Prolonged cholestasis due to hepatitis A virus infection in a young adolescent male with a known case of hemoglobin E disease: early response to steroid therapy

Afsana Yasmin, Lutful Latif Chowdhury — Thu, 14 Mar 2024 00:00:00 +0000

Background: Acute hepatitis due to hepatitis A virus infection is a self-limiting mild disease. Sometimes, it may have an atypical course in few percentages. We reviewed with characteristics, response to steroid therapy, and outcome of prolonged cholestatic jaundice in hepatitis A virus infection. Case summary: We analyzed acute hepatitis with a prolonged cholestatic course due to hepatitis A virus infection in an adolescent with preexisting hemoglobin E disease. Bilirubin was gradually increasing, the maximum total bilirubin was 48.3 mg/dl, and direct 46.6 mg/dl at day 50 of symptoms onset. After that, the steroid was started along with ursodeoxycholic acid. The patient gradually improved clinically and biochemically. Conclusion: Hepatitis A virus infection may cause prolonged cholestatic severe jaundice in a patient with preexisting congenital hemolytic disease. Steroid therapy may induce early recovery.

Hypersecretion of hydrochloric acid as a cause of superior mesenteric artery syndrome. Review

Michael D. Levin — Thu, 14 Mar 2024 00:00:00 +0000

It is currently believed that the cause of superior mesenteric artery syndrome (SMAS) is compression of the duodenum in the angle between the aorta and superior mesenteric artery (SMA). It is recognized that a decrease in aortomesenteric angle (AMA) <25 and intervascular distance <8 mm, caused by fat loss, is characteristic of SMAS. Based on these statements, surgeons operate on patients with symptoms of dyspepsia only based on a reduction of AMA. This study is devoted to the analysis of the literature, including four own studies on this issue.

Results: Measurement of the length of the constriction in the third part of the duodenum on radiograms from available sources showed that its true length ranged from 2.5 to 4.2 (3.30 _ 0.15) cm and began a few centimetres cranial to the AMA. Therefore, it could not have been caused by compression in the AMA. In terms of length (3.20 _ 0.15 cm) and location, this constriction corresponded to Ochsner’s sphincter, which normally short-term contracts to prevent the penetration of an acid bolus into the jejunum. Conscientious studies have shown that AMA is proportional to BMI, i.e., a decrease in AMA is observed in all thin people. An analysis of 211 cases of SMAS made it possible to differentiate two types of diseases. In 101 patients, the disease occurred acutely 1–53 (8.2 _ 1.9) days after stressful situations, accompanied by a catabolic reaction and hypersecretion of hydrochloric acid. In 110 patients, SMAS developed 3

BOHR Journal of Gastroenterology

Prolonged cholestasis due to hepatitis A virus infection in a young adolescent male with a known case of hemoglobin E disease: early response to steroid therapy

Hypersecretion of hydrochloric acid as a cause of superior mesenteric artery syndrome. Review