Results: Cohort characteristics are displayed on Table . A total of 15,560 patients were examined. The mean age of the population was 47 (6 16) years. A greater proportion of patients were white (62%) and female (51%). Mean kPa and CAP were 6 kPa and 264 dB/m, respectably. On simple linear regression short sleep duration was significantly associated with hepatic steatosis (b 5 [8.4], p 5 [, 0.001]). Likewise, on multivariable linear regression after adjusting for age and body mass index (BMI), short sleep duration was significant associated with hepatic steatosis (b 5 [4.0], p 5 [0.013]). However, after adding sex to the model this association was no longer significant (b 5 [2.1], p 5 [0.152]). A relationship was not seen between sleep duration and hepatic fibrosis on unadjusted analysis or when controlling for the same variables described above. Conclusion: Overall, FibroScan® data in NHANES 2017-2020 support a positive association between short sleep duration and hepatic steatosis independently of metabolic factors such as BMI. Prospective studies are required to confirm this association. (Figure)
Introduction: Bezoars are solid masses of indigestible materials that accumulate in the gastrointestinal tract (GIT). They are classified according to their content and sites in the GIT. We present a case of large bowel partial obstruction secondary to bezoar, attributable to chronic opioid use. Case Description/Methods: A 65-year-old male with a history of hypertension, occasional constipation with unremarkable colonoscopy 2 years ago, spinal stenosis with fully functioning activity on chronic opioid use for 10 years, presented with worsening abdominal pain and distension with small bowel movements for 5 days. He reported nausea with no vomiting. Physical exam showed normal vital signs and distended soft abdomen with no tenderness or guarding. CT abdomen showed 10 x 6 cm partially obstructing bezoar in the proximal transverse colon, with decompressed distal colon, and with no small bowel obstruction (Figure). He was started on different laxatives and enemas for 3 days with no improvement. Colonoscopy showed a large obstructing stoolball (Figure ) that was not getting fragmented by polypectomy snares, tripod forceps, or water piks. Surgical removal of the bezoar was then performed with primary anastomosis. He remained stable and was discharged on Senna with instructions for a followup colonoscopy, and to avoid opioids. Discussion: Bezoars are uncommon causes of GIT obstruction. They are classified according to their content into phytobezoars (indigestible food particles), trichobezoars (hair and food particles), and pharmacobezoars (concretions of different medications). They commonly occur in the stomach, however; they can occur in any part of the GIT. Bezoars' common risk factors are altered GIT anatomy or motility such as post abdominal surgery, diabetic gastropathy, Guillain-Barre syndrome, bedridden state, and medications with intestinal hypokinetic effects. Chronic opioid use is the culprit risk factor in our patient. GIT obstruction is a common complication of bezoars although it rarely occurs in the colon. A plain radiograph is usually the first diagnostic modality, however; a CT abdomen is often needed. Management varies from medical to endoscopic or surgical according to the bezoar's size and the associated complications. Our patient was treated surgically after failed medical and colonoscopic treatment. This raises the importance of the concomitant use of stimulant laxatives with opioids and avoiding chronic opioid use in unnecessary conditions to prevent such complications.[2057] Figure 1. On the left, the CT abdomen shows a large proximal transverse colon bezoar. On the right, the colonoscopy shows a large stoolball.
Introduction: IgG4 related disease (IgG4-RD) is a newly recognized, immune-mediated disease with IgG4-positive plasma cell infiltration. Serum IgG4 levels are often elevated (although not required for diagnosis). IgG4-RD can affect a multitude of organs, including but not limited to the pancreatic-biliary system, salivary/lacrimal glands, retroperitoneum, liver, aorta, lymph nodes, and rarely, the gastrointestinal tract. This case highlights the rare GI tract presentation of a patient's heretofore unrecognized IgG4 disease. Case Description/Methods: An 81-year-old woman with past medical history of Sjogren's disease, myelodysplastic syndrome, and chronic myelomonocytic lymphoma presented to the emergency department for melena. Physical exam was unremarkable, but melena confirmed on digital rectal exam. Laboratory studies with hemoglobin nadir at 5.0 g/dL (baseline 8), hypergammaglobulinemia (without monoclonal peak) and elevated IgG4. Gastroenterology was consulted and performed esophagogastroduodenoscopy, showing hemorrhagic gastropathy and friable tissue. Biopsy showed gastric mucosa with patchy severe chronic gastritis and predominant plasma cell infiltration (without light chain restriction), thought to be isolated IgG4 gastropathy. Melena resolved with supportive care. Bone marrow biopsy obtained, appropriately decreased cellularity, no monocytes on flow cytometry. Abdominal computerized tomography with intravenous contrast showed diffusely atrophic pancreas, 4.8 cm infrarenal aneurysmal abdominal aorta (AAA), and post cholecystectomy changes. Reported history of pancreatitis (records unavailable), fine needle aspiration of pancreatic head and tail (ten years prior) showed predominantly acute inflammatory cells, necrotic tissue debris and benign ductal epithelial cells, respectively. Salivary gland biopsies (ten years prior) showed benign mucinous gland tissue and multiple reactive lymphoid follicles. The clinical picture was concerning for possible systemic IgG4 disease. Unfortunately, four months after initial evaluation, patient suffered from a cerebrovascular event and passed away a month later after progressive debilitation. Discussion: On initial evaluation, patient appeared to present with isolated IgG4 gastropathy. Given history of salivary gland disease, pancreatic disease, and AAA, high degree of suspicion exists for underlying IgG4-RD connecting previous diagnoses. Although rare, IgG4-RD may present in various ways, and clinicians must remain vigilant for appropriate diagnosis and treatment.
Figure 1. (A-B) Non-contrast CT abdomen and pelvis done upon initial presentation showing findings suggestive of bowel wall thickening in the ascending colon and cecum concerning for colitis in axial (A) and coronal (B) planes. (C-E) Repeat non-contrast CT abdomen/pelvis in axial (C) and sagittal (D, E) planes which showed increase in colonic distention within the transverse colon measuring up to 7cm (C, E) and increased distention within the cecum and ascending colon (D) concerning for toxic megacolon.
Mirizzi syndrome is a rare condition caused by the obstruction of the common bile duct or common hepatic duct by external compression from multiple impacted gallstones or a single large impacted gallstone in Hartman’s pouch. The condition can easily be confused with choledocholithiasis, bile duct stricture or cholangiocarcinoma due to the presence of obstructive jaundice hence may be overlooked due to the rarity of the condition. The incidence of Mirizzi syndrome among patients with gallstones is reported to range from 0.63 to 5.7%. Furthermore, it poses a differential diagnosis dilemma for the physician as well as radiologists because there are no clinical features or diagnostic procedures that have a 100% specificity and sensitivity. Laparotomy is the preferred surgical technique of choice. For the patients who are poor surgical candidate, mainstay of treatment is biliary stent placement for the restoration of normal biliary drainage. Due to low incidence of the Mirizzi syndrome, an elevated index of suspicion is required to diagnose this condition. At present, there are no well-developed, internationally recognized clinical guidelines for the management of this syndrome. Furthermore, the diagnostic procedures available still pose a barrier in the ability to confirm the diagnosis prior to surgical treatment, even though the diagnostic rate has increased dramatically.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.