdominal imaging (computed tomography and magnetic resonance imaging) demonstrated a lobulated, nodular and heterogeneous right lobe of the liver. Trans-sphenoidal resection of the …

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Hepatic Encephalopathy In Chronic Liver Disease: Predisposing Factors In A Developing Country, Fakhar Qazi, Shameem Behram Khan, Anam Umar

Section of Gastroenterology

Objective: To fi nd out the risk factors for developing Hepatic Encephalopathy in patients suffering from Chronic liver disease.

Background: Hepatic encephalopathy (HE) is a neuropsychiatric disorder that is caused by liver damage. In its pathology, alterations in normal brain function are associated with an increase in blood ammonia, benzodiazepine like substances, products of neurotoxic fatty acids, and other gut derived toxins, which gain access to the brain as a result of liver dysfunction.

Study Design: Hospital based descriptive, cross sectional study.

Settings: Medical Unit 1, Ward- 5, Jinnah Post Graduate Medical Centre, Karachi.

Duration: July 2013 to December 2013. …

Morbidity And Mortality Assessment In Acute Hepatitis-E, Lubna Kamani, Saeed Sadiq Hamid, Faisal Wasim Ismail, Syed Waqas Haider, Safia Awan, Ashfaq Ahmed, Wasim Jafri

Department of Medicine

Background: Hepatitis-E is an enterically transmitted virus causing acute hepatitis. Mostly it is a self-limiting clinical course, but can be life threatening in certain high risk groups. Pakistan is endemic for Hepatitis-E with limited published literature. The aim of this study is to evaluate the predictors of mortality in patients with acute Hepatitis-E.
Methods: We analyzed the medical records of 369 adult patients with Hepatitis-E infection admitted at Aga khan University Hospital, from January 1996 to December 2010. Details of their laboratory investigations, clinical course and complications such as FHF and mortality were noted. The outcome was compared, and determinants …

Undifferentiated Carcinoma With Osteoclast-Like Giant Cells Of The Pancreatic Tail, Patrick Hickey Do, Ranjit R. Nair Md, Victoria A. Loven Md, Jeffrey Brodsky Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

Endoscopic Mucosal Resection And Radiofrequency Ablation For Intramucosal Adenocarcinoma In The Background Of Barrett’S Esophagus: A Case Series, Bonnie Patek Do, Patrick Hickey Do, Hiral N. Shah Md, Shashin Shah Md

Department of Medicine

No abstract provided.

Is It Time To Replace Propranolol With Carvedilol For Portal Hypertension?, Shahab Abid, Saadat Ali, Muhammad Asif Baig, Anam Akbar Waheed

Section of Gastroenterology

Beta-adrenergic receptor antagonists (beta-blockers) have been well established for use in portal hypertension for more than three decades. Different Non-selective beta-blockers like propranolol, nadolol, timolol, atenolol, metoprolol and carvedilol have been in clinical practice in patients with cirrhosis. Carvedilol has proven 2-4 times more potent than propranolol as a beta-receptor blocker in trials conducted testing its efficacy for heart failure. Whether the same effect extends to its potency in the reduction of portal venous pressures is a topic of on-going debate. The aim of this review is to compare the hemodynamic and clinical effects of carvedilol with propranolol, and attempt …

Accuracy Of Melena Identification On Physical Exam In Post Graduate Training – Implications Of Level Of Training, Medical Specialty, Rectal Exam Concordance And Appropriateness Of Therapy, Richard M. Wu, Md, Mph, Eugene Han, Md, Andrew Dargan, Md, Cecilia Kelly, Md, Mitchell Conn, Md, Mba

Division of Gastroenterology and Hepatology Faculty Papers

Introduction

Melena is commonly misidentified by young resident physicians.

The magnitude of this inaccurate physical exam has not been quantified.

Precise identification of melena may have important diagnostic and therapeutic implications.

Bones Of Contention: Bone Mineral Density Recovery In Celiac Disease—A Systematic Review, Patricia Grace-Farfaglia

Nutrition Sciences Faculty Publications

Metabolic bone disease is a frequent co-morbidity in newly diagnosed adults with celiac disease (CD), an autoimmune disorder triggered by the ingestion of dietary gluten. This systematic review of studies looked at the efficacy of the gluten-free diet, physical activity, nutrient supplementation, and bisphosphonates for low bone density treatment. Case control and cohort designs were identified from PubMed and other academic databases (from 1996 to 2015) that observed newly diagnosed adults with CD for at least one year after diet treatment using the dual-energy x-ray absorptiometry (DXA) scan. Only 20 out of 207 studies met the inclusion criteria. Methodological quality …

Evaluation Of Tulane Virus As A Surrogate For The Study Of Human Norovirus, Sabastine Eugene Arthur

Graduate Theses and Dissertations

Among all known causes of acute gastroenteritis, human noroviruses (HuNoV) are the primary cause (68%) of outbreaks and are associated with 78% of illnesses, 46% of hospitalizations, and 86% of deaths. The main obstacle to studying the pathogenesis of HuNoV is the lack of cell culture system and small animal model. Murine norovirus (MNV) and feline calicivirus (FCV) have been utilized as model surrogate viruses to study HuNoV. In this research, a more recent surrogate virus, Tulane virus (TV), was evaluated for physicochemical stability and environmental persistence. The primary goal was to determine the suitability of TV as a surrogate …

