The recently published article "The Burden of Liver Disease in Europe: A Review of Available Epidemiological Data" provides a few figures on the enormous problem that liver disease poses for Europeans. Liver disease is estimated to cause 170,000 deaths annually in Europe, 47,000 of which are attributed to liver cancer; 0.5%-0.7% of the European population is affected by chronic hepatitis B; and prevalence rates of hepatitis C virus (HCV) infection in the last decade in the European population ranged from 0.13 to 3.26%. These HCV-infected populations will develop complications in the years to come. It is of great concern that about 90% of people in Europe infected by viral hepatitis are unaware of their status. Alcoholic and non-alcoholic fatty liver disease (NAFLD) must also be added to the picture. NAFLD is becoming a major concern with the increasing incidence of obesity and type 2 diabetes in Europe. The burden of liver disease is not less pessimistic in North America, Asia and the rest of the world.

Hepatitis B virus (HBV) infection is a problem of global health importance and represents a significant cause of morbidity and mortality world-wide. HBV can be transmitted parenterally, sexually and perinatally. Despite progress on prophylaxis, diagnostic and treatment of HBV infection, it remains one of the major causes of chronic liver disease, cirrhosis or hepatocellular carcinoma. This book presents a compilation of current research including such topics as Hepatitis B and dialysis; Hepatitis B virus infection among middle school students in South Brazil; genotyping and management of chronic Hepatitis B; the risk assessment for Hepatitis B infection and its role in hepatocellular carcinoma; and silencing Hepatitis B virus replication with antiviral Pri-Mir shuttles generated from liver-specific Pol II promoters.

Rapid advances on molecular studies, manipulation of the mouse genome, the development of a number of animal models, and using these in studies of nonalcoholic fatty liver disease (NAFLD) have provided important insights into the pathogenesis of this relatively common disorder. One of the most crucial advances was to recognise the links among obesity, insulin resistance, inflammation and NAFLD. A growing body of literature has shown that insulin resistance and its liver-related consequence, NAFLD, could be the result of generalised inflammation. Genetic and behavioral factors contribute to increased visceral adipose tissue where increased oxidative stress and lipid peroxidation may contribute to dysregulated production of adipocytokines, fatty acids, and bioactive lipids. This chain of these events may contribute to local and peripheral insulin resistance, a central underlying pathophysiological process that may both cause and result from increased peripheral lipolysis and elevated free fatty acid concentrations in the circulation. Abnormally elevated free fatty acids taken up by organs other than adipose tissue, such as liver and skeletal muscle, contributes to steatosis of these organs (ectopic lipogenesis). Increased muscle and hepatocellular lipid content provides substrates for oxidative stress and lipid peroxidation, and also promotes insulin resistance in both liver and muscle by disturbing their downstream insulin signaling cascades. Insulin resistance further increases peripheral lipolysis in adipose tissue, further elevates circulating free fatty acids, inhibits hepatic fatty acid a-oxidation and increases de novo synthesis of both fatty acids and triglycerides in the liver. Excessively produced triglycerides in the liver are either stored as fat droplets or secreted into the plasma as very-low-density lipoproteins. If this complex mechanism of hepatic fat synthesis and secretion capacity is overwhelmed, excessive triglycerides accumulate within the hepatocytes and manifests as NAFLD. A fatty liver is sensitive to hepatocellular injury and sustained injury can manifest as nonalcoholic steatohepatitis (NASH), NASH-associated cirrhosis, and NASH-associated hepatocellular carcinoma. Specific depletion of hepatic natural killer T cells with consequent proinflammatory cytokine polarisation of liver cytokine production might be one reason for this increased hepatic sensitivity against various stimuli. Only a minority of patients with NAFLD have the necroinflammatory changes of NASH. The development of NASH in patients with NAFLD may be the consequence of secondary abnormalities such as injured and dysfunctional mitochondria, generation of reactive oxygen species with down-regulation or consumption of antioxidants causing oxidative stress and lipid peroxidation, increased activity of cytochrome P450 2E1, disturbed production of adipocytokines, and the effects of gut-derived cytotoxic products. The dynamic interplay of these processes in the pathogenesis of NAFLD remains incompletely understood and is an area of active research.

