Intrahepatic Portosystemic Shunt in a Young Female: Views from a Developing Country.

A young female presented to us with abdominal distension along with pedal edema. She had no prior medical or surgical history apart from a caesarean section done a few years prior. Initial workup showed low hemoglobin, low serum albumin and slight raised ESR. Her LFTs were slightly deranged. Ultrasound abdomen had evidence of portal hypertension along with splenomegaly. While ultrasound hepatic Doppler revealed a portosystemic shunt between the portal vein and the left hepatic vein, with a shunt ratio of 7.1%. CT scan abdomen confirmed these findings and a diagnosis of Type III intrahepatic portosystemic shunt and spleno-renal shunt was made. Since the patient was currently asymptomatic, she was advised regular follow-ups and was managed conservatively.

Factors Influencing Quality of Life in Patients with Gastroesophageal Reflux Disease in a Tertiary Care Hospital in Pakistan.

OBJECTIVE: To assess the impact of gastroesophageal reflux disease (GERD) on quality of life (QOL) in local population. STUDY DESIGN: Cross-sectional, descriptive study. PLACE AND DURATION OF STUDY: Hepatogastroenterology Department, Sindh Institute of Urology and Transplantation, Karachi, from June 2016 to December 2017. METHODOLOGY: Patients with GERD visiting the outpatients' clinics were enrolled. Those who had history of dysphagia, malignant disease, anemia, weight loss, cardiovascular diseases, renal failure, cirrhosis, rheumatologic diseases and patients taking non-steroidal anti-inflammatory drugs (NSAIDS) or steroids during the last two weeks were exluded. A predesigned questionnaire was used to calculate GERD impact scale (GIS) score, with a value of >18 being considered as impaired QOL. Chi-square test was used to identify factors associated with impaired QOL. RESULTS: A total of 782 patients with mean age of 37.3 ±8.99 years (range: 18-65 years) were studied. Majority (505, 64.5%) were younger than 40 years of age. Predominant study population were females, i.e. 413 (52.8%). Among these, 127 (16.2%) patients had symptoms lasting more than a year, 132 (16.9%) were smokers, 82 (10.5%) had diabetes mellitus (DM), and 63 (8.1%) had hypertension. A total of 297 (38%) patients had impaired QOL. On logistic regression analysis, the impaired QOL was associated with age greater than 40 years (p=0.001), body mass index (BMI) >25 Kg/m2 (p= 0.001), smoking (p=0.001), hypertension (p=0.001) and diabetes mellitus (p=0.001). CONCLUSION: A significant proportion of patients had impaired QOL due to GERD. Factors affecting QOL in such patients were higher age, increased BMI, history of smoking, hypertension and DM.

Primary hepaticobiliary tuberculosis mimicking gall bladder carcinoma with liver invasion: a case report.

Primary hepatic tuberculosis is a rare presentation and sporadically reported in the literature, mostly from our part of the world. Sometimes the presentation can be atypical and mimics hepatic tumor and poses diagnostic challenge. We, herein, present a case of a 58-year-old man who presented to us with abdominal pain and weight loss. Raised serum alkaline phosphatase (ALP) and imaging raised a suspicion of gall bladder carcinoma with hepatic invasion. Peroperative frozen section revealed hepatic chronic granulomatous inflammation with caseous necrosis consistent with the diagnosis of hepatic tuberculosis. Surgery was postponed and he was put on antituberculous treatment. It is important to consider tuberculosis in the differential diagnosis of the space occupying lesion of liver in a patient with vague symptoms and abnormal findings on imaging.

Non alcoholic fatty liver disease in a young male with celiac disease.

A young emaciated male, known case of celiac disease came with complaints of diarrhea along with 5kgs of weight loss in 3 months' time. He had severe electrolyte abnormalities along with low albumin, low calcium and a high phosphate with deranged liver function test. Ultrasound abdomen had shown fatty liver. Nutrition consult was sought and he was found to have a BMI of 6.8kg/m2. He was started on nutrition support along with supportive therapy, which resulted in weight gain and improvement in his condition.