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Cholestasis Post Liver Transplantation. IN: Lindor, K.; Talwalkar, J., eds. Cholestatic Liver Disease. Totowa, NJ: Humana Press. 2008. pp 171-182.

This chapter on cholestasis that occurs after liver transplantation is from a book that offers health care providers an overview of cholestatic liver disease; cholestasis is defined as a liver disorder characterized by impaired bile flow. The chapter covers biliary complications, preservation or reperfusion injury and ABO incompatibility, small-for-size syndrome, hepatic artery thrombosis, infectious complications, drug-induced acute cellular rejection, chronic rejection, and recurrent disease, including primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and viral hepatitis. The authors caution that cholestasis can occur anytime throughout the posttransplant period, may be intrahepatic or extrahepatic in origin, and has a very broad differential diagnosis. Careful diagnostic imaging of the biliary tree is an important first step in the workup, followed by liver biopsy if clinically indicated. 1 table. 50 references.

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Chronic Pancreatitis. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 469-474.

This chapter on chronic pancreatitis is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. Chronic pancreatitis is an often painful inflammation of the pancreas, characterized by progressive fibrosis that leads to irreversible destruction of exocrine and endocrine tissue. The author notes that chronic pancreatitis is classified broadly into chronic calcifying pancreatitis, chronic obstructive pancreatitis, and chronic autoimmune pancreatitis. The chapter focuses on chronic calcifying pancreatitis, which is characterized by recurrent bouts of clinically acute pancreatitis early in the course of the disease, with eventual development of intraductal stones later in the disease course. Eventually, steatorrhea and diabetes mellitus develop in the majority of these patients. Topics covered include diagnostic tests that may be used, including functional testing; clinical features and natural history; complications, including diabetes mellitus, steatorrhea, pseudocysts, biliary obstruction, duodenal obstruction, and splenic vein thrombosis; and patient care management considerations, particularly coping with chronic abdominal pain. 2 tables. 7 references.

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Disorders of the Kidneys. IN: Tanagho, E.; McAninch, J., eds. Smith’s General Urology. 17th ed. Columbus, OH: McGraw Hill. 2008. pp 506-520.

This chapter about disorders of the kidneys is from an updated edition of a comprehensive textbook about urology that offers an overview of the diagnosis and treatment of diseases and disorders common to the genitourinary tract. The author begins with a consideration of congenital anomalies of the kidneys, including agenesis, hypoplasia, supernumerary kidneys, dysplasia and multicystic kidney, adult polycystic kidney disease (PKD), simple or solitary cyst, renal fusion, and ectopic kidney. For most conditions, the author reviews the etiology and pathogenesis, the pathology, clinical findings, differential diagnosis, complications, treatment, and prognosis. The chapter goes on to describe acquired lesions of the kidneys, including aneurysm of the renal artery, renal infarcts, thrombosis of the renal vein, arteriovenous fistula, arteriovenous aneurysm, renoalimentary fistula, and renobronchial fistula. The chapter is illustrated with numerous black-and-white drawings and photographs. The chapter concludes with an extensive list of references, categorized by topic. 9 figures. 34 references. 17 ..MJ.- Kidney Diseases. Congenital Anomalies. Acquired Disorders. Diagnosis. Symptoms. Etiology. Therapy. Patient Care Management.

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Travel and IBD. Hertfordshire, United Kingdom: National Association for Colitis and Crohn’s Disease. 2008. 10 p.

This fact sheet helps readers with inflammatory bowel disease (IBD) learn about and implement strategies to help them when traveling. The author answers common questions about health insurance and vaccinations, including avoiding malaria; obtaining medical care while traveling, including issues of prescription medications and diet therapy; finding accommodations with private bathroom facilities; packing an emergency travel kit; ideas for car travel, bus and train travel, ferry travel, and air travel; food and drink issues, including treating traveler’s diarrhea; avoiding other health risks such as deep vein thrombosis (DVT), dehydration, and sun exposure; and traveling with a stoma. The fact sheet includes a list of tips for foreign travel, a checklist to review before traveling, and a list of organizations through which readers can obtain more information. Website addresses are provided. 25 references.

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Value of a Team Approach to Monitoring. Nephrology News & Issues. 22(6): 34-36. May 2008.

This article discusses the use of a team approach to the monitoring required for patients who have arteriovenous (AV) fistulae for hemodialysis vascular access. This team is usually composed of dialysis nurses, a vascular access coordinator, nephrologists, interventionalists, and the surgeon who placed the fistula. The authors review suggested methods of surveillance and the diagnostic techniques that can add valuable information to monitoring efforts. The authors maintain that the examination and surveillance techniques they describe can reduce the incidence of complete access thrombosis, a disruptive complication that can be disturbing for the patient. Incorporating these methods into routine dialysis care can increase access survival and thus reduce hospital days, missed treatments, and catheter use. A chart summarizes the clues of an access failure, the recommended physical examination of the access, the periodic surveillance tools to use, how to handle suspected access malfunction, stenosis or thrombosis, and the interventions for salvage of the access. 1 figure. 14 references.

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Vascular Diseases of the Liver. IN: Hauser, S., ed. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 337-344.

