A

Abdomen
largest body cavity that contains the stomach, small intestines, colon, rectum, liver, spleen, pancreas, gall bladder, bladder, kidneys and appendix

Abdominal
relating to the abdomen

Acetaminophen
pain reliever and aspirin substitute found in over-the-counter drugs like Tylenol

Acute
happening suddenly over a short period of time

ALCOHOLIC HEPATITIS - Hepatitis with unique pathologic liver injury varying widely in severity and caused by chronic, heavy alcohol ingestion

Alimentary canal
continuous tube that extends from the mouth to the anus in which food is processed and eliminated

Albumin : is the major plasma protein (approximately 60 per cent of the total). It is synthesized by liver. It have three main functions :

• maintain the osmotic pressure (it's a force that keep back plasma into blood vessel, opposing to blood (hydrostatic) pressure)
• transport of ions (e.g. calcium), bilirubin, fats, hormones and drugs
• store amino acids

Alkaline phosphatase: protein found in bile duct cell membranes; blood levels may be increased in any liver disease, but more markedly with cholestasis.

Alpha-FetoProtein (AFP) : is a glycoprotein synthesized by the fetal liver and some cancers (mainly HCC and testicular germ cell cancer). It's elevated (normal value <15 ng/ml) in:

• HCC (useful for screening of high risk patient). Diagnostic if  greater than 200 ng/ml
• testicular germ cell cancer (not in pure seminoma)
• liver diseases : cirrhosis and chronic hepatitis (< 200 ng/ml) and fulminant hepatitis.
• newborn and mother (decrease progressively after delivery)
• pancreatic, gastric and colonic cancer (less specific)

Ammonia : is a toxic by-product of protein metabolism that is transformed in urea (non toxic) by liver cells. In advanced liver diseases there is a build-up of ammonia, due to liver dysfunction. (normal value <50 mg/dl).

Anemia
decrease in the normal level of red blood cells in the bloodstream

Antibodies (or Immuneglobulins, Ig) : are glycoproteins, produced by immune system, which bind to foreign proteins (antigen), causing their elimination. Specific antibodies are produced after an infection or after a vaccination and protect the body from further infections.Their presence can be assessed with blood test to estabilish if a infecious disease is occurred.
Antibodies can also be administered after exposure to an infectious agent to prevent the development of the disease  (passive immunization).

Antigen : is a substance which is capable of inducing a specific immune response. Antigens are present on viruses, bacteria, toxins, but also on human cells and tissues (they cause auto immune diseases).

ANTI-NUCLEAR ANTIBODY TEST -  ANA Laboratory test, when positive suggests the presence of some form of autoimmune illness.

Artery
a muscular tube that carries blood away from the heart and to all of the other organs of the body

Arthralgia : pain in one ore more joints.

Ascites : accumulation of fluid in the abdominal cavity, usually secondary to liver scarring and increased sinusoidal pressure. Intractable ascites is unresponsive to treatment and continually recurs.

AST : see transaminases.

Asymptomatic : without obvious signs or symptoms of disease.

AZATHIOPRINE - Drug marketed with trade name Imuran. Used to treat a number of diseases of unknown or autoimmune cause. Also used to treat organ transplant recipients to help prevent graft rejection.

B

Benign
not cancerous; does not spread to other parts of the body; the opposite of malignant

Bile : a greenish-yellow fluid secreted by the liver and stored in the gallbladder. Bile contains cholesterol, lecithin, water, bile salts and waste products such as bilirubin and some drugs. Bile salts allow the digestion and the intestinal absorption of fats and then of fat-soluble vitamins (A, D, E and K).

Bile duct
tube that carries bile from the gallbladder to the duodenum

Bilirubin : is a pigment produced when haemoglobin and cytochromes are destroyed. The liver trasforms it into a soluble compound (direct bilirubin) that is elimined with urine and bile. A high level of bilirubin causes yellowing of the eyes and skin, called jaundice.

Biopsy : a procedure used to obtain a small amount of tissue from a organ for microscopic analysis. Biopsy can be accomplished with a biopsy needle, passed through the skin into the organ in question, or by an open surgical incision.

Board Certified
certification from the American Board of Surgery that the surgeon has the skills necessary to specialize in surgery

Blood Cell : there are three main types of cell in the blood stream :

1. erythrocytes (red cell) : carrie oxygen
2. leukocytes (white cell) : fight infections. There are three types of leukocytes :
   1. granulocytes
   2. lymphocytes
   3. monocytes
3. platelets : prevent bleeding

Budd-Chiari Syndrome : it's a rare disease characterized by occlusion of hepatic veins, usually accompanied by ascites, hepatomegaly, and pain in abdomen.

