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Liver Disease: Learning and Leading

When I started out in medicine, differentiating between the various causes of hepatobiliary disease was extraordinarily difficult. It is not easy now (what in medicine ever is?), but modern imaging techniques have certainly helped us dramatically. As well, new discoveries have made more disorders treatable, which is wonderful news for our patients. However, for clinicians that means learning more about liver disease so that we can effectively manage our patients’ conditions. The University of Toronto, my home base, has long been a leader in the study of liver disease. One of my clinical teachers, Victor Feinman, was a leader in the field of liver disease and in particular the study of hepatitis B. One of my contemporaries, Jenny Heathcote, is a world leader in the study of primary biliary cirrhosis. Thus I feel I have a personal tie to this issue’s focus on hepatobiliary disease.

At times it seems like almost all of our older patients have gallstones. Which ones require treatment, and which can be managed conservatively? Our continuing medical education article, “Gallstone Diseases in the Older Adult” by Dr. Simon Yang and Dr. Calvin Law should help us tackle how to manage these patients. With so many routine blood tests being performed these days, it is inevitable that we will all come across patients who have abnormal liver tests. The article “Managing Abnormal Liver Blood Tests in Older People” by Drs. James Frith and Julia Newton should help us with this common problem. For those of us in internal medicine, an expanding belly is much more likely to signify ascites than pregnancy (especially for us geriatricians!). Diagnosis is usually much easier than management, so one of our focus articles is on this topic. I am sure you will find the article “Management of Patients with Ascites” by Dr. Karen Krok and Dr. Andrés Cardénas very useful. Our Biology of Aging column this month is related to our focus theme as well, namely “The Aging Liver” by Dr. David le Couteur, Dr. Arthur Everitt, and Dr. Michel Lebel.

Of course, we have our usual collection of excellent articles on varied topics. Our Cardiovascular Disease column is on “Functional Gains for Stroke Survivors in Response to Functional Electrical Stimulation” by Dr. Janis Daly. The issue of behavioural disturbances in demential is so prevalent, so concerning, and so difficult to manage that we like to revisit the topic on a regular basis, and our Dementia column this month is entitled “Approach to the Management of Dementia-Related Behavioural Problems” by Dr. Michael Passmore. Our Caregiving column this month is on the “Clinician’s Role in the Documentation of Elder Mistreatment” by Dr. Elizabeth Pham and Dr. Solomon Liao. I serve on a committee with some police officers who are experts in elder mistreatment, and their stories are very frightening. Our final article on Technology in Medicine is very patient-focused, namely “Information Communication Technology–Enabled Health Care for Older Adults at Home” by Dr. Simon Brownsell, Dr. Elaine Biddiss, and Dr. Mark Hawley.

Enjoy this issue,
Barry Goldlist