Chronic liver failure is a frequent condition in clinical practice that encompasses all manifestations of patients with end-stage liver diseases. Chronic liver failure is a multiorgan syndrome that affects the liver, kidneys, brain, heart, lungs, adrenal glands, and vascular, coagulation, and immune systems. Chronic Liver Failure: Mechanisms and Management covers for the first time all aspects of chronic liver failure in a single book, from pathogenesis to current management. Each chapter is written by a worldwide known expert in their area and all provide the latest state-of-the-art knowledge. This volume is specifically designed to provide answers to clinical questions to all doctors dealing with patients with liver diseases, not only clinical gastroenterologists and hepatologists, but also to internists, nephrologists, intensive care physicians, and transplant surgeons.

Malignant neoplasms occurring in the biliary tract and pancreas remain a therap- tic challenge. The mechanism of carcinogenesis as well as the growth and spread of these tumors is still poorly understood, making the development of rational tre- ment strategies difficult. In order to improve the clinical results achieved by sur- cal or other medical treatment of such malignant tumors, the establishment of an experimental animal model is critical. For this purpose, attempts were made to induce carcinoma experimentally in the biliary tree and finally an animal model using the hamster was established in 1994 at our laboratory. Because the tumor in this model mimicked the characteristics of human tumors, a series of experimental investigations were conducted to clarify the pathological characteristics of biliary carcinoma, the genetic alterations during biliary carcinogenesis, and the relationship between biliary inflammation and c- cinogenesis. The chemopreventive effects on the occurrence of biliary carcinoma were also successfully examined. In addition, in vitro studies led to the establi- ment of transplantable biliary cancer cell lines and biliary epithelial cell lines by utilizing the hamster model. This monograph represents the collective efforts in hepato-biliary and pancreatic disease research over the past 20 years. I hope that this monograph will be a source of useful knowledge for basic researchers as well as for clinicians involved in the care of patients with hepato-biliary and pancreatic neoplasms. Takashi Kanematsu, M.D., Ph.D.

Great advances have taken place in basic research and the clinical usefulness of dendritic cells (DCs). It has now been clearly established, for instance, that these cells play a crucial role in immune responses against infectious diseases and cancers. Antigen-presenting DCs are widely distributed in the body and regulate both immunity and immune tolerance. Experimental studies have provided important insights into DCs and how they can be used for treating animal models of various diseases that occur in humans. The role of these cells in pathogenesis and the treatment of human diseases is elaborately set forth in this valuable book. Researchers in the field are optimistic that DCs, already in use for treating patients with cancers, soon can be used therapeutically for patients with chronic infections, autoimmune diseases, and allergic manifestations. This volume provides a working definition of DCs and also explains the phenotypes and functions of DCs so that these can be readily understood not only by clinicians but by immunologists, researchers, and students as well.

Hepatology and Transplant Hepatology: A Case Based Approach presents a collection of interesting cases in liver disease seen at a very busy and large liver transplant center in the United States. These cases cover the full range of pathology that an internist or gastroenterologist may expect to see in a lifetime of taking care of patients with acute or chronic liver disease, before or after liver transplant. Each case is presented as you would see it in a clinical situation where a patient presents a complaint or something is noted on exam or blood work. The question/answer format will help one through the problem of making a diagnosis or in considering a differential diagnosis and also point to the best way to manage each condition. The volume is divided into pre-transplant and post-transplant hepatology. Each case is 3 pages with the first page presenting the case and pertinent lab data and 3-4 questions (i.e. differential diagnosis, tests to order, x-rays/CT required).The second page illustrates the tests, scans, biopsies and asks for the pertinent findings. The third page provides the diagnosis and what may have been expected with other diagnoses. Here is a single source dealing with questions specific for patients with complications of advanced liver disease and also clinical situations seen in transplant hepatology. Hepatology and Transplant Hepatology: A Case Based Approach will have great appeal to anyone in hepatology/transplant hepatology and also to residents/fellows and internists interested in gastroenterology.

