Scholars@Duke
Matthew Robert Kappus

Matthew Robert Kappus

Associate Professor of Medicine
Medicine, Gastroenterology
Duke University Hospital, Durham, NC 27617

Selected Publications

2025: The Current State of Functional Assessment in Patients Undergoing Liver Transplantation

Journal Article Current Transplantation Reports · December 1, 2026 Purpose of Review: Frailty has emerged as an important factor in liver transplant evaluation, as frailty is common in cirrhosis and is associated with adverse outcomes before and after transplant. No standardized approach to frailty assessment exists in th ... Full text Cite

Induction of Antigen-Specific T Cell Tolerance by CNP-104 Positively Affects Clinical Response in Primary Biliary Cholangitis (PBC) 9237

Conference The Journal of Immunology · November 1, 2025 Abstract Description PBC is an archetypal autoimmune disease where the dominant autoantigen is mitochondrial PDC-E2. Hitherto, ... Full text Cite

The Liver in Heart Failure and Adults with Congenital Heart Disease.

Journal Article Clin Liver Dis · August 2025 Liver disease is common in patients with heart failure, often resulting from hepatic congestion and decreased perfusion due to reduced cardiac output. Patients with congenital heart disease (CHD) are particularly susceptible to hepatic injury due to their ... Full text Link to item Cite

Liver transplantation provides survival benefit at all levels of frailty: From the Multicenter Functional Assessment in Liver Transplantation Study.

Journal Article Hepatology · April 1, 2025 BACKGROUND AND AIMS: Offering LT to frail patients may reduce waitlist mortality but may increase post-LT mortality. LT survival benefit is the concept of balancing these risks. We sought to quantify the net survival benefit with LT by liver frailty index ... Full text Link to item Cite

The Liver Transplant Comorbidity Index (LTCI): A composite index of ambulatory pre-LT factors to identify patients at increased risk of post-LT mortality.

Conference Hepatology · March 25, 2025 BACKGROUND AND AIMS: Frailty is strongly associated with mortality after liver transplantation. However, national guidelines discourage its use as a sole reason to decline a patient for liver transplantation, as some frail patients have acceptable outcomes ... Full text Link to item Cite

Global prevalence and characteristics of infections and clinical outcomes in hospitalised patients with cirrhosis: a prospective cohort study for the CLEARED Consortium.

Journal Article Lancet Gastroenterol Hepatol · November 2024 BACKGROUND: Infections have a poor prognosis in inpatients with cirrhosis. We aimed to determine regional variations in infections and their association with clinical outcomes in a global cohort of inpatients with cirrhosis. METHODS: In this prospective co ... Full text Link to item Cite

Financial toxicity in living donor liver transplantation: A call to action for financial neutrality.

Journal Article Am J Transplant · October 2024 After 2 decades of limited growth, living donor liver transplant (LDLT) has been increasingly accepted as a promising solution to the growing organ shortage in the US. With experience, LDLT offers superior graft and patient survival with low rates of rejec ... Full text Link to item Cite

Clinically relevant cut-points for changes in the Liver Frailty Index are associated with waitlist mortality in patients with cirrhosis.

Journal Article Liver Transpl · October 1, 2024 Physical frailty is a critical determinant of mortality in patients with cirrhosis and can be objectively measured using the Liver Frailty Index (LFI), which is potentially modifiable. We aimed to identify LFI cut-points associated with waitlist mortality. ... Full text Link to item Cite

Secondary Syphilis Can Simultaneously Mimic Cholestatic Liver Injury and Glomerular Nephropathy.

Journal Article ACG Case Rep J · October 2024 Syphilis, a disease affecting millions, still poses challenges for men who have sex with men in high-income countries and often presents in varying ways. It is exceedingly rare for syphilis to simultaneously cause an acute liver injury and nephropathy. Thi ... Full text Link to item Cite

Highlights in the clinical nutrition literature: A critical appraisal of current research.

Journal Article JPEN J Parenter Enteral Nutr · May 2024 Within the American Society for Parenteral and Enteral Nutrition (ASPEN), the Physician Engagement Committee (PEC) was created in 2017 by the ASPEN Board of Directors with the goal of growing the physician community both nationally and internationally. The ... Full text Link to item Cite

Predictors of Respiratory Failure Development in a Multicenter Cohort of Inpatients With Cirrhosis.

Journal Article Am J Gastroenterol · April 1, 2024 INTRODUCTION: Hospitalized patients with cirrhosis can develop respiratory failure (RF), which is associated with a poor prognosis, but predisposing factors are unclear. METHODS: We prospectively enrolled a multicenter North American cirrhosis inpatient co ... Full text Link to item Cite

Association of body mass index with post-liver transplant outcomes.

Journal Article Clin Transplant · January 2024 BACKGROUND: Patients with obesity have inferior outcomes after general surgery procedures, but studies evaluating post-liver transplant (LT) outcomes have been limited by small sample sizes or lack of granularity of outcomes. We evaluated the relationship ... Full text Link to item Cite

The liver frailty index is a predictor of healthcare utilization after liver transplantation in older adults.

Journal Article Clin Transplant · January 2024 BACKGROUND: Older adults have higher healthcare utilization after liver transplantation (LT), yet objective risk stratification tools in this population are lacking. We evaluated the Liver Frailty Index (LFI) as one potential tool. METHODS: Ambulatory LT c ... Full text Link to item Cite

Refractory Cytomegalovirus Colitis Followed by De Novo Inflammatory Bowel Disease Post-Orthotopic Liver Transplantation.

