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Contraception in Liver diseae

 https://pmc.ncbi.nlm.nih.gov/articles/PMC10878548/ https://www.journal-of-hepatology.eu/article/S0168-8278(23)00181-2/fulltext Any progesterone only option is OK in any patient with any liver disease - for eg MIRENA -> IUD are progesterone only -> it is the estrogen that is tricky in patients with liver disease (eg in Budd chiari, decompensated liver disease, with hepatic adenomas) - Estrogen can cause coagulopathy, estrogen metabolism is affected in decompensated liver disease, and hepatic adenomas growth is promoted by estrogen (increase growth and rupture)
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SPS Serrated polyposis syndrome definition

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  Current criteria for referral to NZFGCS Serrated Polyposis Syndrome Refer a patient to the New Zealand Familial Gastrointestinal Cancer Service where they meet the World Health Organisation (WHO) criteria for a diagnosis of SPS and have  one  of the below features: ∙ Age ≤ 30 years ∙ Personal history of colorectal cancer ≤ 50 yrs ∙ First degree relative with CRC ≤ 50yrs or SPS diagnosed ≤ 50yrs ∙ Failing endoscopic management of polyposis and this group includes patients with multiple dysplastic SSPs. ∙ 10 cumulative adenomas and a diagnosis of SPS.  
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Hep B / HCC screening - ReachB

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 https://www.youtube.com/watch?v=3cP2kvPq7iQ m.c form of acquiring Hep B in Asia - Vertically m.c form of acquiring Hep B in western coutnries: Parenterally (sexual / needles etc) Neonates have immature immune system, so they cant 'fight-off' vertically acquired virus. Over 90% of babies infected with Hep B, go on to have chronic Hep B infection 95% of adults if they acquire Hep B - fight it off! HBV is a DNA virus - replicates efficiently. But is error-prone. Plagued with mutants.  e-antigen negative mutant - tend to be in older patients, tend to be more aggressive. 30-50% of HCC in HBV occurs in absence of cirrhosis. Reveal study - 15 year follow-up study of untreated patients with HEp B. The only factor that was relevant in predicting risk of HCC was viral load at base-line! Viral load more than 10*4 (2000 IU/ml) was predictive of risk of HCC or Cirrhosis (similar graph for Cirrhosis as for HCC) Immune Tolerant Phase: typically after vertical infection. DNA remains very hig...
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