Liver and Biliary Surgery provides an illustrative, instructive, and comprehensive review that depicts the rationale of basic operative principles essential to liver and biliary surgical therapy. The chapters provide pertinent and concise summaries of how to deal with various liver and biliary disorders, spanning benign and malignant problems and minimally invasive procedures. Stages of operative approaches with relevant technical considerations are outlined in an easily understandable manner. Complications are reviewed when appropriate for the organ system and problem. The text is illustrated throughout by line drawings and photographs that depict anatomic or technical principles. A concise, handbook-sized reference work, this book is a valuable resource for all general surgeons and residents in training.

Acute and chronic viral hepatitis infections are serious public health threats around the world. The different infections have different epidemiology and natural his- ries, and children play important roles in each of these. For example, children are important reservoirs for acute hepatitis A, childhood infections are responsible for most of the global morbidity associated with chronic hepatitis B, and perinatal transmission of hepatitis C continues to occur, even as the overall incidence of new infections wanes. Some non-A through E viral hepatitis infections are seen p- dominantly in infants and young children, while others have specific implications for this population. Therapeutic options for children with chronic viral hepatitis are limited when compared to those available for adults, especially for hepatitis B, and considerations given to long-term therapy have dramatic implications when dealing with the long life expectancy of these young patients. With these issues in mind, this unique volume has been created to address the special considerations regarding viral hepatitis in children. It includes the latest information and recommendations specifically directed at the pediatric population, and highlights the knowledge gaps which will need to be filled to improve our understanding of these infections and treatment of this special group. Experienced practitioners from around the world have contributed these reviews, incorporating the latest studies, the current recommendations, and the distinctive pediatric issues that shape clinical care, and will determine the research agenda for this field going forward.

Liver Transplantation: Challenging Controversies and Topics grew out of a need I perceived within the fields of transplant hepatology and liver transplantation. Liver transplantation has rightly gained recognition as an established therapy for end-stage liver disease. Few would argue that liver transplantation is one of the few truly lifesaving and life-altering treatments within medicine and surgery. Not many realize that 20 years passed from the time of the first human liver transplantation in 1963 to its acceptance as therapy by the 1983 NIH Consensus Conference on Liver Transplantation. In 2008, 25 years will have passed since the 1983 NIH conference-a mere 25 years for a field that has provided patients hope, doctors options, and to some the "gift of life. " Many issues in liver transplantation involve indications, patient selection, and outcomes after transplantation-these are standard topics, covered by textbooks of hepatology and transplantation. In contrast, the field of liver tra- plantation is young, evolving, dynamic, and issues and decisions are often controversial. Thus, Dr. Trotter and I, as well as our colleagues at the University of Colorado, felt that a text with a different focus was required, one that highlighted controversy and challenged dogma. Out of this perceived need emerged Liver Transplantation: Challenging Controversies and Topics. To meet the transplant community's need for emerging information about liver transplantation, Dr. Larry Chan, Dr. Igal Kam, and I initiated the Controversies in Transplantation Conference.

- Written by international contributors including specialists in surgery, hematology and oncology.

- The information is presented in an instructive manner, allowing the phycisian to utilize the content immediately.

- Discusses new techniques such as minimally invasive approaches to surgery and new cancer treatments.

In recent years there have been huge advances in the understanding of the genetic and molecular basis of the fibrocystic diseases. This volume provides a thorough review of fibrocyctic diseases that affect the liver. It contains in-depth discussions of the genetics, molecular biology, pathogenesis, histology, clinical presentations, complications of, treatment, and prognosis of the conditions affecting children and adults, and hence will be the gold-standard reference for these conditions. In addition, the histological features that distinguish these conditions from other potentially fibrosing hepatopathies are illustrated. Conditions with syndromic features involving the kidney or other organ systems are also reviewed. Thorough review of the clinical phenotypes, their presentations, treatment, potential complications of, and prognosis is discussed.

Fibrocystic Diseases of the Liver will be an invaluable resource for hepatologists, gastroenterologists, nephrologists, and hepatic surgeons who care for children and adults with liver disease, as well as basic scientists in molecular genetics, hepatobiliary pathophysiology, hepatology and nephrology.

