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347 Approach to the Patient with Liver Disease Jensen GL et al: GLIM criteria for the diagnosis of malnutrition: A con­ sensus report from the global clinical nutrition community. JPEN J Parenter Enteral Nutr 43:32, 2019. Singer P et al: ESPEN practical and pa...

348 Evaluation of Liver Function TABLE 347-6  Child-Pugh Classification of Cirrhosis POINTS TOWARD TOTAL SCORE FACTOR UNITS Serum bilirubin μmol/L <34 34–51 51 mg/dL <2.0 2.0–3.0 3.0 Serum albumin g/L 35 30–35 <30 g/dL 3.5 3.0–3.5 <3.0 Prothrombin time Second...

349 The Hyperbilirubinemias TABLE 348-1  Liver Test Patterns in Hepatobiliary Disorders TYPE OF DISORDER BILIRUBIN AMINOTRANSFERASES ALKALINE PHOSPHATASE ALBUMIN PROTHROMBIN TIME Hemolysis/Gilbert’s syndrome Normal to 86 μmol/L (5 mg/dL) 85% due to indirect fr...

350 Acute Viral Hepatitis Esperance A. K. Schaefer, Raymond T. Chung, Jules L. Dienstag Acute Viral Hepatitis Acute viral hepatitis is a systemic infection affecting the liver predomi­ nantly. Almost all cases of acute viral hepatitis are caused by one of five...

351 Toxic and Drug-Induced Hepatitis Lemon SM et al: Type A viral hepatitis: A summary and update on the molecular virology, epidemiology, pathogenesis, and prevention. J Hepatol 68:167, 2018. Lewis KC et al: Estimated prevalence and awareness of hepatitis C v...

352 Chronic Hepatitis Esperance A. K. Schaefer, Raymond T. Chung, Jules L. Dienstag Chronic Hepatitis Chronic hepatitis represents a series of liver disorders of varying causes and severity in which hepatic inflammation and necrosis continue for at least 6 mon...

353 Alcohol-Associated Liver Disease virus infection: A randomized, double-blind, phase 3 non-inferiority trial. Lancet Gastroenterol Hepatol 1:185, 2017. Dalekos GN et al: Long-term results of mycophenolate mofeteil vs. azathioprine use in individuals in aut...

355 Cirrhosis and Its Complications Cusi K et al: American Association of Clinical Endocrinology clinical practice guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings: Co-sponsored ...

356 Liver Transplantation ■ ■FURTHER READING Bhattacharya D et al: Hepatitis C guidance update 2023 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection. Clin Infect Dis Ciad319:1, 2023. Biggins SW et al: Diagnosis...

357 Diseases of the Gallbladder and Bile Ducts Norton J. Greenberger*, Gustav Paumgartner*, Daniel S. Pratt Diseases of the Gallbladder and Bile Ducts PHYSIOLOGY OF BILE PRODUCTION AND FLOW ■ ■BILE SECRETION AND COMPOSITION Bile formed in hepatocytes is secret...

SECTION 4 Disorders of the Pancreas Section 4 Disorders of the Pancreas Somashekar G. Krishna, Darwin L. Conwell, Phil A. Hart Approach to the Patient with Pancreatic Disease ■ ■GENERAL CONSIDERATIONS Globally, pancreatic disorders, including acute and chroni...

358 Approach to the Patient with Pancreatic Disease Section 4 Disorders of the Pancreas Somashekar G. Krishna, Darwin L. Conwell, Phil A. Hart Approach to the Patient with Pancreatic Disease ■ ■GENERAL CONSIDERATIONS Globally, pancreatic disorders, including ...

359 Acute and Chronic Pancreatitis clinically suspected, EUS imaging is more sensitive than MDCT for the detection of pancreatic malignancy and permits fine-needle aspira­ tion/biopsy (FNA/B). Currently, EUS-guided FNA/B is the diagnostic modality of choice fo...

360 Introduction to the Immune System Immune-Mediated, Inflammatory, and Rheumatologic Disorders PART 11 Section 1 The Immune System in Health and Disease Barton F. Haynes, Kelly A. Cuttle, Anthony S. Fauci Introduction to the Immune System ■ ■DEFINITIONS • A...

364 Anaphylaxis PART 11 Immune-Mediated, Inflammatory, and Rheumatologic Disorders Anaphylaxis David Hong, Joshua A. Boyce ■ ■BACKGROUND Anaphylaxis is a potentially life-threatening systemic allergic reac­ tion involving one or more organ systems that typical...

365 Desensitization ■ ■PREVENTION Avoidance  The simplest and most straightforward approach to the long-term management of a patient with a history of anaphylaxis is strict avoidance of known anaphylactic triggers and education on acute management, specificall...

366 Mastocytosis less for BRCA mutation carriers), and sensitized patients typically have type I symptoms with pruritus, flushing, urticaria, throat tightening, and hypotension with elevated tryptase (Fig. 365-2). ST is positive in >85% of patients with recent...

368 Systemic Lupus Erythematosus thyroiditis. Cancers commonly associated with autoimmunity include melanoma, thyroid cancer, and non-small-cell lung cancer. One spe­ cific example is the development of encephalitis through generation of Abs to N-methyl-d-aspa...