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IL FEGATO IL PANCREAS….. ed I loro segnali

IL FEGATO IL PANCREAS….. ed I loro segnali. Valerio Nobili, M.D. Responsabile UOC Malattie Epatometaboliche Direttore Laboratorio di Ricerca Malattie Epatiche Ospedale Bambino Gesu’ Valerio.nobili@opbg.net. I do not have any conflict of interest .

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IL FEGATO IL PANCREAS….. ed I loro segnali

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  1. IL FEGATO IL PANCREAS…..ed I lorosegnali Valerio Nobili, M.D. Responsabile UOC Malattie Epatometaboliche Direttore Laboratorio di Ricerca Malattie Epatiche Ospedale Bambino Gesu’ Valerio.nobili@opbg.net

  2. I do not have any conflict of interest

  3. ISOLATED ALTERATIONS OF BIOCHEMICAL MARKERS OF LIVER DAMAGE IN AN APPARENTLY HEALTHY PATIENT CAN REPRESENT A CHALLENGE FOR THE CLINICIAN……. ……….AND A LITTLE MORE FOR THE PEDIATRICIAN !!!

  4. ….Therefore, persistently elevated aminotransferases in a child should alert the physician to the possibility of an underlying liver or multisystem disorder and prompt a referral to a specialized center for diagnostic evaluation and management. T. Lamireau et al 2014

  5. 2008, Volume 371, Number 9628, VENTO S, and NOBILI V

  6. “the finding of evenmodestincreases of aminotransferaseconcentrationsshouldnot be overlooked, asitcouldprovide an opportunity for clinicians to reveal and treatnotonlyserioushepaticdiseasesbutalso to modifydetrimentalhabitsthat can be life-threatening in the long term.”

  7. Hepatology 2008;47(3):880-87

  8. The degree of emergency is indicated by the association with increased prothrombin time indicating impending liver failure, and not by the level of increased aminotransferases which is not directly correlated to disease severity. T. Lamireau et al 2014

  9. T. Lamireau et al 2014

  10. Autoimmune HepatitisHistology • Lymphoplasmacytic infiltrate • Interface hepatitis Portal inflammation and invasion of limiting plate

  11. Serumimmunoglobulin G4 and immunoglobulin G1 fordistinguishingimmunoglobulin G4-associated cholangitisfromprimarysclerosingcholangitis Hepatology59, 5, 1954–1963, May 2014 The recent addition of immunoglobulin (Ig)G4-associated cholangitis (IAC), also called IgG4-related sclerosing cholangitis (IRSC),…………,but interpretation of elevated sIgG4 levels remains unclear.

  12. macrovesicularfatty infiltrate (lipocytes, blackarrowhead) and chronicportalinflammation (inflammatorycells, whitearrows), characteristicseen in nonalcoholicsteatohepatitis

  13. 40x views, respectively, of trichrome stain highlighting perivenular fibrosis (black arrows) and steatosis (white arrows).

  14. CF liver disease: • up to 25% with clinically significant disease • Pathogenesis: biliary ductal obstruction from inspissated secretions  biliary fibrosis and cirrhosis • Monitoring: assess HSM, liver enzymes & GGT annually, abdominal ultrasound • Treatment: ursodeoxycholic acid; referral to hepatologist if cirrhosis/portal hypertension

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