The Hepatic circulation is unique among vascular beds. The most obvious unique features include the dual vascular supply; the mechanism of intrinsic regulation of the hepatic artery (the hepatic arterial buffer response); the fact that portal blood flow, supplying two thirds of liver blood flow, is not controlled directly by the liver; the fact that 20% of the cardiac output rushes through the most vascularized organ in the body, driven by a pressure gradient of only a few millimeters of mercury; the extremely distensible capacitance and venous resistance sites; the unidirectional acinar blood flow that regulates parenchymal cell metabolic specialization; and the high concentration of macrophagic (Kupffer) cells filtering the blood. The liver is the only organ reported to have regional blood flow monitored by the autonomic nervous system. This mechanism, when dysfunctional, accounts for the hepatorenal syndrome and offers a mechanistic therapeutic target to treat this syndrome. The trigger for liver regeneration is dependent on hepatic hemodynamics so that chronic liver blood flow regulates liver cell mass. In severe liver disease, the whole body circulation is reorganized, by forming portacaval shunts, to accommodate the increased intrahepatic venous resistance. These shunts protect the venous drainage of the splanchnic organs but lead to loss of major regulatory roles of the liver. The development of knowledge of the hepatic vasculature is presented from a historical perspective with modern concepts summarized based on the perspective of the author's four decades of devotion to this most marvelous of organs. Table of Contents: Acknowledgements / Historical Perspectives / Overview / Fluid Exchange / Capacitance / Resistance in the Hepatic Artery / Resistance in the Venous System / Fetal and Neonatal Hepatic Circulation / In Vivo Pharmacodynamic Approaches / Nitric Oxide / Adenosine / Hepatic Nerves / Hepatic Circulation and Toxicology / Hepatorenal Syndrome / Integrative Hepatic Response to Hemorrhage / Blood Flow Regulation of Hepatocyte Proliferation / Multiple Mechanisms Maintaining a Constant Hepatic Blood Flow to Liver Mass Ratio / Pathopharmacology and Repurposing Drugs as a Research Strategy / References

Hepatic insulin resistance and altered insulin metabolism, as characterised by the desensitisation of hepatic parenchymal cells to insulin, play a role in the pathogenesis of liver disease, particularly resulting in steatosis and steatohepatitis. By the same token, type II diabetic patients are at higher risk for developing liver diseases, including steatosis, hepatitis, cirrhosis, and hepatocellular carcinoma. On the other hand, established liver disease from any cause leads to glucose intolerance and peripheral insulin resistance systemically. The link between insulin resistance and liver pathology reviewed in this book suggests that insulin resistance is closely related with a variety of liver diseases. Recent evidence indicates that the AMP activating protein kinase (AMPK) in conjunction with p70 ribosomal S6 kinase 1 (S6K1) serves as a key signalling pathway regulating insulin-dependent physiological functions; thus, this pathway serves as a target for the therapy of diseases associated with insulin resistance. In this chapter, the regulatory role of the AMPK-S6K1 pathway is discussed in terms of enhancing insulin receptor signalling with insulin receptor substrate-1/2 and phosphatidylinositol phosphate kinase activity, which may contribute to preventing and/or treating insulin resistance in the liver.

Malignant neoplasms occurring in the biliary tract and pancreas remain a therap- tic challenge. The mechanism of carcinogenesis as well as the growth and spread of these tumors is still poorly understood, making the development of rational tre- ment strategies difficult. In order to improve the clinical results achieved by sur- cal or other medical treatment of such malignant tumors, the establishment of an experimental animal model is critical. For this purpose, attempts were made to induce carcinoma experimentally in the biliary tree and finally an animal model using the hamster was established in 1994 at our laboratory. Because the tumor in this model mimicked the characteristics of human tumors, a series of experimental investigations were conducted to clarify the pathological characteristics of biliary carcinoma, the genetic alterations during biliary carcinogenesis, and the relationship between biliary inflammation and c- cinogenesis. The chemopreventive effects on the occurrence of biliary carcinoma were also successfully examined. In addition, in vitro studies led to the establi- ment of transplantable biliary cancer cell lines and biliary epithelial cell lines by utilizing the hamster model. This monograph represents the collective efforts in hepato-biliary and pancreatic disease research over the past 20 years. I hope that this monograph will be a source of useful knowledge for basic researchers as well as for clinicians involved in the care of patients with hepato-biliary and pancreatic neoplasms. Takashi Kanematsu, M.D., Ph.D.

