Track 1: Cellular and Molecular Gastroenterology & Hepatology

The human liver is perceived as a non-immunological organ which primarily engaged in metabolic, nutrient storage and detoxification activities but it has many unique immunological properties, including induction of immune tolerance, strong innate immunity, poor adaptive immune response versus over-reactive autoimmunity and hematopoiesis in the fetal liver. The healthy liver is a site for immunological activity with a diverse immune cell repertoire as well as non-hematopoietic cell populations. The innate immunity like hepatocytes provides protection against hepatic and systematic bacterial infections. Kupffer cells, also known as stellate macrophages and Kupffer-Browicz cells are specialized macrophages located in the liver, lining the walls of the sinusoids that form part of the mononuclear phagocyte system.

·Alpha-1 antitrypsin deficiency

·Drugs or toxins

·Wilson’s disease and related disorders

·Bacterial Infection

·Bile Duct Obstruction

·Protozoan Infection

·Hepatotoxicity

The liver is a visceral organ which has a unique power of regeneration, this property is called homeostasis, in spite of surgically removed the liver can grow back to a full size. Liver regeneration involves the regeneration of liver cells like hepatocytes which possess an unlimited capacity for proliferation, sinusoidal endothelial cells, and biliary epithelial cells. It is a highly controlled process regulated on highly redundant signals by complex pathways and these signaling pathways are known to stimulate by growth factors, hormones, cytokines, and nuclear receptors but the excess accumulation of fats may interfere with the regeneration mechanism of the hepatocytes.

·The clonogenic capacity of hepatocytes

·Proliferation and differentiation

·Hepatocyte growth factor

·Other factors

There is a higher genetic diversity in tumor cells which holds at the gene expression level. Through knowing the gene expression level we can regulate the hepatocellular carcinoma during hepatitis viral infection. Disease progression in HBV and HCV induced can influence by both environmental factors and genetic risk factors. Nucleic acid-mediated gene therapy has been undergoing clinical trials which may result towards prevention of chronic liver diseases by regulating mechanism of different proteins expression using miRNA overexpression and miRNA functional silencing.

·Genetics and epigenetics of liver cancer

·Human liver proteome project

Hepato-nephrology is the field that deals with how the liver disease is affecting the kidney function. Hepatorenal syndrome is the medical condition that occurs in patients suffering from fulminant liver failure, alcoholic hepatitis, and cirrhosis which results in rapid deterioration of kidney function with an infection, bleeding in the gastrointestinal tract or overuse of diuretics. Patients show other symptoms like jaundice, altered mental status, evidence of decreased nutrition, the presence of ascites and elevated pressures in the portal vein system, elevated pressures in the portal vein system.

·Trichohepatoenteric syndrome

·Hepatorenal syndrome

Hepato-cardiac disorders are defined as the liver disease affecting the heart or the heart disease affecting the liver or the condition affecting heart and liver at the same time. During the Differential diagnosis of liver injury or disease, in a cardiologist, clinical practice, ask for collaboration between the hepatologists and cardiologists. In patients with the advanced liver disease may show and various abnormalities like some diastolic and systolic dysfunctions, reduced cardiac performance. Cardiac evaluation in liver disease patients is important, after a liver transplantation may improve cardiac function or have a reversal effect. Systemic disease with effect liver and heart are congenital, inflammatory and metabolic and alcoholism. The Hepato-pulmonary disorder which causes low oxygen levels in your blood is associated due to the formation of microscopic intrapulmonary arteriovenous dilations occurring in patients with liver cirrhosis. The mechanism is obscure due to increased hepatic production or decreased hepatic clearance of vasodilators. Due to the overperfusion related to ventilation, causes vascular dilations especially in increased cardiac yield individuals with resulting from systemic vasodilation and people having low oxygen levels in the blood encounter shortness of breath, which can become more severe over time.

·Portal hypertension

·The hepatopulmonary syndrome

·Hepatic hydrothorax

Liver cancer is the condition which occurs when normal cells in the liver become abnormal in appearance and destructive to the adjacent normal tissues, which can spread to other areas of liver or to the other organs outside of the liver. Cancer cells are characterized by the procurement of several capacities amid the stages of tumor genesis, maintenance of proliferation signaling, induction of angiogenesis, activation of invasive resistance to cell death, inhibition of growth suppressors, and metastatic pathways, ability to evade immunological destruction and alteration of cellular metabolism. The clonogenic capacity of stem cells was evaluated by the stem cell colony formation assay.

·Liver cell carcinoma

·Hepatocellular carcinoma

·Hepatoma

·Cholangiocarcinoma

·Hepatoblastoma

·Angiosarcoma of liver

·Kupffer cell sarcoma

·Other sarcomas of liver

Neurological deficits related to liver illness may influence the CNS, the peripheral nervous framework, or both. The most serious neurological complication of acute liver failure and hepatic encephalopathy result in the advancement of the brain edema. Cognitive dysfunction is detected in Hepatitis C along with serious fatigue and mood disorders. Alterations in the brain metabolites show CNS change in these patients when recognized by magnetic resonance spectroscopy. The most widely recognized aspect of this relation is that hepatocellular failure may be complicated by the behavioral syndrome of hepatic encephalopathy, in which neurotransmission in the brain altered, profound fatigue in patients with chronic cholestasis is, may also be associated with altered neurotransmission in the brain.

