Curbside Consultation of the Liver: 49 Clinical Questions

Mitchell L. Shiffman, MD

  • $99.95
  • ISBN 10 1-55642-815-4
  • ISBN 13 978-1-55642-815-9
  • 272 pp Soft Cover
  • Pub. Date: 2008
  • Order# 78154

Are you looking for concise, practical answers to questions that are often left unanswered by traditional liver references? Are you seeking brief, evidence-based advice for complicated cases or complications? Curbside Consultation of the Liver: 49 Clinical Questions provides quick and direct answers to the thorny questions commonly posed during a “curbside consultation” between colleagues.

Dr. Mitchell Shiffman has designed this unique reference, which offers expert advice, preferences, and opinions on tough clinical questions commonly associated with the liver. The unique Q&A format provides quick access to current information related to the liver with the simplicity of a conversation between two colleagues. Numerous images, diagrams, and references are included to enhance the text and to illustrate the treatment of the liver.

Curbside Consultation of the Liver: 49 Clinical Questions provides information basic enough for residents while also incorporating expert advice that even high-volume clinicians will appreciate. Gastroenterologists, fellows and residents in training, and medical students will benefit from the user-friendly and casual format and the expert advice contained within.

Some of the questions that are answered:

  • How often should I follow a patient who had chronic hepatitis C after they achieved a sustained virologic response?
  • Should I stop the HIV medications in a patient who has developed an elevation in serum liver transaminases?
  • What should I tell my patient who is a carrier for alpha-1-antitrypsin deficiency?
  • Which patients with fatty liver disease on an ultrasound examination require a liver biopsy?
  • Which patients with chronic liver disease should I screen for hepatocellular carcinoma?
  • How much ascites is safe to remove at any time?
  • Dedication

  • Acknowledgments

  • About The Editor

  • Contributing Authors

  • Preface

  • Section I: Viral Hepatitis C

  • Question 1: What Is The Likelihood That My Patient With Chronic Hepatitis C Will Develop Cirrhosis, Hepatocellular Carcinoma, And/Or Hepatic Decompensation?

  • Seela Ramesh, MD ; Mitchell L. Shiffman, MD

  • Question 2: How Should A Patient Who Tests Positive For Chronic Hepatitis C But Has Persistently Normal Serum Aminotransaminases Be Evaluated?

  • Ramesh Ashwath, MD; Mitchell L. Shiffman, MD

  • Question 3: Do All Patients With Chronic Hepatitis C Virus Require A Liver Biopsy?

  • Ramesh Ashwath, MD; Mitchell L. Shiffman, MD

  • Question 4: How Often Should I Measure Chronic Hepatitis C Rna While Treating A Patient With Peginterferon And Ribavirin?

  • Mitchell L. Shiffman, MD

  • Question 5: When A Patient Receiving Peginterferon And Ribavirin Therapy Develops Anemia Should I Prescribe Epoetin Alfa Or Reduce The Dose Of The Ribavirin?

  • Mitchell L. Shiffman, MD

  • Question 6: Is There Anything I Can Do To Improve The Chance That An African American With Chronic Hepatitis C Will Respond To Peginterferon And Ribavirin?

  • Mitchell L. Shiffman, MD

  • Question 7: Is It Safe To Treat Patients With Chronic Hepatitis C And Cirrhosis With Peginterferon And Ribavirin?

  • Mitchell L. Shiffman, MD

  • Question 8: How Often Should I Follow A Patient Who Had Chronic Hepatitis C After He Achieved A Sustained Virologic Response?

  • Mitchell L. Shiffman, MD

  • Section Ii: Viral Hepatitis B

  • Question 9: Which Patients With Chronic Hepatitis B Require A Liver Biopsy?

  • Wei Hou, MD; Mitchell L. Shiffman, MD

  • Question 10: How Do I Decide Which Medication To Utilize In A Patient With Hepatitis B Virus?

  • Mitchell L. Shiffman, MD

  • Question 11: Can I Ever Stop Treatment In A Patient With Chronic Hepatitis B Receiving An Oral Antiviral Agent?