This book, the proceedings of Falk Symposium 163 Chronic Inflammation of Liver and Gut, held in Hangzhou, P.R. China, on March 14--15, 2008, presents the most recent progress in chronic inflammatory diseases of liver and gut. It focusses on molecular understanding, the therapeutic state of the art and future options of treatment.

The first part of the book concentrates on basic and clinical aspects of IBD. Chapters demonstrate the role of the immune system, genetic factors and the intestinal microflora in IBD, and give an evidence-based update on the current diagnostic and therapeutic options and present future perspectives for the management of IBD. The second part is devoted to chronic liver diseases with particular focus on the liver as an immune organ, treatment strategies of viral hepatitis and liver fibrogenesis. The final part deals with basic and clinical aspects of liver cirrhosis, hepatocellular carcinoma and liver transplantation. The book concludes with an outlook on therapeutic options of hepatic stem cells. Throughout, international experts from the USA, the People s Republic of China and Europe contribute their experience in different aspects of the mechanisms and management of chronic inflammatory diseases of liver and gut. "

A practical, portable handbook, newly updated with nearly 100 color images and figures, The Little GI Book: An Easily Digestible Guide to Understanding Gastroenterology, Second Edition is an invaluable resource for anyone new to the world of gastroenterology and hepatology. Featuring new information on the latest advancements in gastroenterology and hepatology and written in a friendly, conversational style, The Little GI Book will help readers learn the core concepts of digestive health and disease and absorb important information without a hiccup. Author Dr. Douglas G. Adler provides a comprehensive, soup-to-nuts guide to gastrointestinal anatomy, physiology, disease states, and treatment. With new color images throughout, The Little GI Book guides the reader through the entire gastrointestinal tract, starting at the top with the esophagus, ending at the bottom with the colon and rectum, and covering everything in between: the stomach, small intestine, liver, pancreas, bile ducts, and gallbladder. The Little GI Book is an indispensable pocket guide for residents, students, nurse practitioners, office staff, industry sales force, and anyone who works in the GI industry but isn't a gastroenterologist.

Despite numerous hepatitis C virus infection studies, its pathogenesis and medical treatment have not been fully explained. This comprehensive volume, written by experts in the field, covers the most recent advances in the study of HCV, moving from basic research to clinical applications. The first chapters of this volume analyze the full spectrum of immune responses to HCV. The volume also includes contributions that explain the state of the art in IFN-alpha treatment of HCV patients.

This book is the proceedings of Falk Symposium 157, entitled ?Chronic Hepatitis: Metabolic, Cholestatic, Viral and Autoimmune?, held in Freiburg, Germany, on 10--11 October 2006 (one of three symposia during the XIII Falk Liver Week 2006). It provides up-to-date information on new developments in the field of chronic hepatitis and its various entities. In recent decades we have learned how heterogeneous the clinical entity of chronic hepatitis has become. The liver, as the central organ of metabolism and detoxification, is more than ever a target of disease processes evolving from the spread of obesity in the western world. Apart from nonalcoholic steatohepatitis (NASH), alcoholic liver disease is still the most prevalent liver disease in the west...