C

Capsid : the proteic coat that covers the genome (DNA or RNA) of a virus. The capsid is built up of subunits  that self assemble in a pattern typical of a particular virus.

Capillaries
smallest blood vessels of the circulatory system that connect arteries and veins; also referred to as capillary beds and network of capillaries

Caput medusae: literally "Medusa's head"; dilated, varicose veins around the umbilicus, which may be seen in patients with cirrhosis of the liver.

Carrier :  an individual who hosts a virus or has a gene (or the genes) that cause a disease, withouth displaing its symptoms. A carrier however can transmit the viral disease to other person and genetic disorders to his/her offspring.

Centers for Disease Control and Prevention (CDC) : is an USA agency, responsible for estimating prevalence rates and making epidemiological studies (http://www.cdc.gov/).

Ceruloplasmin: copper transporter protein; blood levels are usually decreased in Wilson's disease.

Chemotherapy
treatment of cancer with anti-cancer drugs

Cholangitis : is an inflammation of  bile ducts.

Cholestasis : it 's a stoppage or suppression of the flow of bile.

Chronic : a disease or a symptom that persists for a long period of time without recovers.

CHRONIC HEPATITIS - Prolonged inflammation and death of liver cells persisting for six months or more caused by hepatitis viruses, autoimmune factors, and on occasion, unknown conditions.

Cirrhosis : pathologically-defined disease characterized by diffuse, irreversible fibrosis of the liver surrounding regenerative nodules.

Coagulopathy: increased bleeding tendency due to decreased hepatic synthesis of clotting factors.

Colorectal
relating to the colon and the rectum

Complete Blood Count (CBC) : is a blood test that determines the number of red blood cells, white blood cells and platelets present in the patients.

Cryoglobulins : abnormal plasma immunoglobulins (IgG or IgM) that precipitates when serum is cooled. They cause damage to blood vessels (vasculitis) and therefore to the tissues that they fed.

Cryoglobulinemia : is a condition characterized by the presence of cryoglobulins in the blood.

CT Scan COMPUTERIZED TOMOGRAPHY - A specialized x-ray procedure utilizing multiple radiographic films of the liver to construct with computer technology, a 2-dimensional picture of the liver. 

CYCLOSPORINE A - Drug marketed with trade names Sandimmune and Neoral. Given to organ transplant recipients to prevent the body from rejecting the graft. Inhibits immune system from rejecting foreign tissue.

D

DNA : Deoxyribo-Nucleic Acid (see genome).

Diagnosis : the determination of the nature of a case of disease.

Diuretic : a medication that promotes the excretion of salts and water from the kidney, increasing the volume of urine produced.

Drug : any animal, vegetable, or mineral substance used in the composition of medicines.

E

Endemic : a disease or an agent present or usually prevalent in a population or geographical area at all times.

Encephalopathy : alteration in sleep patterns and mental status, ranging from forgetfulness and mild confusion to coma; may be caused by circulating gut-derived brain-toxic proteins not cleared by a dysfunctional liver.

Endoscope : a flexible viewing instrument used for inspection of any cavity of the body. It has diagnostic (e.g. biopsy) and therapeutic capabilities (e.g. esophageal varices sclerotherapy) through special channels.

Envelope : is the outer layer of some viruses (e.g. HBV). It derives from plasma membrane of the host cell.

Eosinophils : are a type of granulocytes. They destroy parasitic organisms and play a major role in allergic reactions (hypersensitivity). They also secrete chemical mediators that can cause bronchoconstriction in asthma.

Erythrocytes : see red blood cells.

Esophageal Varices : is an abnormal dilatation of the veins in the esophagus, that occurs as the result of portl hypertension due to liver cirrhosis. Varices are prone to rupture, causing a serious bleeding.

Exacerbation : an increase in the severity of a disease or of its symptoms.

F

Falciform ligament
band of strong fibrous tissue that connects the right lobe and the left lobe of the liver

Ferritin : is an iron storage protein found mainly in liver. It's released in blood, where it can be dosed, giving information on iron body storage. Higher than normal values can be seen in haemochromatosis.

Fibrosis : is the deposition of collagen, that forms a fibrose (scar) tissue, poor of blood vessels and of cells and that therefore impair liver function. Liver fibrosis represents the wound healing response of the liver to a long term disease that damage it. Liver fibrosis leads to cirrhosis.

Food and Drug Administration (FDA) : the U.S. Agency responsible for regulation of biotechnology food products. The major laws under which the agency has regulatory powers include the Food, Drug, and Cosmetic act, and the Public Health Service Act.

