An Unusual Zoonosis: Liver Abscess Secondary to Asymptomatic Colonic Foreign Body

A liver abscess may arise following any insult to gut integrity allowing portal drainage of bacteria to hepatocytes. Foreign bodies such as bones, toothpicks and items of stationery have previously been implicated in compromising gut epithelium. Here we present the case of a 57 year old man suffering from a left liver abscess. This was defined on CT which incidentally also identified a chicken bone protruding through the wall of the distal sigmoid colon. Whilst unwell with upper abdominal pain and sepsis, the presumed source of portal sepsis within the colon remained asymptomatic throughout. Following percutaneous drainage, the liver abscess resolved but the chicken bone had not passed at two months, necessitating atraumatic removal at colonoscopy. A high rate of incidental diagnoses suggests that unidentified foreign bodies may be vastly under recognised in cases of hepatic sepsis. Thus, identification of the precise mechanism of the liver insult demands thorough consideration; foreign body should be considered in all cases.

Comparison of Pancreas-Transplanted Type 1 Diabetic Patients with Portal-Venous Versus Systemic-Venous Graft Drainage: Impact on Glucose Regulatory Hormones and the Growth Hormone/Insulin–Like Growth Factor-I Axis

Context: Pancreas grafts can be drained through the iliac vein (systemic drainage) or the portal vein. Objective: We hypothesized that normalization of portal insulin in patients with portal pancreas graft drainage stimulates the GH/IGF-I axis and thereby contributes to glucose control. Methods: We compared patients after combined kidney and pancreas transplantation with portal drainage (n = 7) to patients with systemic drainage of the pancreas graft (n = 8) and nondiabetic controls (n = 8). Overnight fasting sera were analyzed for free and total IGF-I and IGF-binding proteins. Glucose regulatory hormones were examined after an oral glucose tolerance test and GH after stimulation with GHRH. Results: Systemic drainage led to higher basal and stimulated insulin levels than portal drainage (P < 0.05), but increments in response to oral glucose were reduced in both transplanted groups (P < 0.05 vs. controls). However, glucose tolerance was similar in all groups. Circulating free and total IGF-I and IGF-binding protein-3 were similar to control levels in the systemic drainage group but elevated in the portal drainage group (P < 0.05). Consistently, the GH response was reduced in the portal drainage group (P < 0.05 vs. controls) and correlated inversely with free IGF-I (r = −0.63, P < 0.05). Conclusion: Portal drainage of pancreatic endocrine secretion in pancreas graft recipients raises IGF-I and lowers GH secretion. These changes might explain that glucose regulation is maintained despite lower peripheral insulin levels, compared with patients with systemic graft drainage and nondiabetic control subjects.

Integrative physiology of splanchnic glutamine and ammonium metabolism

The substrates for hepatic ureagenesis are equimolar amounts of ammonium and aspartate. The study design mimics conditions in which the liver receives more [Formula: see text]than aspartate precursors (very low-protein diet). Fasted dogs, fitted acutely with transhepatic catheters, were infused with a tracer amount of 15NH4Cl. From arteriovenous differences, the major [Formula: see text] precursor for hepatic ureagenesis was via deamidation of glutamine in the portal drainage system (rather than in the liver), because there was a 1:1 stoichiometry between glutamine disappearance and[Formula: see text] appearance, and the amide (but not the amine) nitrogen of glutamine supplied the 15N added to the portal venous [Formula: see text] pool. The liver extracted all this [Formula: see text] from glutamine deamidation plus an additional amount in a single pass, suggesting that there was an activator of hepatic ureagenesis. The other major source of nitrogen extracted by the liver was [14N]alanine. Because alanine was not produced in the portal venous system, we speculate that it was derived ultimately from proteins in peripheral tissues.