This chapter on vascular diseases of the liver is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. The author divides vascular diseases into disorders of hepatic inflow, which are diseases of the portal venous and hepatic arterial inflow, and disorders of hepatic venous outflow. The chapter reviews the anatomy of the splanchnic circulation, which comprises the arterial blood supply and venous drainage of the entire gastrointestinal tract from the distal esophagus to the mid-rectum and includes the spleen, pancreas, gallbladder, and liver. Specific disorders are discussed: chronic mesenteric venous thrombosis, hepatic artery thrombosis, hepatic artery aneurysm, hepatic artery-portal vein fistulas, ischemic hepatitis, hereditary hemorrhagic telangiectasia, and veno-occlusive disease. A final section covers Budd-Chiari syndrome, a heterogeneous group of disorders characterized by obstruction of hepatic venous outflow and often related to hematologic abnormalities, particularly myeloproliferative disorders. 1 figure. 3 tables. 11 references.

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Vascular Disorders of the Gastrointestinal Tract. IN: Hauser, S.C. Mayo Clinic Gastroenterology and Hepatology Board Review. 3rd ed. New York, NY: Informa Healthcare USA. 2008. pp 167-174.

This chapter on vascular disorders of the gastrointestinal (GI) tract is from a comprehensive textbook that provides an in-depth examination of essential knowledge in gastroenterology, hepatology, and the related areas of pathology, endoscopy, nutrition, and radiology. The author cautions that mesenteric ischemia, or lack of blood flow, can occur from any of the many different conditions that decrease intestinal blood flow. The chapter covers patient history and examination, the recommended initial diagnostic evaluation, superior mesenteric artery embolus, superior mesenteric artery thrombus, nonocclusive mesenteric ischemia, mesenteric venous thrombosis, chronic mesenteric ischemia, ischemic colitis, and miscellaneous syndromes, including celiac artery compression, and vasculitis. The chapter is illustrated with black-and-white photographs. 3 figures. 3 tables. 17 references.

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ABC of Clinical Hematology. Williston, VT: Blackwell Publishing Inc. 2007. 99 p.

This book on clinical hematology is from a series of resource books written by specialists for nonspecialists. The book is designed to be easy to use and covers the symptoms, investigations, treatment, and management of conditions presenting in day-to-day practice. The book includes fifteen chapters covering iron deficiency anemia, macrocytic anemias, hereditary anemias, polycythemia, essential thrombocythemia and myelofibrosis, chronic myeloid leukemia, the acute leukemias, platelet disorders, the myelodysplastic syndromes, multiple myeloma and related conditions, bleeding disorders, thrombosis and anticoagulation, lymphoproliferative disorders including chronic lymphocytic leukemia, stem cell transplantation, hematological disorders at the extremes of life, hematological emergencies, and the impact of molecular biology and gene therapy on the field of hematology. The book includes full-color photographs and illustrations. Each chapter concludes with a list of references, and a detailed subject index appears at the end of the text.

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Antiphospholipid Syndrome. IN: Hematology 2007. Washington, DC: American Society of Hematology. 2007. pp.136-142.

This chapter, from the annual Hematology 2007, describes the antiphospholipid syndrome (APS), an autoimmune thrombophilic condition that is marked by the presence of antibodies that recognize phospholipid-binding proteins. Patients with APS tend to present with vascular thrombosis and pregnancy complications, especially recurrent, spontaneous miscarriages. The author focuses on updated diagnostic and therapeutic approaches to this disorder. The author recommends that testing for antiphospholipid (aPL) antibodies should usually be restricted to patients who have had thrombosis, embolism, or pregnancy complications that may be attributable to APS, and to patients with systemic lupus erythematosus (SLE) even if they have not had these manifestations. An initial venous thromboembolism (VTE) in patients with confirmed APS should be treated with warfarin. Recurrence of VTE in the face of standard treatment should be treated with higher intensity coagulation or in selected situations with a form of low-molecular-weight heparin (LMWH). For pregnant patients with VTE, the author recommends treatment with prophylactic dose heparin plus low-dose aspirin (81 milligrams daily), with modification of administration for delivery, followed by resumption of prophylactic anticoagulation. 2 figures. 3 tables. 41 references.

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Aspirin and Clopidogrel Resistance. IN: Hematology 2007. Washington, DC: American Society of Hematology. 2007. pp. 114-120.

This chapter, from the annual Hematology 2007, reviews the use of aspirin and clopidogrel in patients with cardiovascular disease, focusing on patients who experience aspirin and clopidogrel “resistance.” The authors caution that this term infers a lack of therapeutic response and a single underlying mechanism, which is misleading. The incidence of “resistance” detected in clinical studies varies with the definition applied and assay used to measure response. Rather than true resistance, however, there is a variable patient response that reflects the unique pharmacology and pharmacokinetics of each drug, the clinical significance of which remains to be established. The authors discuss true “aspirin resistance” in which, despite 95 percent inhibition of serum thromboxane B2 by aspirin, residual platelet aggregation is detected in some cases. They consider whether heritable factors directly and indirectly related to platelet cyclooxygenase may influence aspirin response. The authors conclude that, in contrast to aspirin, the response to clopidogrel is highly variable and reflects the bioavailability of the active metabolite and not “resistance” of the receptor to inhibition. 2 tables. 46 references.

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