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.

This book provides a comprehensive account on individually rare, but collectively frequent diseases of the liver. In the first part, conditions such as hepatic vascular malformations, ischemic cholangiopathy, hepatic artery occlusion, sinusoidal conditions and Budd-Chiari syndrome are discussed among others. The second part examines the causes of vascular liver disease namely, coagulation disorders, neoplasm disorders, non-malignant blood disorders, systemic diseases and toxins, among others. The unique expertise of the authors, who are all members of the Vascular Liver Disease Disorders Group, an independent network of researchers with a common interest in Vascular Liver Diseases, are merged for an optimal pragmatic and individualized approach. This book is of interest to a broad range of experts, such as hepatologists, internists, radiologists and angiologists.

In this issue of Radiologic Clinics, guest editors Drs. Benjamin M. Yeh and Frank H. Miller bring their considerable expertise to the topic of Hepatobiliary Imaging. Top experts in the field offer comprehensive reviews of every major aspect of hepatobiliary imaging: biliary cancer, trauma, vascular disorders, and benign liver disease. This issue also includes articles on imaging modalities (MR, CT, ultrasound), contrast agents, and "Pearls and Pitfalls." Contains 13 practice-oriented topics including abbreviated MR liver protocols; update on MR contrast agents for liver imaging: what to use and when; biliary imaging interpretation pearls and pitfalls: CT and MRI; update on biliary cancer imaging; atypical liver malignancies and diagnostic pitfalls; and more. Provides in-depth clinical reviews on hepatobiliary imaging, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

An easily accessible guide to diagnosing and managing critical situations, Emergencies in Gastroenterology and Hepatology aids doctors in dealing with acutely sick patients quickly and effectively. The book provides practical advice on how to make difficult decisions in an emergency situation. Areas covered include life and death emergencies, as well as the broad problems faced by on-call Gastroenterologists and Hepatologists on a daily basis. The focus throughout is on immediate management, but the book also includes reference to long term follow up for certain problems. Each chapter has an associated algorithm, which summarises the contents of the chapter, providing an aide memoir for the reader and facilitating learning, as well as being a quick reference tool. Bullet-point information for speed and clarity combined with the integral cross-referencing system, further enables quick access to the necessary information.

In consultation with Dr. Charles Lightdale, Dr. DiMaio has assembled a list of articles devoted to endoscopy in hepatology with the most current and clinically relevant content. Dr. DiMaio invited top experts from well-known institutions to contribute reviews on the following topics: EUS in the evaluation of unexplained biliary dilation and liver function test abnormalities; EUS-guided liver biopsy; Advances in endoscopic imaging of the biliary tree; Expert evaluation of indeterminate biliary strictures; Stenting for benign and malignant biliary strictures; Endoscopic management of biliary issues in the liver transplant patient; Endoscopic management of complex biliary stone disease; EUS-guided biliary drainage; ERCP and EUS-guided drainage of the gallbladder; EUS-guided interventions for the measurement and treatment of portal hypertension; Endoscopic management of portal hypertension-related bleeding; EUS for diagnosis and staging of liver tumors; ERCP-guided ablation for cholangiocarcinoma; and EUS-guided ablation of liver tumors. Readers will come away with the most current clinical information they need to improve outcomes in patients with liver disease.

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.

This book is written for the primary care clinician to help update knowledge of pediatric endocrinology (with an emphasis on diabetes) from both ancient and modern times. The current and future shortage of pediatric endocrinologists necessitates steady, rejuvenated information on diabetes and other endocrine disorders for primary care clinicians as they care for the child and adolescent with complex endocrine dilemmas and disorders. In view of this shortage and the rapidly increasing knowledge in pediatric diabetes as well as understanding indications for referral to pediatric endocrinologists in the 21st century, au courant assiduous information aimed at primary care clinicians in these areas becomes increasingly important.

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.

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 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.

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.