A rare case report of high-grade primary B-cell intestinal lymphoma in young adult, with a focus on radiological role in the diagnosis and management.

In contrast to the common extra-nodal intestinal lymphoma, intestinal lymphoma of primary origin is rare. We present an interesting case of 35-year-old male patient presented with abdominal pain, then deteriorated rapidly and developed small bowel perforation. Initial diagnosis was made by computed tomography, and subsequently the diagnosis was confirmed by ultrasound-guided biopsy and histopathological assessment. This case report emphasizes on the importance of the radiological role in the diagnosis and management of such case to avoid catastrophic sequalae and complications such as intestinal obstruction, perforation, and intra-abdominal sepsis.

Implementation of a care bundle improves the management of patients with non-alcoholic fatty liver disease.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is common and is associated with liver-related and cardiovascular-related morbidity. Our aims were: (1) to review the current management of patients with NAFLD attending hospital clinics in North East England (NEE) and assess the variability in care; (2) develop a NAFLD 'care bundle' to standardise care; (3) to assess the impact of implementation of the NAFLD care bundle. METHODS: A retrospective review was conducted to determine baseline management of patients with NAFLD attending seven hospitals in NEE. A care bundle for the management of NAFLD was developed including important recommendations from international guidelines. Impact of implementation of the bundle was evaluated prospectively in a single centre. RESULTS: Baseline management was assessed in 147 patients attending gastroenterology, hepatology and a specialist NAFLD clinic. Overall, there was significant variability in the lifestyle advice given and management of metabolic risk factors, with patients attending an NAFLD clinic significantly more likely to achieve >10% body weight loss and have metabolic risk factors addressed. Following introduction of the NAFLD bundle 50 patients were evaluated. Use of the bundle was associated with significantly better documentation and implementation of most aspects of patient management including management of metabolic risk factors, documented lifestyle advice and provision of NAFLD-specific patient advice booklets. CONCLUSION: The introduction of an outpatient 'care bundle' led to significant improvements in the assessment and management of patients with NAFLD in the NEE and could help improve and standardise care if used more widely.