Fulminant hepatitis : a severe and rapidly progressive form of hepatitis accompanied by hepatocellular death and hepatic failure.

G

Genome :  one or more molecules of nucleid acid, called chromosomes, that encode the genetic informations (genes) required to determinate the structure, function and behavior of a cell or of a virus. Human genome has 46 chromosomes of DNA. Viruses can have a DNA (e.g. HBV) or a RNA (e.g. HCV) genome.

Glycogen : is a branched polymer of D glucose and represents the major short term storage of glucose of animal cells and is particularly abundant in the liver and to a lesser extent in muscle.

Glycolysis : is the conversion of glucose to pyruvate, with production of energy (2 molecule of ATP). The glycolytic pathway takes place in the cytosol of cells.

Granulocytes : are a type of white blood cells with numerous cytoplasmic granules. They are subdivided, according to the staining properties of the granules, into eosinophils, basophils and neutrophils.

H

Hemoglobin (or haemoglobin) : is the oxygen carrying protein found in red blood cells. A low concentration of hemoglobin in blood is called anemia.

Hepatic : pertaining to the liver.

Hepatic artery
blood vessel that carries oxygen-rich blood to the liver from the heart

Hepatic portal vein
blood vessel that carries oxygen-poor blood from the liver back to the heart

Hepatic Stellate Cells (or Ito cells) : reside in the space of Disse and in normal liver are the major storage site of vitamin A. When a chronic liver injury occurs (e.g. a chronic hepatitis), these cells start produce collagen and other extracellular matrix proteins, that lead to liver fibrosis and then to cirrhosis.

Hepatitis : is an inflammation of the liver, that can be caused by viruses, bacteria, drugs or toxins. If persist for more than 6 months is called chronic hepatitis.

HEPATITIS A ANTIBODY (Anti HA) - Main laboratory test used to detect hepatitis A. Detects antibody produced by patient's immune system in response to hepatitis A virus.

HEPATITIS A - Hepatitis caused by hepatitis A virus. Most  common in children and adolescents. Usually resolves in a few weeks. Almost  never fatal. Transmitted by contaminated food and water.

Hepatic encephalopathy: is a serious complication of advanced liver disease caused by toxins, that the liver is no more able to remove from the bloodstream. It is clinically manifested by personality changes and impaired intellectual ability, awareness, and neuromuscular functioning.

Hepatologist : is a physican who specializes in the liver and its diseases.

Hepatocellular necrosis: localized tissue death of hepatic cells.

Hepatocellular carcinoma (HCC): a primary liver tumor more common in patients with cirrhosis.

Hepatocytes: liver cells.

Hepatorenal syndrome: poorly understood terminal kidney failure in the setting of hepatic disease.

Histology : the study of cells and tissue structure on the microscopic level. The study is performed on small amount of tissue obtained with a biopsy.

Homeostasis : tendency of the body to maintain a stable internal environment, using a variety of counterbalancing control systems.

Human Leukocyte Antigen (HLA) : is the human Major Histocompatibility Complex (MHC).

Hyperbilirubinemia : abnormally high levels of bilirubin in the blood.

I

Incubation period : is the amount of time that elapses between infection and the development of symptoms. It varies for the  different hepatitis viruses.

Inflammation : a localized protective response induced by injury or destruction of tissues. It is characterised in the acute form by the classical signs of pain, heat, redness, swelling and loss of function. Histologically, it's characterized by dilatation of arterioles, capillaries and venules, with increased permeability and blood flow (cause heat and redness), exudation of fluids, including plasma proteins and leucocytic migration into the inflammatory focus (cause pain, swelling and loss of function).

Intrahepatic : within the liver.

Infection : is the invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in the development of a disease.

INTERFERON - Drug produced by several companies with brand names: Intron, Roferon, and Infragen for the treatment of hepatitis B and C. Interferons are natural substances produced by the body that help to strengthen the immune system and display anti-viral activity against infections such as hepatitis C.

INFERGEN® (interferon alfacon-1), also known as consensus interferon, is marketed for the treatment of adults with chronic hepatitis C virus (HCV) infections. It is currently the only FDA approved, bio-optimized interferon developed through rational drug design and the only interferon with data in the label specifically for non-responding or refractory patients. InterMune's sales force re-launched Infergen in January 2002 with an active campaign to educate U.S. hepatologists about the safe and appropriate use of Infergen, which represents new hope for the more than 50 percent of HCV patients who fail other currently available therapies.

IVDU : Intravenous drug use.