Drs. Busuttil and Klintmalm present Transplantation of the Liver, 3rd Edition, which has been thoroughly revised to offer you the latest protocols, surgical approaches, and techniques used in this challenging procedure. Encompassing today's expert knowledge in the field, this medical reference book is an ideal single source for authoritative, up-to-date guidance on every imaginable aspect of liver transplantation. "They have, in fact, succeeded in raising the bar yet again and making their work product even better in the third edition of Transplantation of the Liver." Forewords by, Thomas E. Starzl, June 2015 Access valuable pearls, pitfalls, and insights from Dr. Ronald Busuttil and Dr. Goran Klintmalm, two of the world's preeminent experts in liver surgery. Understand today's full range of transplantation techniques with complete step-by-step descriptions of each, and access the background information and management options for each hepatic disease entity. Take advantage of detailed discussions of everything from pathophysiology and patient and donor selection, to transplantation anesthesia and operative procedures; immunosuppression; postoperative care; and ethical issues. Overcome your toughest challenges in liver transplantation. Many new and thoroughly revised chapters include: Deceased Organ Donation after Cardiac and Brain Death; Liver Transplantation for Non-Alcoholic Steatohepatitis; Extended Criteria Donors; Best Techniques for Biliary and Vascular Reconstruction in Living Donor Transplantation; Small for Size Syndrome; Dual Grafts for Transplantation; Arterial Reconstructions-Pitfalls; Transition of Pediatric Patients to Adulthood; Immunosuppressive Biologic Agents; Long Term Toxicity of Immunosuppressive Therapy; Stem Cell and Liver Regeneration; and Extracorporeal Perfusion for Resuscitation of Marginal Grafts. Stay current in your field and optimize patient outcomes with coverage of the most recent advances in living donor transplantation, pediatric transplantation, and gene and stem cell therapy. Access the latest information on anti-rejection/immunosuppressive drugs, as well as comprehensive discussions of each drug or combination of drugs used to suppress immune system. Effortlessly search the entire text online at Expert Consult. With 104 additional contributing experts

Hepatitis delta virus which causes severe acute and chronic liver disease was discovered following the detection of a novel antigen-antibody system in hepatitis B virus carriers. Currently, HDV is classified as a subviral satellite of hepatitis B virus. However, unlike other satellite viruses, the dependence of HDV on HBV is limited solely to the provision of an envelope of hepatitis B surface antigen for virus assembly. Research into the molecular virology of the HDV life cycle has revealed a fascinating collection of biology. These insights are now beginning to be translated into new potential treatment strategies. There are currently still an estimated 15 million HDV carriers worldwide.

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The most recent developments in research on hepatic encephalopathy, inborn hyperammonaemic syndromes and nitrogen metabolism, including clinical aspects, were presented by international acknowledged experts in this active research field at the 12th International Symposium on Hepatic Encephalopathy, which was held from June 1 to 4, 2005 in Solingen, Schloss Burg, Germany. This book comprehensively summarizes the most important novel issues on hepatic encephalopathy and nitrogen metabolism and is of interest not only for scientists in the field, but also for interested clinicians. This update of present knowledge will provide a platform for future research in the field of hepatic encephalopathy and nitrogen metabolism.

Few fields of medicine have witnessed such impressive progress as the diagnosis and treatment of liver tumors. Advances in imaging technology, the development of novel contrast agents, and the introduction of optimized scanning protocols have greatly facilitated the non-invasive detection and characterization of focal liver lesions. Furthermore, image-guided techniques for percutaneous tumor ablation have become an accepted alternative treatment for patients with inoperable liver cancer. This book provides a comprehensive and up-to-date overview of the role of diagnostic and interventional radiology in respect of liver tumors. The volume moves from background sections on methodology and segmental liver anatomy to the main sections on the diagnosis of benign and malignant liver lesions. An integrated approach, focused on the correlation of ultrasound, CT, and MR imaging findings, is presented. Finally, a full section describes the principles, methods, and results of percutaneous tumor ablation techniques.

Portal hypertension is the most important complication of a great variety of both acute and chronic liver diseases. Nevertheless, hepatic cirrhosis is the most frequent cause of portal hypertension. Gastrointestinal bleeding due to rupture of oesophageal varices is, without doubt, the most severe complication of portal hypertension. At present, great advances are being made in the pathophysiology and in the development of new therapeutic tools for controlling and preventing this severe clinical event.

