This book provides a comprehensive review of the studies concerning HBV epidemiology, pathogenesis and treatment. In addition, it describes recent advances in the knowledge of immune response function, promoting either viral control or persistence, and effects of antiviral therapy in patients with HBV acute or chronic infection are reported. Although mechanisms involved in inflammatory and immune response in acute and chronic HBV infections have been extensively studied, several questions remain unresolved. Moreover, in recent years several key steps in research have contributed to improve our present knowledge of immunopathogenesis of HBV infection.

Hepatitis B virus (HBV), discovered in 1966, infects more than 350 million people in the world. The infection of HBV is a leading cause of chronic carriage of the virus and progressive liver diseases, such as hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC). HBV consists of a circular, partially double-stranded DNA molecule of 3.2 kb in length, which contains four overlapping reading frames that code for surface proteins (HBsAg), core proteins (HBcAg/HBeAg), the viral polymerase, and the transcriptional transactivator X protein. Chronic hepatitis appears to be due to a suboptimal cellular immune response that destroys some of the infected hepatocytes and does not purge the virus from the remaining infected hepatocytes, thereby permitting the persisting virus to trigger a chronic indolent necroinflammatory liver disease that sets the stage for development of HCC. However, the mechanisms responsible for malignant transformation in chronic HBV infection are not well defined, and both viral and host factors have been implicated in the process. All cases of HCC occur after many years of chronic hepatitis which could, theoretically, provide the mitogenic and mutagenic environment to precipitate random genetic and chromosomal damage, and lead to the development of HCC. Hepatitis B virus X protein (HBx), an important transforming inducer, plays a crucial role in HCC development. HBx has the capability to influence a variety of signal transduction pathways within the cells. Monitoring of the HBV genotypes and antibody to Hepatitis B x antigen (anti-HBx) are significant for predicting early diagnosis of liver cirrhosis and HCC. HBV and Hepatitis C virus or HIV coinfections can accelerate the course of chronic liver disease and facilitate progression to cirrhosis and HCC. As for therapy of liver diseases, five drugs are now FDA-approved for the treatment of HBV, including interferon (IFN), lamivudine, adefovir, entecavir, and peginterferon alfa-2a. Moreover, the prevention for HBV infection is very important. It is likely that the most important outcome of the research on HBV has been the invention, development, and application of the vaccine against HBV. However, at present most investigators focus on basic research rather than practical applications. The HBV research should be focused on animal models and clinical practice. The technology update in HBV research and the multisubject combination may be attached importance to next a few decades. Some molecular approaches, such as antisense, oligonucleotides, ribozymes, RNA interference targeting HBV mRNA, are available in antiviral therapies.

The liver is a large organ that sits in the right upper abdomen, just under the right lung. It is one of the body's most "intelligent" organs in that it performs so many different functions at the same time. The liver makes proteins, eliminates waste material from the body, produces cholesterol, stores and releases glucose energy and metabolises many drugs used in medicine. It also produces bile that flows through bile ducts into the intestine where it helps to digest food. This organ also has the ability to regenerate itself if it is injured or partially removed. Cirrhosis is scarring of the liver that involves the formation of fibrous (scar) tissue associated with the destruction of the normal architecture of the organ. Many types of chronic injury to the liver can result in scar tissue. This scarring distorts the normal structure and re-growth of liver cells. The flow of blood through the liver from the intestine is blocked and the work done by the liver, such as processing drugs or producing proteins, is hindered. Until recently, the most common cause of cirrhosis of the liver in the United States was attributed to alcohol abuse. Because of the rapid increase of hepatitis C virus infection, hepatitis C has now taken over first place (26%), with alcohol abuse falling to second place, but only slightly behind at 21%. This outstanding book elucidates new and important research results from throughout the world.

