מבוא לגסטרואנטרולוגיה ומחלות כבד . דר. טיבריו הרשקוביץ המכון לגסטרואנטרולוגיה ומחלות כבד ביה"ח האוניברסיטאי הדסה. Infectious etiology of peptic ulcer disease.
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Infectious etiology of peptic ulcer disease
Barry Marshall, being a trainee in internal medicine working in Stewart Goodwins Laboratory in Perth, Australia, was with serendipity successful in culturing the bacteria.
Over the Easter holiday the Petri dishes with bacterial cultures were inadvertently left in the incubator in five, instead of two days, as recommended for Campylobacter.
When the dishes were examined after the holidays, small colonies with a shiny appearance were detected. This is the first successful culture and isolation of a bacterium from
the stomach of a patient with gastritis.
The findings were presented at a Campylobacter meeting 1983. Initially the
reports of an association between the bacterium and gastritis were met with great scepticismfrom the established scientific community. The findings were later published in
One major question is whether the bacterium is the cause of gastritis or simply an innocent bystander that happen to colonise a damaged mucosa.
In order to rule this out, Barry Marshall and Arthur Morris decided to inoculatethemselves by drinking a solution containing vast amounts of the bacterium under acid suppression with cimetidine
Both developed signs of an acute gastric flu-like illness, with gastric distension, nausea and vomiting.
After 10 days endoscopy revealed contraction of H pylori and chronic gastritis, which gradually subsided over the next two weeks.
Renewed endoscopy could not disclose the organism and the gastritis was
In the case of Morris the symptoms remained as a common gastritis
These cases are the ones to confirm the Kochs postulate that the bacterium
itself indeed is the cause of disease
Gastroenterology is the branch of medicine whereby the digestive system and its disorders are studied.
The name is a combination of three Ancient Greek words gaster=stomach, enteron=intestine and logos=reason. Gastroenterology is an Internal Medicine Subspecialty
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Bread & Butter
Non-Invasive: Test of Fibrosis
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Halfon Am J Gastro. 2006; 101: 547-55
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Cales, J Hepatol. 20054; 42: 1373-1383
-A new noninvasive technique to estimate liver fibrosis by measuring liver stiffness.
- Based on the propagation velocity of
elastic shear waves through the liver tissue.
-The harder the tissue the faster the
shear wave propagates.
Ultrasound acquisition chip
Digital signal processing
Patient data base
Toxic fatty acids
Further liver damage
via vicious cycle:
Bone Marrow Activity
Liver failure endogenous intoxication
watersoluble and non-soluble
Water-based human body
non water soluble
BINDING SITE RELATED DISTRIBUTION
Balance of watersoluble substances
Balance of protein bound substances
The MARS membrane
The MARS membrane
The MARS principle
Combination with different equipment
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SK, a 33 year old woman, married and a mother of 3 children, a travel agency director
2000- 3rd trimester/2nd pregnancy
continuous abdominal pain
elevation of liver enzymes (hepatocellular up to 2 times the upper limit of the normal range -ULN)
How often do you see such a patient?What is your differential diagnosis?When do you consult the hepatologist?Who is in charge of the case?
Following 3 daysThe classical liver diseases of pregnancy, AFLP, HELLP, IHCP, were ruled outShe underwent a negative evaluation for viral, autoimmune (including celiac disease) and metabolic etiologies Abdominal Ultrasound- normal liver and spleen
Would you suggest a liver biopsy at this stage?
Following 10 daysAbdominal pain continued and she developed severe pruritus
Repeated Abdominal US was normal
Serum bile acids were normal
Would you recommend Ursodeoxycholic acid at this stage?
A liver biopsy?
A Liver biopsy demonstrated: non-specific chronic hepatitis mildly active and portal fibrosis early septal formation diffuse steatosis
She was treated by ursodeoxycholic acid
with minimal improvement
If you don't approve her pregnancy, how can you prevent it?
During pregnancy, 3rd trimester, she developed a
classical picture of recurrent biliary colic, mild pruritus and
elevation of hepatocellular liver enzymes ( 6 times the
normal range) and normal liver in abdominal US
Sludge in gallbladder