GASTROENTEROLOGY ARTICLE OF THE WEEK
September 30, 2010
Ebert EC, Nagar M, Hagspiel KD. Gastrointestinal and hepatic complications of sickle cell disease. Clin Gastroenterol Hepatol 2010;8:843-849.
1. A patient with sickle cell disease is admitted with a painful crisis. He has severe RUQ pain, has had a Cholecystectomy. He is febrile, has an enlarged tender liver. AST is 250, ALT is 150, t. bili is 8.9, direct is 3.2, hemoglobin has remained stable at 7.5-8.0 for the last 3 days Most likely cause
a. common bile stone
b. sickle cell intrahepatic cholestasis
c. hepatic sequestration
d. liver abscess
e. acute sickle cell hepatic crisis
True or False
2. Most duodenal ulcers in patients with sickle cell disease are due to acid hypersecretion
3. Diffuse abdominal pain, ileus and peritoneal irritation may be caused by small infarcts in the mesentery and abdominal viscera and does not always require surgical intervention
4. Splenic infarction is most commonly seen in hemoglobin S-S disease
5. Patient’s with cirrhosis, sickle cell disease and encephalopathy, taking chelators for iron overload may benefit from zinc supplementation to treat encephalopathy
6. About 40% of patients with acute vaso-occlusive disease have liver involvement with RUQ pain, and mixed pattern of liver enzyme elevations
7. Patients with sickle cell disease have an increased incidence of cirrhosis even in the absence of other liver problems
8. A normal HIDA scan in a patient with sickle crisis and RUQ pain effectively excludes acute calculous cholecystitis.