Hepatobiliary Manifestations of Diseases Involving Other Organ Systems

Preface
Hepatobiliary Manifestati ons
of Systemic Diseases

Ke-Qin Hu, MD
Guest Editor

Hepatobiliary manifestations can be the clinical presentation of other systemic disor-

ders that are commonly seen in our daily practice and usually require gastroenterology
or hepatology consultation. Understanding these clinical issues would enrich our
knowledge and improve outcomes of the patient care. Some of these conditions
have been well reviewed in a 2002 issue of Clinics in Liver Disease edited by Dr Herbert
L. Bonkovsky. This issue of Clinics in Liver Disease denotes to an updated and system-
atic review on hepatobiliary manifestations of other systemic disorders. It has been my
privilege and pleasure to assemble a group of expert clinicians to present their views
and share their vast experiences in these complicated clinical issues.
The first review by Drs Weisberg and Jacobson provides an excellent summary on
common hepatobiliary manifestations of cardiovascular diseases. The article begins by
introducing a physiologic base of macro- and microcirculation of the liver, followed by
most common clinical issues, such as ischemic hepatitis and congestive hepatopathy.
Both hepatopulmonary syndrome and portopulmonary hypertension are well-
known pulmonary complications of liver diseases. The article by Drs Kochar and Fallon
reviews hepatobiliary manifestations of some common pulmonary disorders, including
respiratory failure and hepatic dysfunction, genetic and granulomatous disorders, and
the liver.
Many liver diseases coexist with chronic renal disease. Dr Wong’s article provides
an up-to-date summary on this complicated topic. Besides covering nephrogenic
ascites, a common clinical presentation, this article covers some other common but
sometimes overlooked issues, such as nephrogenic hepatic dysfunction, renal tubular
disorders, and cholestasis, dialysis, and the liver.
Liver diseases and endocrine disorders may have a bidirectional and complex rela-
tionship. Drs Maheshwari and Thuluvath’s article systematically reviews these issues.

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The article concisely summarized the complicated relationship between metabolic

syndrome and non-alcoholic fatty liver disease. It also reviews the hepatobiliary mani-
festation of other common endocrine disorders, such as thyroid dysfunction, adrenal
insufficiency, and sex hormone-related disorders.
Drs Singh and Pockros provide a very detailed review on hepatobiliary manifesta-
tions of hematologic and oncologic diseases by dividing their article into two sections:
nonmalignant hematologic disorders and malignant hematologic disorders.
Hepatobiliary manifestations of gastrointestinal and nutritional disorders can occur
as part of the clinical spectrum of the underlying disease or as a consequence of the
treatment of the disease. The article by Dr Samarasena and me provides a thorough
review on a selection of gastrointestinal and nutritional disorders including inflamma-
tory bowel disease, celiac disease, Whipple’s disease, and parenteral nutrition asso-
ciated disorders.
Infectious disease can present with a wide variety of hepatobiliary manifestations
from asymptomatic elevations in aminotransaminases to acute liver failure, hepatic
fibrosis, and cirrhosis. Drs Talwani, Gilliam, and Howell contribute an excellent review
on this complicated topic. HIV infection can be associated with various hepatobiliary
manifestations. Dr Merwat and Vierling’s article well addresses two major and
common issues: HIV and HCV coinfection and hepatotoxicity of HIV medications.
Rheumatologic diseases typically have multisystem involvement, including
common hepatobiliary manifestations. Drs Schlenker, Halterman, and Kowdley’s
article provide an in-depth review on this complicated topic. Few publications have
covered the topic “Dermatologic disorders and the liver” in the past. Drs Satapathy
and Bernstein have done an excellent job. Their article provides a great review on
primary dermatologic disorders affecting the liver.
Liver dysfunction is common in both critically ill and postoperative patients.
Drs Aronsohn and Jensen’s article addresses this important and complicated topic
from hypoxic liver injury, liver dysfunction in sepsis, postoperative liver dysfunction,
to parenteral nutrition-associated hepatobiliary manifestations.
Pregnancy may cause complex physiologic changes that may result in hepatobili-
ary manifestations and related liver disorders. Thus, we include this topic in this issue
of Clinics in Liver Disease. We appreciate that Drs Pan and Perumalswami have
contributed a thorough review on this topic.
I hope that you will enjoy this issue of Clinics in Liver Disease. I am indebted to all
the authors for their outstanding contributions of this issue, and Dr Norman Gitlin, the
Consulting Editor, for his invitation and support to my participation as Guest Editor for
this issue. Also, I would like to thank Kerry Holland for her outstanding editorial
support.
Finally, I would like to thank my wife Chang Hong Yu and my daughter Shirley X. Hu
for their love, support, and inspiration.

Ke-Qin Hu, MD
Division of Gastroenterology and Hepatology
University of California, Irvine
School of Medicine
101 The City Drive
Orange, CA 92868, USA
E-mail address:
kqhu@uci.edu