Characterization And Investigation Of Fungi Inhabiting The Gastrointestinal Tract Of Healthy And Diseased Humans, Mallory J. Suhr

Department of Food Science and Technology: Dissertations, Theses, and Student Research

Gastrointestinal microbiome studies have failed to include fungi in total community analyses. As a result, their diversity and function in the gut is poorly understood. Recent work has begun to uncover the role intestinal fungi play in diet, immune system development, interactions with other microorganisms in the gut, and pathogenesis of diseases. Advances in sequencing technologies allow for the ability to profile the fungal gut microbiome (“mycobiome”) in healthy and diseased states. This thesis explores the mycobiome in 1) healthy humans with a vegetarian diet and 2) pediatric small bowel transplant recipients that develop fungal bloodstream infections.

The gut mycobiome …

Granular Cell Tumor Of The Common Hepatic Duct As An Unusual Cause Of Jaundice In A Hepatitis C Patient: Looking Beyond The Tip Of The Iceberg!, Tripti R. Chopade, Mbbs, Colin L. Smith, Md, Warren R. Maley, Md, Ali A. Siddiqui, Md, David A. Sass, Md

Division of Gastroenterology and Hepatology Faculty Papers

Introduction

Granular cell tumors (GCTs) are rare, benign mesenchymal tumors of Schwann cell origin. Since they were originally described by Abrikossoff in 1926,most GCTs have been described in the dermis, oral area, or subcutaneous tissue of the chest and arms. Only 5%-9% of reported cases have involved the gastrointestinal tract and fewer than 1% of cases have occurred in the biliary tract.Tumors involving the bile duct are difficult to distinguish radiographically from more common etiologies of biliary stricturing, and a tissue diagnosis is difficult to obtain endoscopically. Diagnosis and treatment is most often made via surgical resection.

Refractory Case Of Esophageal Web In A Male Patient With Alcoholic Liver Disease, Bonnie Patek Do, Shashin Shah Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

Albumin Administration In Patients With Spontaneous Bacterial Peritonitis At A Tertiary Hospital: A Retrospective Clinical Analysis, Padmavathi Mali, Rajan Kanth, Sudheer Muduganti

Journal of Patient-Centered Research and Reviews

Purpose

Albumin is recommended for the treatment of spontaneous bacterial peritonitis (SBP) in patients at high risk for mortality. We assessed adherence to guidelines for administration of albumin for SBP in clinical practice at a private tertiary care hospital.

Methods

A retrospective clinical analysis of all cases of SBP diagnosed at a tertiary referral center from January 1, 2006, to December 31, 2012, was performed. Patients were identified electronically and manually validated. The appropriateness of albumin administration for treatment of SBP was assessed in all patients in whom mortality risk could be established and separately for patients who did or …

An Unlikely Cause Of Possible Hormone-Dependent Abdominal Pain In Young Fertile Females: A Case Series, Bonnie Patek Do, Hiral Shah Md, Shashin Shah Md

Department of Medicine

No abstract provided.

Site-Specific Immunomodulator: A Novel Treatment For Crohn's Disease, Brian Bressler, Kevin P. Bethel, Ralf Kleef, Sophie L. Reynolds, Simon Sutcliffe, David W. Mullins, Hal Gunn

Dartmouth Scholarship

We investigated the mechanism of action, safety, and efficacy of the Site-Specific Immunomodulator (SSI) QBECO, a novel immunotherapy for Crohn’s disease (CD). Using human monocytic THP-1 cells, we demonstrate that SSI QBECO (derived from the common colon bacteria E. coli) activates macrophages to an M1 phenotype (associated with enhanced capacity to eliminate bacteria and activate innate immune responses). We assessed SSI QBECO in a compassionate use protocol of ten adult patients with active CD. Patients with moderate to severe clinical symptoms receiving conventional CD treatments and/or complementary therapies were included, except patients receiving anti-TNF medications. SSI QBECO was self-administered subcutaneously …

Interferon Lambda-3 Polymorphism And Response To Pegylated Interferon In Patients With Hepatitis D, Zaigham Abbas, Javed Yakoob, Muhammad A. Umer,, Minaam Abbas, Saeed Hamid

Section of Gastroenterology

Background: Specific single nucleotide polymorphisms (SNPs) near the interferon lambda-3 (IFNλ3) gene (formerly interleukin 28B) influence the response to treatment with interferon in hepatitis C patients. We aimed to investigate such an influence in hepatitis D patients.
Methods: The study population consisted of hepatitis D patients who were previously treated with pegylated interferon for one year and who were spontaneous clearers of the virus post recent superinfection. The SNP of IFNλ3, rs12979860, was determined by polymerase chain reaction-restriction fragment length polymorphism protocol.
Results: The total number of patients was 64; median age was 30.5 years and 53 were male. The …

Female Gender In Esophageal Intramucosal Adenocarcinoma Treated With Endoscopic Mucosal Resection: A Case Series, Patrick Hickey Do, Shashin Shah Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.