The liver is a large organ that sits in the right upper abdomen, just under the right lung. It is one of the body's most "intelligent" organs in that it performs so many different functions at the same time. The liver makes proteins, eliminates waste material from the body, produces cholesterol, stores and releases glucose energy and metabolises many drugs used in medicine. It also produces bile that flows through bile ducts into the intestine where it helps to digest food. This organ also has the ability to regenerate itself if it is injured or partially removed. Cirrhosis is scarring of the liver that involves the formation of fibrous (scar) tissue associated with the destruction of the normal architecture of the organ. Many types of chronic injury to the liver can result in scar tissue. This scarring distorts the normal structure and re-growth of liver cells. The flow of blood through the liver from the intestine is blocked and the work done by the liver, such as processing drugs or producing proteins, is hindered. Until recently, the most common cause of cirrhosis of the liver in the United States was attributed to alcohol abuse. Because of the rapid increase of hepatitis C virus infection, hepatitis C has now taken over first place (26%), with alcohol abuse falling to second place, but only slightly behind at 21%. This outstanding book elucidates new and important research results from throughout the world.

The liver is a large organ that sits in the right upper abdomen, just under the right lung. It is one of the body's most 'intelligent' organs in that it performs so many different functions at the same time. The liver makes proteins, eliminates waste material from the body, produces cholesterol, stores and releases glucose energy and metabolises many drugs used in medicine. It also produces bile that flows through bile ducts into the intestine where it helps to digest food. This organ also has the ability to regenerate itself if it is injured or partially removed. Cirrhosis is scarring of the liver that involves the formation of fibrous (scar) tissue associated with the destruction of the normal architecture of the organ. Many types of chronic injury to the liver can result in scar tissue. This scarring distorts the normal structure and re-growth of liver cells. The flow of blood through the liver from the intestine is blocked and the work done by the liver, such as processing drugs or producing proteins, is hindered. Until recently, the most common cause of cirrhosis of the liver in the United States was attributed to alcohol abuse. Because of the rapid increase of hepatitis C virus infection, hepatitis C has now taken over first place (26%), with alcohol abuse falling to second place, but only slightly behind at 21%. This outstanding new book elucidates new and important research results from throughout the world.

The liver is a large organ that sits in the right upper abdomen, just under the right lung. It is one of the body's most "intelligent" organs in that it performs so many different functions at the same time. The liver makes proteins, eliminates waste material from the body, produces cholesterol, stores and releases glucose energy and metabolises many drugs used in medicine. It also produces bile that flows through bile ducts into the intestine where it helps to digest food. This organ also has the ability to regenerate itself if it is injured or partially removed. Cirrhosis is scarring of the liver that involves the formation of fibrous (scar) tissue associated with the destruction of the normal architecture of the organ. Many types of chronic injury to the liver can result in scar tissue. This scarring distorts the normal structure and re-growth of liver cells. The flow of blood through the liver from the intestine is blocked and the work done by the liver, such as processing drugs or producing proteins, is hindered. Until recently, the most common cause of cirrhosis of the liver in the United States was attributed to alcohol abuse. Because of the rapid increase of hepatitis C virus infection, hepatitis C has now taken over first place (26%), with alcohol abuse falling to second place, but only slightly behind at 21%. This outstanding book elucidates new and important research results from throughout the world.

The latest edition of this textbook provides a comprehensive, state-of-the-art overview of the major issues specific to the field of pediatric gastroenterology, hepatology, and nutrition. The textbook begins with a section on gastroenterology and nutrition that presents the overall scope of issues encountered in children suffering from disorders of the gastrointestinal tract, pancreas, and/or presenting nutritional issues, as well as current and future prospects on the use of prebiotics, probiotics, and postbiotics. The second section is centered around hepatology, reviewing congenital and acquired disorders of the biliary tract and liver, as well as analyzing available diagnostic and therapeutic procedures and future perspectives. Written by experts in the field, Textbook of Pediatric Gastroenterology, Hepatology and Nutrition: A Comprehensive Guide, Second Edition is an indispensable resource for students, trainees, and clinicians, sure to distinguish itself as the definitive reference on this topic.

This book assembles recent achievements in both basic research and clinical management in the field of hepatology, virology and immunology. It provides up-to-date information for clinicians who can apply the relevant knowledge to their daily clinical practice and for researchers who are interested in clinically orientated studies. The updated and detailed technology, state-of-the-art treatment strategies provided in this book serve as references for clinicians and resident physicians in the daily management of ACLF. The rationality and strategies for basic research as well as patient management in this book can also be a valuable reference for other fatal and end stage liver diseases than HBV induced ACLF. This volume 1 has 6 chapters and focuses on the definition, research technology, virology, genetics, and immunology.

