RSS Feeds
Update in Hepatology
2000-2001 Series: Update Sessions from ACP-ASIM's 2000 Annual Session
Margaret Ring Gillock, Editor; David Cramer, MD, Co-Editor; and Paul T. Kefalides, MD, Co-Editor
Hepatology is an area in which research is under great pressure to meet emerging clinical challenges. The viral hepatitis epidemic has caused an influx of patients with symptomatic and asymptomatic liver disease into physicians' offices. Simultaneous developments in molecular biology have led to insights into viral pathogenesis and inherited metabolic diseases. The result has been a new era of promise in diagnosing and treating liver disease. This Update summarizes advances in hepatology over the past 2 years. I recount some important aspects of the history of viral hepatitis and hemochromatosis and describe notable new reports that may help guide an internist's approach to patients with these liver diseases.
Hepatitis A
Most internists have seen patients with hepatitis A virus (HAV) infection, and it is viewed as a rather benign condition. Only 1 out of 10 000 patients has a severe and aggressive course. In immunosuppressed or elderly patients, however, fulminant hepatitis occurs more frequently. Moreover, the older patients commonly seen by internists can develop a prolonged cholestatic illness that resembles drug-induced cholestasis or raises suspicion of pancreatobiliary cancer.
Although much of the U.S. population is exposed to HAV at some time, certain groups are at increased risk. Travelers to the tropics or developing countries may consume contaminated food or water. Day care centers and fast-food restaurants have been the site of common-source outbreaks. Shellfish have been frequent offenders when oyster beds become contaminated with sewage and, therefore, HAV. Now that the viral genetic sequence of HAV is known, the Centers for Disease Control and Prevention can determine whether a single source caused an outbreak.
HAV Is Easily Spread
Hutin and colleagues' report of a multistate, foodborne outbreak illustrates excellent epidemiologic work. Contaminated frozen …
