Early Onset of Intrahepatic Cholestasis of Pregnancy: a Case Report

Intrahepatic cholestasis of pregnancy (ICP) is a disorder characterized by pruritus and elevated liver function tests. Associated with a high incidence of adverse perinatal outcomes, ICP requires thorough attention in clinical practice. In addition, there is a high rate of stillbirth in cases of ICP. Women with ICP should be informed of the inability to predict stillbirth. Multi-disciplinary cooperation is critical for managing the condition and ensuring better pregnancy outcomes.

Early Onset of Intrahepatic Cholestasis of Pregnancy: a Case Report

Intrahepatic cholestasis of pregnancy is a disorder, characterized by pruritus and elevated liver function tests. Associated with a high incidence of adverse perinatal outcomes, intrahepatic cholestasis of pregnancy (ICP) requires thorough attention in clinical practice. In addition, there is a high rate of stillbirth in cases of ICP. Women with ICP should be informed of the inability to predict stillbirth. Multi-disciplinary cooperation is critical for managing the condition and ensuring better pregnancy outcomes.

Characteristics and outcomes of patients with COVID-19 and liver injury: a retrospective analysis and a multicenter experience

Background and aims: Patients with COVID-19 frequently present abnormal elevated liver function tests of unknown clinical significance. We aimed to investigate the characteristics and factors influencing outcome in patients with confirmed SARS-CoV-2 infection and liver injury on admission. Methods: This is a retrospective observational study of patients hospitalized in two COVID units in Romania. Relevant data on clinical and laboratory parameters and medication administered during the admission were analyzed to identify predictors of a negative outcome. Patients with confirmed COVID-19 and liver function tests (LFTs) above the upper limit of normal were included in the analysis. Results: From 1,207 patients, we identified 134 patients (11%) with abnormal LFTs during hospitalization. The majority of patients had mildly elevated levels and a predominantly cholestatic pattern of liver injury. Patients who received lopinavir/ritonavir were more likely to have increased ALAT levels (p<0.0001). Sixteen patients had pre-existing chronic liver disease, and they were more likely to suffer from severe COVID-19 (p=0.009) and have a negative outcome (p<0.001), but on multivariate analysis, only the severity of COVID-19 was predictive of death (OR 69.9; 95% CI 6.4-761.4). Conclusions: Mild liver injury is relatively common in COVID-19 and possibly influenced by medication. Patients with chronic liver disease are at high risk for negative outcome, but the severity of the infection is the only predictor of death.

Right lower quadrant mass in a geriatric patient

An 88-year old man presented at the geriatric outpatient clinic with fatigue and weakness since three weeks. One month before presentation, he was admitted with erysipelas of the left lower leg. After discharge, he progressively developed loss of appetite and fatigue. The day before presentation, he noticed a painless swollen lump in his right lower quadrant (Figure 1A). His medical history consisted of a transient ischemic attack, osteopenia, polymyalgia rheumatica treated with steroids, appendicular abscess treated with antibiotics and percutaneous drainage six years before, gallstones, chronic kidney disease, iron deficiency anemia and diverticulosis. Laboratory findings showed an elevated CRP (191.0mg/dL [≤ 5.0mg/dL]) and mildly elevated liver function tests. A computed tomography scan was performed and showed a large abdominal mass

Refeeding Patients with Moderate and Severe Eating Disorders: A Retrospective Cohort Study

Background: Anorexia Nervosa (AN) is a life-threatening mental illness that can cause significant medical complications, including the potentially fatal refeeding syndrome. Registered dietitians (RDs) are a critical part of an eating disorder multidisciplinary team that focuses treatment on safe weight restoration and nutrition rehabilitation. Method: This study is a description of how the nutrition rehabilitation protocol of 395 adult patients diagnosed with AN and admitted to residential eating disorder treatment is implemented, how the protocol is sustained throughout a patient’s treatment stay to achieve desired weight gain, and how the patients’ biochemical and clinical progress proceeded between admission and discharge, including laboratory results and body mass index (BMI). Results: One hundred twenty-six patients required phosphorus supplementation for refeeding hypophosphatemia (RH); admission BMI was not significantly different between those with and without RH. The 15% of patients who required enteral nutrition at any point during their admission gained significantly less weight than patients who only received an oral meal plan. 34.4% of patients admitted with starvation induced hepatitis, 28.6% experienced refeeding hepatitis at some point, 21.0% of patients had elevated liver function tests 2 weeks into refeeding and 28.6% at discharge. Conclusions: This study demonstrated overall effectiveness in achieving weight restoration goals with aggressive kcal increases without a single incidence of refeeding syndrome and infrequent RH. No significant biochemical changes were observed during refeeding. With close medical supervision and concurrent RD oversight, a refeeding approach with consistent calorie increases that is more aggressive than previously recommended appears to be safe.

Biliary Sphincter of Oddi Dysfunction

Sphincter of Oddi dysfunction (SOD) is a syndrome caused by either dyskinesia or stenosis of the sphincter of Oddi. It has been categorized into biliary and pancreatic SOD based on clinical features and laboratory findings. We present a case of a 51-year-old female (post-cholecystectomy) who presented with intermittent chronic right upper quadrant pain. Laboratory investigations showed persistently elevated liver function tests and a dilated common bile duct without the presence of any stones. Endoscopic retrograde cholangiopancreatography with manometry showed an elevated sphincter of Oddi pressure, thus confirming the diagnosis of SOD. She underwent endoscopic sphincterotomy and papillotomy with normalization of liver function tests and resolution of her chronic symptoms.

Anaplasmosis Presenting With Respiratory Symptoms and Pneumonitis

Anaplasmosis is a now common tick-borne illness that is characterized by the presence of fever, myalgias, thrombocytopenia, and elevated liver function tests. We report 4 cases with an atypical presentation with pulmonary symptoms and imaging findings, along with the characteristics of each patient, clinical course, and response to therapy.