This book focuses on the critical care of the patient with acute, acute on chronic and chronic liver failure as well as the peri-operative care of the patient with liver transplantation. Each of these disease processes is unique in pathophysiological manifestations, underpinnings of physiology and treatment options. Patients with acute, chronic or acute on chronic liver failure are a growing fraction of ICU admissions. Hepatic Critical Care serves as the essential reference for both practicing intensivists at community hospitals and tertiary referral centers. This textbook is also targeted towards trainees specifically interested in taking care of patients with liver disease and liver transplantation.

Gallstone disease is one of the most prevalent digestive diseases, resulting in a considerable amount of financial and social burden in the USA. Approximately 20 million Americans have gallstones. Because gallstone disease is a common clinical problem, basic and clinical studies on this disease continue to advance at a rapid pace, and a book focusing on basic science, current diagnosis and management of gallstones will greatly help practicing gastroenterologists, gastroenterological endoscopists, physicians and surgeons to understand the etiology of this disease and the availability of effective medical therapies. In this book, recognised medical experts discuss recent advances in the epidemiology, pathophysiology, pathogenesis, genetics and diagnosis, as well as endoscopic, medical and surgical therapies of gallstone disease. This compilation on gallstone disease was written by fifty authors from eight countries (Canada, China, Germany, Italy, Japan, the Netherlands, the United Kingdom, and the USA). There are thirty chapters in this book. Chapters One and Two discuss the epidemiology and natural history of cholesterol and pigment gallstone disease. Chapters Three through Six summarise recent progress in the pathogenesis of gallstone disease from a physical-chemical and pathophysiological perspective. Chapter Seven elucidates the roles of the immune system and the microbiome on the pathogenesis of cholesterol gallstones. Chapters Eight and Nine review the roles of nuclear receptors and the enterohepatic circulation of bile acids in cholesterol gallstone diseases. Chapters Ten through Twelve discuss the discovery of Lith genes and more fundamental knowledge concerning the genetic determinants and the molecular mechanisms underlying the critical role of Lith genes in gallstone formation in mice and humans. Chapter Thirteen discusses gallstones in pregnancy and explains why gallstone prevalence is higher in women than in men. Chapters Fourteen through Eighteen discuss the effects of diet, insulin resistance, obesity, diabetes, and nonalcoholic fatty liver disease on the formation of cholesterol gallstones. Chapter Nineteen provides diagnostic flow charts for biliary lithiasis. In Chapter Twenty, important non-invasive imaging findings of common gallbladder pathology are reviewed, and current strategies for the optimal use of imaging in the evaluation of patients with suspected gallbladder disease is discussed. Chapter Twenty-One evaluates current pharmacological therapy in cholesterol gallstones. Chapter Twenty-Two describes laparoscopic cholecystectomy. Chapters Twenty-Three through Twenty-Six discuss surgical treatment and endoscopic management of common bile duct stones and hepatolithiasis. Chapter Twenty-Seven reviews recent progress on the endoscopic treatment of bile duct stones with endoscopic papillary large balloon dilation. Chapter Twenty-Eight addresses surgical treatment of gallstones and their complications. Chapter Twenty-Nine discusses treatment of intrahepatic duct stones from a Western perspective. Chapter Thirty describes the history and incidence rate of Mirizzi syndrome, and summarises recent progress in its classification, diagnosis, and management. The articles in this book provide a state-of-the-art review of the current knowledge on the lithogenesis and the management of gallstone disease, as well as promote future epidemiological investigation, basic and translational research, and clinical studies on this prevalent biliary disorder worldwide.