  • Wei Hou, MD; Mitchell L. Shiffman, MD

  • Question 12: How Do I Know When A Patient Receiving An Oral Antiviral Agent Has Developed Resistance And What Do I Do When This Happens?

  • Mitchell L. Shiffman, MD

  • Question 13: How Do I Treat A Patient Who Is Coinfected With Chronic Hepatitis B And C Viruses?

  • Mitchell L. Shiffman, MD

  • Section Iii: Liver Disease In Patients With Hiv Infection

  • Question 14: How Does Having Hiv Affect The Likelihood That My Patient With Chronic Hepatitis C Will Develop Cirrhosis?

  • Kevin M. Comar, MD; Richard K. Sterling, MD, MSc, FACP, FACG

  • Question 15: Which Patients With Chronic Hepatitis C And Hiv Coinfection Should Be Treated With Peginterferon And Ribavirin?

  • Kevin M. Comar, MD; Richard K. Sterling, MD, MSc, FACP, FACG

  • Question 16: Is There A Simple Way To Treat A Patient Who Is Coinfected With Hepatitis B Virus And Hiv?

  • Richard K. Sterling, MD, MSc, FACP, FACG

  • Question 17: What Things Could Cause My Patient With Hiv To Develop Jaundice?

  • Richard K. Sterling, MD, MSc, FACP, FACG

  • Question 18: Should I Stop Hiv Medications In A Patient Who Has Developed An Elevation In Serum Transaminases?

  • Richard K. Sterling, MD, MSc, FACP, FACG

  • Section Iv: Genetic Disorders That Cause Chronic Liver Disease

  • Question 19: What Is The Best Screening Test For Genetic Hemochromatosis?

  • Peter Dienhart, MD; Jayanta Choudhury, MD; Anastasios A. Mihas, MD, DMSc, FACT, FACG

  • Question 20: How Frequently Should I Have A Patient With Genetic Hemochromatosis Undergo Phlebotomy?

  • Peter Dienhart, MD; Jayanta Choudhury, MD; Anastasios A. Mihas, MD, DMSc, FACP, FACG

  • Question 21: What Is The Best Screening Test For Wilson’S Disease?

  • Opang Cheung, MD; Anastasios A. Mihas, MD, DMSc, FACP, FACG

  • Question 22: What Should I Tell My Patient Who Is A Carrier For Alpha-1-Antitrypsin Deficiency?

  • Anastasios A. Mihas, MD, DMSc, FACP, FACG

  • Question 23: Do All Patients With Autoimmune Hepatitis Require Immune Suppressive Medications?

  • R. Todd Stravitz, MD

  • Question 24: My Patient With Autoimmune Hepatitis Cannot Take Corticosteroids. Are There Other Medications I Could Use?

  • R. Todd Stravitz, MD

  • Question 25: Do I Need To Perform A Liver Biopsy In All Patients With Autoimmune Hepatitis Prior To Initiating Steroids?

  • Andres Mogollon, MD; R. Todd Stravitz, MD

  • Section V: Fatty Liver Disease

  • Question 26: Which Patients With Fatty Liver Disease On Ultrasound Require A Liver Biopsy?

  • Arun J. Sanyal, MD; B. Marie Reid, MD

  • Question 27: An Obese Patient With Hypercholesterolemia Was Recently Started On A Statin And Is Now Found To Have Elevated Serum Liver Transaminases. Do I Need To Stop This Medication?

  • Arun J. Sanyal, MD; Jayanta Choudhury, MD

  • Question 28: What Is The Best Treatment To Utilize In A Patient With Fatty Liver Disease And Type 2 Diabetes Mellitus?

  • Arun J. Sanyal, MD; Puneet Puri, MD

  • Question 29: My Patient With Chronic Hepatitis C Also Has Evidence Of Nonalcoholic Steatohepatitis On His Liver Biopsy. What Can I Do To Increase His Chance Of Responding To Peginterferon And Ribavirin Treatment?

