Malnutrition is a liver cirrhosis complication affecting more than 20%-50% of patients. Although the term can refer to either nutrient deficiency or excess, it usually relates to undernutrition in cirrhosis settings. Frailty is defined as limited physical function due to muscle weakness, whereas sarcopenia is defined as muscle mass loss and an advanced malnutrition stage. The pathogenesis of malnutrition in liver cirrhosis is multifactorial, including decreased oral intake, maldigestion/malabsorption, physical inactivity, hyperammonemia, hypermetabolism, altered macronutrient metabolism and gut microbiome dysbiosis. Patients with chronic liver disease with a Body Mass Index of < 18.5 kg/m
2
and/or decompensated cirrhosis or Child-Pugh class C are at the highest risk of malnutrition. For patients at risk of malnutrition, a detailed nutritional assessment is required, typically including a history and physical examination, laboratory testing, global assessment tools and body composition testing. The latter can be done using anthropometry, cross-sectional imaging including computed tomography or magnetic resonance, bioelectrical impedance analysis and dual-energy X-ray absorptiometry. A multidisciplinary team should screen for and treat malnutrition in patients with cirrhosis. Malnutrition and sarcopenia are associated with an increased risk of complications and a poor prognosis in patients with liver cirrhosis; thus, it is critical to diagnose these conditions early and initiate the appropriate nutritional therapy. In this review, we describe the prevalence and pathogenesis of malnutrition in liver cirrhosis patients and discuss the best diagnostic approach to nutritional assessment for them.
Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders, and medical students are at a higher risk for this disorder, given their stressful lives. This study aims to identify the prevalence of IBS and the associated risk factors among MS. A cross-sectional study was conducted among medical students at all academic levels. Data were collected from January to September 2018 using a validated, self-administered, and anonymous questionnaire. Five hundred eighty-five students were included, and an IBS diagnosis was made in 37 students. Older students and those in higher clinical years are at greater risk for developing IBS (P <.02 and.001, respectively). The factors associated with IBS (adjusting for known confounders) included a family history of IBS [adjusted odds ratio (AOR): 7.06 (95% CI: 2.923 - 17.069)], rare use of over-the-counter pain medications, [AOR: 2.806; 95% CI: 0.004-0.431; P <.003] and students experiencing high levels ofanxiety [AOR : 3.33 (95% CI: 1.392 -7.981); P<.002]. In this study, the risk of IBS among medical students was 6.6%.
Primary amyloidosis is the most prevalent type of amyloidosis and is usually due to plasma cell dyscrasia. It more commonly presents with renal and cardiac involvement and, although the liver is frequently involved in primary amyloidosis, it rarely causes clinically apparent disease. The most common form of hepatic involvement is hepatomegaly and mild elevation of alkaline phosphatase. Diagnosis requires tissue biopsy that demonstrates positive staining for Congo red and treatment is ideally a combination of chemotherapy and hematopoietic cell transplantation. The prognosis of hepatic amyloidosis associated with liver failure is poor. Here, we report a fatal case of primary amyloidosis in the setting of multiple myeloma in a 54-year-old man who presented with acute liver failure.
Inflammatory bowel disease is associated with higher rates of anxiety and depression compared to the general population. We aimed to determine the prevalence of anxiety and depressive symptoms among patients with ulcerative colitis and correlation to disease activity. In this cross-sectional study, we collected data from 70 consecutive ulcerative colitis patients over one year at our inflammatory bowel disease outpatient clinic through an interview and a questionnaire containing patient demographics and disease characteristics. Anxiety and depressive symptoms were characterized using the Generalized Anxiety Disorder-7 questionnaire and Patient Health Questionnaire-9, respectively, with ulcerative colitis disease severity assessed by the Partial Mayo scoring system. The majority of our patients were females (68.6%) and the mean age was 39.3 years. Rates of anxiety and depressive symptoms among ulcerative colitis patients were 65.7% and 58.6%, respectively. Depressive symptoms were significantly associated with patient-reported disease activity (r = 0.361; p = 0.010). Significant percentages of ulcerative colitis patients were appreciated to have anxiety and depressive symptoms, and there was a correlation between patient-reported disease activity and depressive symptoms. At this high rate of prevalence, it is justified to screen patients for the presence of psychiatric comorbidities.
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.