Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_47_библиотеки_им_акад_М_И_Перельмана
.pdf
123
Clinical Cases
in Hepatology
NoraV.Bergasa
Editor
Clinical Cases in Hepatology
Nora V. Bergasa
Editor
Clinical Cases in Hepatology
The author(s) has/have asserted their right(s) to be identied as the author(s) of this work in
accordance with the Copyright, Designs and Patents Act 1988.
ISBN 978-1-4471-4714-5 ISBN 978-1-4471-4715-2 (eBook)
https://doi.org/10.1007/978-1-4471-4715-2
© Springer-Verlag London Ltd., part of Springer Nature 2022
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer-Verlag London Ltd. part of
Springer Nature.
The registered company address is: The Campus, 4 Crinan Street, London, N1 9XW, United Kingdom
Editor
Nora V. Bergasa
Department of Medicine, H+H/Metropolitan
Physician Afliate Group of New York
New York, NY
USA
New York Medical College
New York, NY
USA
Hepatology
H+H/Woodhull
Brooklyn, NY
USA
I dedicate this book to my mother, Delia, who
showed her bravery and love for me: she let
me go as an adolescent to live free from the
oppressive communist Cuban regimen.
https://t.me/medicina_free
vii
Preface
This book is the beginning of clinical hepatology. As such, it concerns some of the
most common conditions seen in the hepatology clinics of two community hospitals
where I have worked for several years. The book is intended for residents, gastroen-
terology and hepatology fellows, nurse practitioners, and physician assistants who
want to become familiar with the approach to patients with liver disease.
I have worked on this book for several years with long breaks in between, which
has resulted in a product that includes dramatic changes in the discipline of hepatol-
ogy and which include the development of drugs that cure chronic hepatitis C, clini-
cal trials on primary biliary cholangitis, and the approval of a new medication to
treat this disease, the name of which changed from primary biliary cirrhosis during
the writing of this book, and the expansion in the study of nonalcoholic fatty liver
disease. I am indebted to Springer for having waited for the completion of this book.
New York, NY NoraV.Bergasa, MD, MACP
https://t.me/medicina_free
ix
Acknowledgements
I thank the colleagues who contributed to this book.
Dr. Barbara S.Koppel, MD, FAAN, Professor of Clinical Neurology at NewYork
Medical College, Valhalla, NewYork, was my academic editor. I am very grateful
for her important contribution to this book.
From New York City, Health + Hospitals/Woodhull, Brooklyn, Dr. Anatole
Sladen, Department of Radiology, provided the radiographic images. Dr. Cesar del
Rosario, Chief of Pathology, provided most of the pictures of liver histology. From
the Icahn School of Medicine at Mount Sinai, New York, Dr. Maria Isabel Fiel,
Professor of Pathology, contributed the liver histology picture in Chap. 10.
Martha M.Dao from GRAPHIC (+WEB) DESIGN MMD for the illustrations.
I am grateful to the patients for their trust; it has been my greatest privilege to
provide their medical care. I am thankful for the medical residents, gastroenterology
fellows, physician assistants, and a dedicated Doctor in Pharmacy who have worked
with me in the hepatology clinic over the years.
I thank God every day for my life, for the opportunities I have had, and for open-
ing doors for me when others closed.
https://t.me/medicina_free
xi
Contents
1 The Liver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Nora V. Bergasa
2 Approach to the Patient with Liver Disease . . . . . . . . . . . . . . . . . . . . . 5
Nora V. Bergasa
3 Primary Biliary Cholangitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Nora V. Bergasa
4 Autoimmune Hepatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Nora V. Bergasa
5 Primary Sclerosing Cholangitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Nora V. Bergasa
6 Chronic Hepatitis C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Nora V. Bergasa
7 Chronic Hepatitis B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Nora V. Bergasa
8 Alcohol Induced Liver Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Nora V. Bergasa
9 Nonalcoholic Fatty Liver Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Nora V. Bergasa
10 Alpha-1-Antitrypsin Deficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Nora V. Bergasa
11 Hemochromatosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
Nora V. Bergasa
12 Wilson’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
Nora V. Bergasa
https://t.me/medicina_free
xii
13 Tumors of the Liver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
Nora V. Bergasa
14 Drug Induced Liver Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
Nora V. Bergasa
15 Complications of Liver Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443
Nora V. Bergasa
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Contents
https://t.me/medicina_free
1© The Author(s), under exclusive license to Springer-Verlag London Ltd., part
of Springer Nature 2022
N. V. Bergasa (ed.), Clinical Cases in Hepatology,
https://doi.org/10.1007/978-1-4471-4715-2_1
Chapter 1
The Liver
NoraV.Bergasa
The liver is a gland surrounded by Glisson’s capsule. It is located in the right upper
quadrant of the abdomen, triangular in shape, and comprised of the right and left
lobes, also known as the right and left livers, divided by the round and falciform
ligaments. The quadrate lobe is in the liver’s inferior surface, limited by the umbili-
cal ssure, the gallbladder bed, and the hilus. The caudate lobe is in the liver’s
posterior surface; it is limited to the right by the inferior vena cava and to the left by
the ssure of the ligamentum venosum [
1].
The right, middle, and hepatic veins divide the liver into four sectors, each
receiving a portal pedicle. Each part of the liver that gets a portal pedicle is called a
segment, of which there are eight. The right liver is comprised of two sectors,
divided themselves into two segments. The anterior sector is comprised of segment
V, inferiorly, and segment VIII, superiorly. The posterior sector is divided into seg-
ment VI inferiorly and segment VII superiorly [1].
The left liver has two sectors; the anterior sector is comprised of segment IV,
medially, and segment III laterally. The posterior sector of the left liver contains
segment II [
1].
The caudate lobe is segment I, which receives its blood ow from the right and
left branches of the portal veins and hepatic artery, and its veins drain directly into
the inferior vena cava [1].
N. V. Bergasa (*)
Department of Medicine, H+H/Metropolitan, New York, NY, USA
New York Medical College, Valhalla, NY, USA
Hepatology, H+H/Woodhull, Brooklyn, NY, USA
https://t.me/medicina_free
Соседние файлы в папке Библиотека им академика М.И. Перельмана