  • Arun J. Sanyal, MD; Onpang Cheung, MD, MPH

  • Question 30: Can A Patient Of Normal Body Weight, A Normal Serum Cholesterol Level, And No History Of Diabetes Have Fatty Liver Disease?

  • Arun J. Sanyal, MD

  • Section Vi: Cholestatic Liver Disease

  • Question 31: When Should I Initiate Treatment With Ursodeoxycholic Acid And What Dose Should I Utilize In My Patient With Primary Biliary Cirrhosis?

  • Puneet Puri, MD; Velimir A. Luketic, MD

  • Question 32: What Type Of Testing Does My Patient With Primary Biliary Cirrhosis Require?

  • Velimir A. Luketic, MD

  • Question 33: Is Ursodeoxycholic Acid Effective For The Treatment Of Primary Sclerosing Cholangitis?

  • B. Marie Reid, MD; Velimir A. Luketic, MD

  • Question 34: Should I Be Screening My Patients With Primary Sclerosing Cholangitis For Cholangiocarcinoma?

  • Michael Fuchs, MD, PhD, FEBG

  • Question 35: Should All Patients With Suspected Primary Sclerosing Cholangitis Undergo An Endoscopic Retrograde Cholangiography To Confirm This Diagnosis?

  • Michael Fuchs, MD, PhD, FEBG

  • Question 36: My Patient With Ulcerative Colitis Recently Underwent A Total Colectomy For Severe Dysplasia. Does This Reduce The Risk That He Will Get Primary Sclerosing Cholangitis?

  • Michael Fuchs, MD, PhD, FEBG

  • Section Vii: Cirrhosis

  • Question 37: Which Asymptomatic Patients With Cirrhosis Should Undergo An Upper Endoscopy To Determine Whether They Have Esophageal Varices?

  • Nagib Toubia, MD; Adil Habib, MD; Douglas M. Heuman, MD

  • Question 38: I Just Banded Actively Bleeding Varices In A Patient With Known Cirrhosis. The Patient Is Now Hemodynamically Stable. Is There Anything Else I Should Recommend?

  • Nagib Toubia, MD; Adil Habib, MD; Douglas M. Heuman, MD

  • Question 39: Which Patients With Chronic Liver Disease Should I Screen For Hepatocellular Carcinoma?

  • Douglas M. Heuman, MD; Adil Habib, MD

  • Question 40: Should I Vaccinate My Patients With Cirrhosis For Hepatitis A And B?

  • Douglas M. Heuman, MD; Adil Habib, MD

  • Question 41: A Healthy Patient Not Known To Have Chronic Liver Disease, With Normal Liver Chemistries And Liver Function, Was Found To Have A 4-Centimeter Liver Mass On Ultrasound. Should I Biopsy This?

  • Douglas M. Heuman, MD; Adil Habib, MD

  • Question 42: I Was Asked To See A Patient With Tense Ascites. How Much Ascites Is Safe To Remove At Any One Time?

  • Adil Habib, MD; HoChong S. Gilles, MS, FNP; Leslie M. Gallagher, MS, ANP; Douglas M. Heuman, MD

  • Question 43: I Have Been Increasing The Dose Of Diuretics In My Patient With Ascites Over Several Weeks. He Still Has Ascites But Has Now Developed An Elevation In Serum Creatinine To 2.0 Mg/Dl. What Should I Do?

  • Douglas M. Heuman, MD; Adil Habib, MD

  • Question 44: My Patient With Cryptogenic Cirrhosis Was Recently Hospitalized With Spontaneous Bacterial Peritonitis. How Long Should She Be Treated With Antibiotics?

  • Paul Arnold, MD; Adil Habib, MD; Douglas M. Heuman, MD

  • Question 45: My Patient With Cirrhosis Has An Elevated Serum Ammonia But No Symptoms Of Hepatic Encephalopathy. How Much Lactulose Should I Recommend?

  • Paul Arnold, MD; Adil Habib, MD; Douglas M. Heuman, MD

  • Question 46: My Patient With Hepatic Encephalopathy Continues To Be Mildly Confused Despite Taking Lactulose Twice Daily And Having Multiple Episodes Of Diarrhea Daily. Should I Increase The Dose Further?