Chronic liver disease is one of the most prevalent diseases in the developed world. The large amount of new knowledge has resulted in subspecialities, even in issues such as hepatology. Thus every day, it is more difficult to access all relevant information that is being published. Additionally, biomolecular techniques lead to a level of complexity that is only beneficial when dealt with by professionals. This book attempts to give a broad overview of the molecular biology of the liver, emphasizing how this knowledge is the basis of further treatment. Thus, pathophysiology and therapies are updated in viral hepatitis, hepatic encephalopathy and portal hypertension, among others. However, appended issues that apparently are less relevant such as the stem cell and endocannabinoids are included. These two issues will soon be of importance due to their close relationship with the liver tissue and especially with liver disease. There are also new paradigms such as cell death and the implication of the extracellular matrix, which are also addressed. In addition, important issues such as the stellate cells and their intimate relationship with fibrogenesis are treated in-depth. Also the fundamental role of endothelin in chronic liver disease is examined. Because of its prevalence, NASH was discussed with special interest, with a focus on the process from fatty liver to molecular biology of liver cells and metabolism in chronic liver disease. The authors believe that this is a broad vision that describes the basic pathophysiological mechanisms shared by many liver diseases, giving rational support for specific therapies.

Acute cholecystitis is a pathological entity of inflammatory origin, with a high prevalence worldwide. The term cholecystitis defines an inflammation of the gallbladder. Although most people with gallstones do not have symptoms and will not go on to develop cholecystitis, cholecystitis occurs most commonly due to blockage of the cystic duct with gallstones (cholelithiasis). In this book, Chapter One provides a contemporary review of acute cholecystitis (AC). Chapter Two examines the diagnosis and treatment options for AC. Chapter Three focuses on the diagnostic work-up of patients with AC. Chapter Four discusses early and delayed cholecystectomy as a treatment for AC. Chapter Five examines the current literature as it pertains to the management of patients who present with Grade II (moderate) acute cholecystitis, specifically looking at the timing of operation and the appropriateness of drainage procedures. Chapter Six reviews cholecystitis in systemic lupus erythematosus.

With approximately 8,000 liver transplant operations per year world-wide, this surgical procedure has become relatively routine. Improvements in surgical and anesthetic techniques and immunosuppression have resulted in improved outcomes, but cardiovascular events and sepsis remain the principal obstacles to further lowering morbidity and mortality rates. Consequently, cardiovascular assessment and optimisation are of increased interest to anaesthetists and other professionals involved in liver transplant programs. This book summarises the current knowledge on preoperative hemodynamic profiling and cardiovascular assessment of patients awaiting liver transplantation.

This book presents topical research in the study of liver cirrhosis, including etiologic types of end stage chronic liver disease; hepatocellular carcinoma screening in the cirrhotic patient; hepatic myofibroblasts and their role in liver fibrogenesis; the role of trace elements in the pathogenesis of liver cirrhosis and cell-based therapy for liver cirrhosis.

Insulin resistance (IR) and metabolic syndrome are associated with the pathogenesis and progression of non-alcoholic fatty liver disease (NAFLD). It encompasses a spectrum of hepatic pathology, ranging from simple steatosis in its most benign form (fatty liver), going through nonalcoholic steatohepatitis (NASH) in its intermediate form, until cirrhosis and hepatocellular carcinoma, its most advanced forms. This book presents current research on the background of fatty acid oxidation; hepatic steatosis and its progression to NASH and cirrhosis; fibrosis and myofibroblastic cells differentiation; methods of diagnosis; clinical features and laboratory tests and, finally, rodent NAFLD and NASH models.

Sex does matter. One of the most compelling reasons for understanding the biological differences, which are not so explained at this time, is that there are striking differences in human disease. The most obvious and best-studied differences between the sexes are in the reproductive systems. Much less study has been done on sex differences in non-reproductive areas of biology. Liver cancer is undoubtedly predominant in men and postmenopausal women. Almost anyone may "feel," but not recognise the sex-associated difference in liver cancer as a fact. How does sex matter in the incidence of liver cancer? After considering the data and examples presented in this book, anyone will be provided unique opportunities to obtain a better understanding of differences of chronic liver disease between the sexes. Some of these differences can be explained by what we now know. Some are unexplained and point to important questions for future study. Being female or male is an important basic human variable that affects health and liver disease throughout the life span. A better understanding the biological mechanisms underlying the sex-associated differences in chronic liver disease would provide valuable information to design care of health and liver disease more effectively for individuals, both females and males.

