The Hepatorenal Syndrome (HRS) is one of many potential causes of Acute Kidney Injury (AKI) in patients with decompensated liver disease.

HRS is associated with poor prognosis and represents the end-stage of a sequence of reductions in renal perfusion induced by progressively severe hepatic injury.

The pathophysiology of HRS is complex with multiple mechanisms interacting simultaneously, although HRS is primarily characterised by renal vasoconstriction.

A recently revised diagnostic criteria and management algorithm for AKI has been developed for patients with cirrhosis, allowing physicians to commence treatment promptly.

Vasopressor therapy and other general management, such as antibiotic prophylaxis, need to be initiated while patients are assessed for eligibility for transplantation. Liver transplantation remains the treatment of choice for HRS but is limited by organ shortage.

Other management options, such as transjugular intrahepatic portosystemic shunt, renal replacement therapy and molecular absorbent recirculating system, may provide short term benefit for patients not responding medical therapy while awaiting transplantation.

Clinicians need to be aware of the pathophysiology and management principles of HRS to provide quality care for patients with multi-organ failure.

Fatty liver is defined as an accumulation of fat, mainly Triacylglycerol (TAG) in liver. Fatty liver in dairy cows is categorized into mild, moderate and severe fatty liver. Obesity in pregnant cow is crucial etiological factor for postpartal development of fatty liver. Namely, obese cows have a greater decrease in feed intake during the period around parturition and, therefore, have a more severe negative energy balance during early lactation which leads to increased lipolysis of adipose tissue. Non Esterified Fatty Acids (NEFA), released from the stored TAG in the adipose tissue, are readily taken up by liver. The excess of NEFA may be converted to TAG and deposit in liver. Liver biopsy is the only reliable method for the detection of fatty liver, especially for the determination of its severity through the estimation of total lipids and TAG. Ecography may be considered as noninvasive, on-farm method for diagnosis of fatty liver which is not commonly used do to the not widely achievable equipment. Since some metabolic and endocrine parameters are significantly correlated with fatty liver degree, they may be used as diagnostic indicators of fatty liver. The significance of those indicators for diagnosis of fatty liver is present in this review. Additionally, indicators that may be used for prediction of fatty liver are explained. Specially attention was given to glucose, NEFA, BHBA, liver enzymes, total bilirubin, total protein, albumin and urea as well as some hormones involved in lipid metabolism. Achievements of novel methods, like genomic and proteomic profiling of biological fluids of diseased cows, in providing tools for diagnosis and prognosis of this metabolic disease are presented.

The treatment of primary gastric lymphoma is evolving in post-rituximab era. The role of Helicobacter pyroli eradication alone can cure not only Mucosa-Associated Lymphoepithelial Tumor (MALT) but also some of diffuse large B cell lymphoma with or without MALT component. The efficacy of rituximab containing chemotherapy is so effective that the role of surgery is overshadowed. There are many studies, although most of them were retrospective trials, however it highlights the current mainstay of immune-chemotherapy provided an outstanding long term survival more than 80-90%.H pylori In real world there are substantial patients may receive surgery first, yet still needs post-operative adjuvant chemotherapy for some of them has a risk of relapse of lymphoma. And recent studies showed there’s no statistical difference between the two modalities. The main reason for patients proceeded to surgery as primary treatment is the gastroenterologist preference and showed no difference in terms of progression free survival and overall survival. The rituximab was introduced to lymphoma treatment since 1999, and demonstrated a superior long term survival in diffuse large B cell lymphoma for R-CHOP relatively to CHOP regimen. The highly effective treatment made PGL being easily curable disease; furthermore there are new insights of why and how the antibiotic therapy as exclusive treatment for limited disease will be a mainstay in treating this malignancy. We make a proposal how to treat the primary gastric lymphoma and MALT, and highlight the changing treatment modalities with regards to the integration of Helicobacter pyroli eradication to conventional chemotherapy as well as the complimentary role of surgery and radiotherapy.

Aims: The aim of this study was to demonstrate epidemiological, clinical and endoscopic characteristics of acute Upper Gi Bleeding (UGIB) with a focus on Peptic Ulcer Bleeding (PUB).

Methods: This study included 2198 consecutive patients that were referred to our emergency department due to acute Upper Gi Bleeding (UGIB) from January 2008 to December 2012. All patients under went urgent upper GI endoscopies within 24 hours of admission, and 842 patients diagnosed with PUB were enrolled and prospectively followed.

Results: The cumulative incidence of UIGB was 126/100000 for a 5-year period. Two out of five patients had a bleeding peptic ulcer, of which 440 (52.3%) patients had a bleeding gastric ulcer, 356 (42.3%) had a bleeding duodenal ulcer, 17 (2%) had both bleeding gastric and duodenal ulcers and 29 (3.5%) patients had bleeding ulcers on gastroenteric anastomosis. PUB was more common in men. Average patient age was 65.9 years. The majority of patients with PUB were taking agents that attenuate the cytoprotective function of the gastric and duodenal mucosa (57%).Half of the patients received a red blood cell transfusion, with a median of 2.2 units. Re-bleeding occurred in 77(9.7%) patients and 47 (5.9%) required surgical intervention. The thirty-day morality was 5.2%, and 10% of patients died from uncontrolled bleeding and concomitant diseases.

Conclusion: PUB is the main cause of UGIB, characterized by a significant re-bleeding rate and mortality.