·HCV/HIV Co-infection epidemiology

·Wilson Disease

Histological examinations of liver biopsy before treatment showed accumulation of fat within the hepatocytes, bile duct endothelium and epithelium and kupffer cells which contain the portal macrophages. The liver serves as the filtration ground of absorbed intestinal luminal contents which are particularly susceptible to microbial antigens.

·Transudative Ascites

·Cholestasis

·Centrilobular Necrosis

·Peliosis hepatis

Liver diseases are mostly seen as in a grown-up, however, a huge number of children from babies to teens experience from different types of liver diseases. The volume of the liver and the blood flow decreases with age, immune responses against pathogens or neoplastic cells are lower in the elderly reducing their tolerability to treatments for liver diseases. Liver regeneration capacity shows a decline in age, reduced proliferation of hepatocytes, but the level of hepatic enzymes and high-density lipoprotein cholesterol is well maintained. Pediatric hepatology focuses on the diagnosis and treatment of liver and liver-related disease in infants and children.

·Gilbert’s disease

·Hemochromatosis

·Liver Failure

·Liver Cirrhosis

·Hepatorenal syndrome

·Liver Fibrosis

·Neonatal Jaundice

Hepato-biliary diseases includes a heterogeneous group of liver and biliary system caused by bacterial, viral and parasitic infections, toxic chemicals, alcohol consumption, metabolic disorders, cardiac failure, and neoplasia. Some of the hepato-biliary diseases appear to be a genetically determined metabolic trait; the physiological abnormality underlying the formation of gallstones is an accumulation of bile supersaturated with cholesterol causing cholesterol gallstones. Recent progress in the molecular biology and genetic control of lipoproteins and lipids metabolism may provide an opportunity for new studies on these diseases.

·Primary biliary cholangitis

·Caroli disease

·Bile duct hamartoma

Hepatitis occurs due to the inflammation in tissues of the liver caused due to the viral infection which can harm the organ which may further lead to cirrhosis, fibrosis and liver cancer. Hepatitis is a devastating disease that progress slowly but results in damage to the liver. Hepatitis A is the most common cause’s acute hepatitis in children in the Middle East. Establishment of HBV vaccination to cover all neonates and high-risk group, screening of donor blood can help in improving the case. Recent advancement in the treating hepatitis built on incremental improvements can transform it into new forthcoming treatments that can be potentially cured.

·Autoimmune hepatitis

·Alcoholic hepatitis

·Viral Hepatitis

·Granulomatous hepatitis

Certain liver diseases are uniquely associated with pregnancy like Hyperemesis gravidarum is intractable, dehydrating vomiting in the first trimester of pregnancy occurs due to liver dysfunction. Intrahepatic cholestasis of pregnancy is pruritus and elevated bile acids in the second half of pregnancy, accompanied by high levels of aminotransferases and mild jaundice. The common condition in hepatic tenderness and liver dysfunction in pregnancy is severe preeclampsia it is further complicated by low platelet count, elevated liver tests, and hemolysis. Signs and symptoms of liver disease during pregnancy is not specific, fertility can be restored by liver transplantation by this pregnancy may have a good outcome.

·Hyperemesis gravidarum

·Intrahepatic cholestasis of pregnancy

·HELLP syndrome

Colorectal Disease substantially varies from benign lesions to malignant and cancerous growth. Colorectal cancer is the 3rd leading cancer-related death; the main cause of death is liver metastasis which leads to a liver tumor. A variety of tests and procedures are used to screen and diagnose colorectal disease, including Colonoscopy, flexible sigmoidoscopy, Endoscopic ultrasound, Capsule endoscopy.

·Screening and therapeutic colonoscopy

·Endoscopic ultrasound

·Endoscopic mucosal resection

·Anal manometry

·Colorectal cancer surgery( proctology)

·Fecal microbiota transplant

·Pelvic floor physical therapy

Liver transplant is an operation that replaces a replaces a person’s diseased heart with a partial or a whole liver from a donor. A rare condition in newborn infants is Biliary atresia in which the common bile ducts, which carry bile out of liver and present between the liver and small intestine is absent or blocked. Bariatric surgery performed on people, who have obesity through a variety of procedures. Removing a tissue sample (biopsy) from the liver may help diagnose liver disease. Liver biopsy is done using a long needle inserted through the skin to extract a tissue sample and then analyzed in a laboratory.        

·Immunosuppressive management

·Graft rejection

·Living donor transplantation

·Bariatric surgery

·Liver Biopsy

Liver imaging is basically for precise diagnosing biliary tract issue and is imperative for identifying liver injuries or damage and patients with a suspected malignancy is important because the liver is the common site of metastatic spread and those who are at the risk of developing hepatocellular carcinoma.

·Ultrasonography

·Computerized Tomography

·Magnetic Resonance Imaging

·Angiography

·Positron Emission Tomography