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.

This book discusses in detail new aspects of the metabolic basis of important chronic liver diseases. Entities such as non-alcoholic fatty liver disease (fatty liver and Non-Alcoholic SteatoHepatitis -- NASH), diabeties in chronic hepetitis C, hemochromatosis, Wilson's disease, Gaucher disease, porphyria, as well as liver cirrhosis and its metabolic consequences will be discussed in detail. These clinical conditions are highly prevalent and affect millions of patients in the USA and world-wide. For example, non-alcoholic fatty liver disease is the most common cause of elevated liver enzymes in the general population. This field has been practically transformed over the last few years, with many new insights gained, regarding both pathogenesis and effective novel treatments.

The latest information on living with and treating liver disorders

"The Liver Disorders and Hepatitis Sourcebook, Revised Edition," gives you frank assessments of the latest therapies and drugs. It also provides advice on how you can navigate the day-to-day challenges of living with a liver disorder, and diet and nutrition guidelines, including the truth about the effectiveness of herbal remedies and liver-cleansing diets.

This book presents state-of-the-art information summarizing the current understanding of a range of liver diseases, and reviews some key diagnostic and therapeutic advances. The book is a collection of selected clinical and scientific topics divided into two volumes, each divided into two sections. The first volume treats the cellular, biochemical and immunological mechanisms underlying liver diseases; the second focuses on clinical liver disease pathophysiology and related diagnostics and therapeutic insights. It is hoped that the target readers - hepatologists, clinicians, researchers and academicians - will be exposed to new ideas, and subjects beyond their own scientific disciplines. In addition, students and all those who wish to enlarge their knowledge of advances in the field of liver diseases will find this book a good source of information.

This book guides practitioners in the assessment of patients with a liver problem. The emphasis is on the role of macro- and microscopic pathology in elucidating pathogenesis as well as identifying confounding features of image findings that may lead to a more elaborate differential diagnosis. If appropriate, the role of light and electron microscopic examination, along with the role of specific stains and molecular techniques, is illustrated. In addition, the concept of each liver disease is summarized briefly and its up-to-data is provided, and unresolved problems in diagnosis, treatment, and pathogenesis are clearly described.The approach in this book is a practical one with a focus on the evaluation of illustrative cases, simultaneously demonstrating cross-sectional images (ultrasonography, computed tomography, magnetic resonance imaging, and angiography), pathological findings, and peritoneoscopic images. The diagnosis and therapy are summed up in helpful tables, and association of clinical manifestations with image analysis and pathological findings is shown to be important in differential diagnosis and treatment. With the authors comprising internationally renowned experts, this book will serve as a useful source of information for medical students, physicians, internists, hepatologists, gastroenterologists, radiologists, and pathologists worldwide.

Each volume in this richly illustrated series, published in association with the Papanicolaou Society of Cytopathology, provides an organ-based approach to the cytologic and histologic diagnosis of small tissue samples. Benign, pre-malignant and malignant entities are presented in a well-organized and standardized format, with high-resolution color photomicrographs, tables, and lists of key specific morphologic criteria. Example vignettes allow the reader to assimilate the diagnostic principles in a case-based format. This volume provides comprehensive coverage of both surgical pathology and cytopathology of focal liver lesions. Extensively illustrated throughout, it contains key cytologic and histologic features, practical points, radiologic and morphologic pictures, flow charts, and tabulated summaries for easy comprehensive overview and quick reference and provides a pragmatic algorithmic approach to cytohistologic diagnosis. With over 700 printed photomicrographs and a CD-ROM offering all images in a downloadable format, this is an important resource for all anatomic pathologists.

Radioembolization is a widely used treatment for non-resectable primary and secondary liver cancer. This handbook addresses the radiation biology, physics, nuclear medicine, and imaging for radioembolization using Yttrium-90 (90Y) microspheres, in addition to discussing aspects related to interventional radiology. The contents reflect on and off-label treatment indications, dose-response relationships, treatment-planning, therapy optimization, radiation safety, imaging follow-up and many other facets of this therapy necessary for both novice and advanced users alike.