  • Douglas M. Heuman, MD; Adil Habib, MD

  • Section Viii: Liver Transplantation

  • Question 47: My Patient With Cirrhosis Suffers From Severe Fatigue But Has Normal Liver Function And Has Never Had A Major Complication Of Cirrhosis. Should I Refer This Patient For A Liver Transplant?

  • Amrita Sethi, MD; R. Todd Stravitz, MD

  • Question 48: What Should I Recommend For My Patient With Cirrhosis Who Was Recently Found To Have A New 2-Centimeter Liver Mass By Ultrasound Screening?

  • Lawrence Chang, MD; R. Todd Stravitz, MD

  • Question 49: I Have Been Asked To See A Patient Who Had A Liver Transplant 5 Years Ago In Another State. He Has Not Been Seen By His Liver Transplant Center In 2 Years. His Serum Creatinine Is 2.5 Mg/Dl But His Liver Enzymes And Liver Function Tests Are Normal. He Does Not Want To Go Back To His Transplant Center. What Should I Do?

  • R. Todd Stravitz, MD

"It is well written and easy to read. The innovative format that the book applies in which each chapter is entitled by a relevant question, makes it very friendly to the reader and increases its potential to be a quick reference book or companion book for the clinical hepatologist. It is up-to-date, and the use of simple diagrams and tables increase the value of this book. It is a must read for the gastroenterology/Hepatology fellow, for the junior Hepatology attending and even for senior hepatologists who would like a quick review of current literature. As the title indicated, it answers typical curbside questions, that often require an extensive search of the literature and deep insight into the hepatology field."

— Mayra J. Sanchez, MD, Gastroenterology and Hepatology Fellow, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, Journal of Clinical Gastroenterology

"Each question is answered efficiently with appropriate charts and figures. The bridge between medical literature and actual medical practice is a unique aspect to this text. The authors do a great job of separating evidence-based guidelines from expert opinion or personal practice. The overall quality of this text was excellent. Curbside Consultation of the Liver will be a welcome companion for hepatology textbooks and practice guidelines. Physicians, from the resident to the hepatologist, presented with these clinical questions will find this text to be a quick review and adjunct in clinical practice."

— Geoffrey Fillmore, DO & Mark Jeffries, DO, Scott and White Hospital, Texas A&M Health Science Center,
Practical Gastroenterology

“The questions are common and practical; as such the book does an admirable job of meeting the objectives. The chapters are written by the well regarded hepatology faculty from Virginia Commonwealth University Medical Center as well as gastroenterology fellows from this institution. They impact a solid and practical command of the field and are credible authorities. This is a very useful practical approach to commonly encountered hepatology management questions. The format is enjoyable and the information easy to comprehend. It represents a welcome change from the usual staid textbook fare.”

— Willem JS de Villiers, MD, PhD, University of Kentucky College of Medicine, Doody Enterprises, Inc.

Mitchell L. Shiffman, MD received his MD degree from the State University of New York, Upstate Medical Center in Syracuse, NY. He then completed internship and residency training in Internal Medicine at the Medical College of Virginia (now the Virginia Commonwealth University Medical Center) in Richmond, VA. He remained at this institution for fellowship training in Gastroenterology and Hepatology, which included two years of research training funded by a National Institutes of Health training grant. After completing his training, Dr. Shiffman joined the faculty of the Virginia Commonwealth University as an Assistant Professor of Medicine and has remained at this institution throughout his academic career. He is currently a Professor of Medicine, and has been the Chief of the Hepatology Section and Medical Director of the Liver Transplant Program at the VCU Medical Center for over a decade.

Dr. Shiffman has authored or coauthored over 200 original articles, editorials, reviews, and/or book chapters. His clinical research has focused on improving our understanding and developing better treatments for viral hepatitis B and C. He is a member of the Board of Trustees of the American College of Gastroenterology, and has served on numerous NIH grant review committees and is a member of the Editorial Boards of Liver Transplantation and Liver International.

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