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%.

No abstract

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.

No abstract