Non-alcoholic fatty liver disease (NAFLD) is closely related to insulin resistance, type 2 diabetes mellitus, and obesity. It is nowadays considered a multisystem disease with a strong association with cardiovascular disease and arterial hypertension, which interfere with changes in the coagulation system. Coagulation disorders are common in patients with hepatic impairment and are dependent on the degree of liver damage. Patients with NAFLD may have preserved overall hemostatic profile, but many studies suggest a trend toward a procoagulant state. Hypercoagulable state in NAFLD patients may even induce progression of hepatic injury. Endothelial dysfunction is present in the systemic and portal vein circulation in NAFLD patients, and platelets are being recognized as modulators of liver diseases through various mechanisms. Through a literature review, we discuss possible disorders in the coagulation cascade and fibrinolysis, endothelial dysfunction, and platelet abnormalities in patients with NAFLD. Considering the processes and mechanisms involved in the hemostatic abnormalities associated with NAFLD, directly related to liver disease or indirectly related through inflammatory processes and metabolic disorders, several potential therapeutic targets have been identified and reviewed here.
Aim: Estimation of the difference in frequency and type of comorbidities in patients with chronic obstructive pulmonary disease (COPD), grouped by COPD severity stages according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), from 1 to 4.The data subjects and methods: This study included 168 COPD patients with an equal share of patients in each GOLD stage (GOLD I 47 subjects, GOLD II 43, GOLD III 41 and GOLD IV 37 subjects). All data subjects, 106 men and 62 women (median age 66), were processed according to the successive arrival at the
Necrotizing pancreatitis remains a challenging and unpredictable condition accompanied by various complications. Endoscopic ultrasound-guided transmural drainage and necrosectomy have become the standard treatment for patients with walled-off necrosis (WON). Endoscopic therapy via lumen-apposing metal stents (LAMS) with large diameters has shown success in the management of pancreatic fluid collections, but there are few data on specific complications of that therapy. We report a case of infected WON and concomitant fungemia following LAMS placement and necrosectomy. In addition, a systematic literature review of current related studies has been provided.
Background The diagnosis of Crohn’s disease (CD) can sometimes be challenging. Enteropathy associated T cell lymphoma (EATL) is a rare aggressive lymphoma highly associated with celiac disease1. It usually affects small bowel, with signs and symptoms which may mimic CD. Methods We present a case of a 37-year-old male patient with coeliac disease, CD and (mis)diagnosed EATL in proximal jejunum. Results Patient was referred to our clinic with a constant epigastric pain, weight loss (BMI 17.5), intermittent temperatures, joint pain and diarrhoea. Laboratory tests were normal. Serology for coeliac disease was highly positive. Abdominal ultrasound showed small amount of ascites. EGD showed small shallow stomach ulcers and aphthous mucosal changes of postbulbar part of duodenum. Histology suggested coexisting CD and celiac disease. CT scan detected thickened duodenal wall and suspected duodenal stenosis and enteroscopy was performed. Approximately 80 cm from pyloric ring multiple jejunal ulcers were found. Unfortunately, biopsy was not performed. Colonoscopy showed small ulcers of terminal ileum and histology was nonspecific. Diagnosis of coexisting CD and coeliac disease was established. Therapy with PPI, systemic glucocorticoids and azatioprine was introduced. Three months later patient was in a good clinical condition, but EGD showed multiple gastric and duodenal small ulcers. Dose of azathioprine was optimized because patient refused biologics. After six months of asymptomatic period EGD showed mucosal healing. Azatioprine was continued. One year after the diagnosis of CD he was admitted again to our hospital because of intermittent fevers, severe periumbilical pain, weight loss and dehydration. Laboratory tests showed anemia (Hb 111 g/L), leucocytosis (L12.6/L) an elevated CRP (168 mg/L). CT scan detected jejunal perforation with multiple liver and spleen abscesses. He went under surgery with jejunal resection and histological findings from resected jejunum suggested EATL. In two postoperative days, the patient had progressive liver injury and suppression of bone marrow activity, and despite all supportive treatments he died. Conclusion EATL is a serious complication of coeliac disease, it rarely develops in young people and presents diagnostic challenge especially in CD patients. The aim of this report was to raise awareness of the importance of endoscopy with tissue sampling and cross sectional imaging especially in refractory coeliac disease and CD patients.
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