This book contains the papers presented and discussed during the Symposium on 'Portal Hypertension in the 21st Century', held in Montreal, Canada, in April 2004, and sponsored by Axcan Pharma Inc. and NicOx S.A. There are eight sections covering basic mechanisms, new drugs, prevention and current treatment of variceal bleeding, prevention of recurrent bleeding and hepatic hemodynamic monitoring.

An international faculty of authors have contributed chapters at an outstanding scientific level which will be vital reading for scientists and clinicians alike."

In several liver diseases, the underlying cause cannot always be eliminated, i.e. the progression of liver disease cannot be prevented. This is particularly true for non-responders to the treatment of chronic hepatitis C (HCV). It is relevant for more than 40 per cent of patients with HCV genotype 1 and up to 20 per cent of patients with genotype 2 or 3. Several approaches are now underway to prevent or ameliorate mechanisms of disease progression. In Asia, and particularly in Japan, Glycyrrhizine-SNMC has been widely used for this purpose. At present, SNMC is under clinical evaluation in Europe.

This book is the proceedings of the Falk Symposium No. 137 on "Liver Diseases: Advances in Treatment and Prevention" (part of the XII International Falk Liver Week 2003 in honour of Hans Poppera (TM)s 100th birthday, held on October 17-19, 2003). It covers our present knowledge of the diagnosis, treatment and prevention of liver diseases, including hepatitis B, hepatitis C and delta hepatitis as well as alcoholic liver diseases, non-alcoholic steatohepatitis and the hereditary liver diseases haemochromatosis, Wilsona (TM)s disease and alpha-1-antitrypsin deficiency. In addition to these clinical entities, the sequelae of liver cirrhosis and its complications, including the clinical management of ascites, the hepatorenal as well as the hepato- and porto-pulmonary hypertension syndrome are discussed. New developments with respect to liver support systems and liver transplantation are further highlights of the proceedings.

The main topics mentioned above are complemented by state-of-the-art chapters on "Hepatocellular Carcinoma," "Emerging Hepatitis Viruses" and "Fulminant Liver Failure" that are of interest to both basic scientists as well as clinicians. A special section is devoted to "Liver Histology" as a tribute to Hans Popper who contributed eminently to the basic and clinical aspects of hepatology.

All in all, Liver Diseases: Advances in Treatment and Prevention provides an exciting overview of the current developments in the treatment and prevention of viral, alcoholic, non-alcoholic and hereditary liver diseases, presented by an international faculty of outstanding scientists and clinicians.

During the last decade, knowledge about cholestatic liver disease and concomitant diseases, such as ulcerative colitis, cholangio- and hepatocellular carcinoma, pancreas and colon cancer, has increased considerably. Studies on ursodeoxycholic acid treatment alone or in combination with immunosuppressive compounds and their positive effects on biliary liver disease as well as on so-called overlap syndromes or intestinal tumors are published in increasing numbers, and stimulate discussion on whether or not ursodeoxycholic acid is able to improve the general condition and/or life expectancy of patients. On the other hand, genetics, aetiological and pathogenetic aspects are still difficult to comprehend, but are the absolute prerequisite for the development of better treatment options. This book is the proceedings of Falk Symposium No. 136 (Part I of the XII Falk Liver Week, held in Freiburg, Germany, on October 15-16, 2003), and contains stimulating, exciting and controversial papers on clinical and also basic research at the highest scientific level.

This book, the proceedings of a Falk Workshop on `Topical Steroids in Gastroenterology and Hepatology', held in Berlin, Germany, on 14 June 2003, critically discusses the current role of budesonide in gastroenterology, hepatology, surgery and oncology and focuses especially on potential new indications for the use of budesonide. A number of smaller clinical studies and anecdotal case reports with impressive clinical effects are reported in patients with gastrointestinal, hepatic, oncological and surgical problems. In addition, the use of budesonide for the treatment of distal ulcerative colitis and ileocolonic Crohn's disease is evaluated with respect to its role in an evidence-based management of IBD. Finally, as clinical experience with the use of budesonide is increasing, safety issues and the side-effect profile of budesonide is addressed.