J K

Kuppfer Cells : are specialised macrophage of the liver sinusoids. They are part of the reticuloendothelial system.

L

Lethargy : abnormal drowsiness or stupor, a condition of indifference.

Leukocytes (or white blood cells) : blood cells that  fight infections and other diseases. They can be found in blood and lymphatic system. There are three types of leukocytes : granulocytes, lymphocytes and monocytes.

Limiting plate: layer of hepatocytes surrounding each portal triad and separating it from the surrounding sheets of hepatocytes.

LIVER BIOPSY - Procedure used to take a sample of the liver to study under a microscope to determine the degree of liver damage or the type of liver injury. Can be performed by passing a needle between the ribs on the right side or at the time of surgical procedure where the abdomen is opened.

Lymph nodes
small glands located throughout the lymphatic system that store cells that help fight infection and disease

Lymphocytes : are a type of white blood cells that fight infection with high specificity. There are 2 types of these cells (see B-Lymphocytes and T-Lymphocytes).

M

Major Histocompatibility Complex (MHC) : is a complex family of genetically inherited proteins that play a critical role in immune response to foreign organisms. It is also involved in autoimmune disease and in transplant rejection. MHC are located on cell surface and work like receptors, that interact with immune cells. In mammals there are 2 classes of MHC :

• Class I : is present on the surface of all cells. T-lymphocytes use it to recognize infected cells.
• Class II : is present only on Antigen Presenting Cells (APC) and is involved in the activation of immune response.

Malaise
vague feeling of discomfort like the onset of an illness

Malignant
cancerous; cancer cells that may spread to other parts of the body

Monocytes : one of three types of white blood cells. Monocytes can exit from blood vessels and reach the tissues, where they evolve into macrophages.

Myalgia : pain in one or more muscles.

Myoglobin : is a oxygen store protein found in muscles.

N

Needlestick Injury : penetrating stab wounds caused by a needle. It can cause the transmission of blood-borne pathogens.

Neutrophils : are a type of granulocytes. They are phagocyte and are increased when a bacterial infection occurs.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) : are commonly used drugs with anti-inflammatory, fever-reducing, and pain-relieving properties. They works by inhibiting cyclooxygenase, an enzyme responsible for making prostaglandins.

Nucleus : is the major organelle of eukaryotic cells. It contains the cell genome (chromosomes), that is separated from the cytoplasm by the nuclear envelope.

Nuclear Envelope : a membrane system that surrounds the nucleus of eukaryotic cells. Consists of inner and outer membranes, separated by perinuclear space and perforated by nuclear pores.

O

Oncogene : a gene that induces cancer. It can be a gene of a normal cell that becomes alterated (see proto-oncogene), or derives from a virus (viral oncogene) that infects a normal cell.

Oncogenic : an event or a cause that induces cancer.

Opportunistic infections: are infections that occur in persons with weak immune systems due to AIDS, cancer or immunosuppressive drugs such as corticosteroids or chemotherapy.

P Q

PCR (Polymerase Chain Reaction) : it's a  technique used to amplificate DNA. Also RNA can be amplificate, but it must be first transformed into RNA. A test based on PCR is very sensitive and is used to detect the presence and the amount of DNA or RNA of a specific organism (e.g. a virus) in the blood or tissue.

Phagocyte : a cell that is capable of phagocytosis (eat foreign particles or other cells). The main mammalian phagocytes are neutrophils and macrophages.

Pharmacocynetic : is the study of the time courses of absorption, distribution and elimination of drugs.

Plasma Cells : are specialized white blood cells that produce antibodies. They derives from B-lymphocytes.

Platelets
special blood cells that cause blood to clot and stop bleeding

Portal hypertension: abnormal increase in portal blood pressure, usually due to obstruction of, or increased resistance to, portal blood flow.

Portosystemic  shunting: development of blood vessels that connect the portal and systemic circulation while bypassing the liver.

Portal system: includes all the veins that drain the small and large intestines, stomach, and spleen and that converge into the portal vein to drain into the liver.

Portal triad (or tract): consists of three components: branch of the hepatic artery, branch of the portal vein, and a biliary duct, all held tightly together by a limiting plate of hepatocytes at the periphery of the lobule.

Portal Vein : is a large vein that carries blood from the spleen, pancreas, stomach and intestines to the liver.

PORTAL-SYSTEMIC ENCEPHALOPATHY - Refers to a condition of mental status changes, ranging from mild confusion to a coma-state resulting from increased ammonia transferred to the brain because of the inability of the liver to remove this toxic compound from the circulation. 

PREDNISONE - Drug used to treat a number of autoimmune diseases. Broken down by body into a product normally produced by the adrenal gland. Has broad immunosuppressive effects and is often used for management of organ transplant recipients.

PRIMARY BILIARY CIRRHOSIS - Chronic liver disease, most common in women, caused by inflammation of bile ductules leading to a raised serum alkaline phosphatase and serum bilirubin. Course may be prolonged over many years or may proceed to liver failure in 3-5 years.

Protease Inhibitors : these drugs block the ability of the viral protease to cleave the finished viral polypeptide sequence into the smaller functional enzymes, thus interfering with further production of viruses. This is the newest group of HIV drugs available on the market (saquinavir and ritonavir). Protease inhibitors specific for HCV are under study.

Prothrombin time (PT): laboratory test that measures the clotting of blood in seconds; abnormally increased PT signifies bleeding risk due to deficient synthesis of clotting proteins.

Proto-oncogene : a normal cellular gene that is activated to become an oncogene by  mutation,  deletion, rearrangement over expression or inappropriate expression.

Pruritus: itching.

Quasispecies : the genetic heterogeneity of viral population within an infected individual.

R

Resection : removal of a portion or all of an organ or other structure.

Ribavirin : is an antiviral drug (is a nucleoside analogue) active against respiratory syncytial virus and hepatitis C virus (HCV).

Risk factors : are an aspect of personal behaviour or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition.

RNA : Ribo-Nucleic Acid. Plays a role in transferring information from DNA to the protein-forming system of the cell. Some viruses, like HCV, have a genome of RNA.

S

SGOT : see transaminases.

SGPT : see transaminases.

Sign : is the objective evidence of a disease, perceptible to the examining physician.

Spider angiomas: red capillary tufts in the skin that blanch on pressure; often found in patients with cirrhosis.

Splenomegaly : enlargement of the spleen. It's a sign of portal hypertension.

Spontaneous bacterial peritonitis (SBP): bacterial infection of ascitic fluid.

Sonographer
technician who specializes in the operation of ultrasound equipment

Steatorrhea : decreased absorption of dietary fats, resulting in their passage to the distal bowel which causes foul-smelling diarrhea; can be caused by deficiency of bile salts.

Steatosis (fatty liver) : abnormal lipid increase in the liver.

Subcutaneous Injection : the delivery of a medication into the subcutaneous tissues via injection.

Symptom : is the subjective evidence of disease perceived by the patient (symptom).

T

Tissue : a group of similar cells united to perform a specific function.

T-Lymphocytes (or T-Cell) : are a type of white blood cells responsible for cell-mediated immunity. They originate from lymphoid stem cells that migrate from the bone marrow to the thymus, where differentiate under the influence of the thymic hormones.There are three subpopulations of T-lymphocytes :

• T cytotoxic (or Tc) : kills cells infected by viruses.
• T helper (or Th) : stimulates immune response. It's infected and destroyed by HIV, leading to AIDS.
• T suppressor (or Ts) : inhibits immune response.

TOXIC HEPATITIS - Hepatitis caused by an industrial chemical such as carbon tetrachloride or phosphorus.

Transaminases (SGOT or AST, SGPT or ALT) : are enzymes present in liver cells. They are released in bloodstream when a liver damage occurs.

Transmission : the passage or transfer, as of a disease from one individual to another.

U

Ultrasound Guided Biopsy : is the use of ultrasound imaging to guide a biopsy needle to obtain a sample of tissue for analysis by a pathologist.

ULTRASOUND EXAMINATION - A test that utilizes ultrasound waves to bounce off internal organs of the body to construct a picture used by physicians as a non-invasive study of the liver.

V

Varices : small protruded vessels. Varices in esophagogastric region are one of the major complications of cirrhosis.

Viral Hepatitis : a liver inflammation caused by viruses. There are seven specific hepatitis viruses (HAV, HBV, HCV, HDV, HEV, HGV and TTV). Other viruses, like cytomegalovirus (CMV) and Epstein-Barr virus (EBV), can also cause hepatitis, but their primary target is not the liver.

Viral load : is the number of viral particles in a sample of blood plasma. It is measured by PCR and bDNA tests and is expressed in number of copies or equivalents per millilitre.

Viremia : the presence of virus particles in the blood. It can be detecteted and dosed with a test called PCR.

Virion : a single virus particle, complete with coat.

W X Y Z

Wilson's disease: inherited metabolic disorder in which copper accumulates in the liver and in the central nervous system, causing hepatitis, cirrhosis, and neuropsychiatric symptoms

Wild Type : the naturally-occuring, normal, non-mutated version of a gene or of an organism.