Journal Article ACG Case Rep J · December 2023 Cytomegalovirus (CMV) and inflammatory bowel disease (IBD) are both immune-mediated complications that affect orthotopic liver transplantation patients. In this report, we present a 60-year-old man who underwent orthotopic liver transplantation for cryptog ... Full text Open Access Link to item Cite

Real-world Experiences in the Transplantation of Hepatitis C-NAAT-positive Organs.

Journal Article Transplant Direct · November 2023 BACKGROUND: Hepatitis C virus (HCV) nucleic acid amplification test (NAAT)-positive donors have increased the organ pool. Direct-acting antivirals (DAAs) have led to high rates of treatment success and sustained virologic response (SVR) in recipients with ... Full text Link to item Cite

Physical Activity and Nonalcoholic Fatty Liver Disease: A Roundtable Statement from the American College of Sports Medicine.

Journal Article Med Sci Sports Exerc · September 1, 2023 Although physical activity (PA) is crucial in the prevention and clinical management of nonalcoholic fatty liver disease, most individuals with this chronic disease are inactive and do not achieve recommended amounts of PA. There is a robust and consistent ... Full text Link to item Cite

American College of Sports Medicine (ACSM) International Multidisciplinary Roundtable report on physical activity and nonalcoholic fatty liver disease.

Journal Article Hepatol Commun · April 1, 2023 BACKGROUND AND AIMS: We present findings from the inaugural American College of Sports Medicine (ACSM) International Multidisciplinary Roundtable, which was convened to evaluate the evidence for physical activity as a means of preventing or modifying the c ... Full text Link to item Cite

Association of Frailty With Health-Related Quality of Life in Liver Transplant Recipients.

Journal Article JAMA Surg · February 1, 2023 IMPORTANCE: Frailty has been recognized as a risk factor for mortality after liver transplant (LT) but little is known of its association with functional status and health-related quality of life (HRQL), termed global functional health, in LT recipients. O ... Full text Link to item Cite

Toolkit for the early career transplant hepatologist

Journal Article Clinical Liver Disease · February 1, 2023 Full text Cite

Frailty, mortality, and health care utilization after liver transplantation: From the Multicenter Functional Assessment in Liver Transplantation (FrAILT) Study.

Journal Article Hepatology · June 2022 BACKGROUND AND AIMS: Frailty is a well-established risk factor for poor outcomes in patients with cirrhosis awaiting liver transplantation (LT), but whether it predicts outcomes among those who have undergone LT is unknown. APPROACH AND RESULTS: Adult LT r ... Full text Link to item Cite

Frailty and the Risk of Acute Kidney Injury Among Patients With Cirrhosis.

Journal Article Hepatol Commun · April 2022 Acute kidney injury (AKI) and frailty are major drivers of outcomes among patients with cirrhosis. What is unknown is the impact of physical frailty on the development of AKI. We included adults with cirrhosis without hepatocellular carcinoma listed for li ... Full text Link to item Cite

30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass: a propensity score-matched analysis of the GENEVA data.

Journal Article Int J Obes (Lond) · April 2022 BACKGROUND: There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in p ... Full text Link to item Cite

Cognitive Impairment and Physical Frailty in Patients With Cirrhosis.

Journal Article Hepatol Commun · January 2022 Physical frailty and impaired cognition are common in patients with cirrhosis. Physical frailty can be assessed using performance-based tests, but the extent to which impaired cognition may impact performance is not well characterized. We assessed the rela ... Full text Link to item Cite

Loneliness in adults awaiting liver transplantation at 7 U.S. transplant centers.

Journal Article Ann Hepatol · 2022 INTRODUCTION: Loneliness, "a subjective feeling of being isolated", is a strong predictor of adverse health. We characterized loneliness in patients with end-stage liver disease (ESLD) awaiting liver transplantation (LT). METHODS: We surveyed loneliness in ... Full text Link to item Cite

30-Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID-19 pandemic - The GENEVA study.

Journal Article Pediatr Obes · December 2021 BACKGROUND: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. OBJECTIVES: This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This was a g ... Full text Link to item Cite

The relationship between frailty and cirrhosis etiology: From the Functional Assessment in Liver Transplantation (FrAILT) Study.

Journal Article Liver Int · October 2021 BACKGROUND & AIMS: Cirrhosis leads to malnutrition and muscle wasting that manifests as frailty, which may be influenced by cirrhosis aetiology. We aimed to characterize the relationship between frailty and cirrhosis aetiology. METHODS: Included were adult ... Full text Link to item Cite

Wearables, Physical Activity, and Exercise Testing in Liver Disease.

Journal Article Semin Liver Dis · May 2021 Physical inactivity is a major cause of deterioration in all forms of advanced liver disease. It is especially important as a driver of the components of the metabolic syndrome, with nonalcoholic fatty liver disease rapidly becoming the dominant cause of l ... Full text Link to item Cite

A Multicenter Pilot Randomized Clinical Trial of a Home-Based Exercise Program for Patients With Cirrhosis: The Strength Training Intervention (STRIVE).

Journal Article Am J Gastroenterol · April 2021 INTRODUCTION: We developed the strength training intervention (STRIVE), a home-based exercise program targeting physical function in patients with cirrhosis. In this pilot study, we aimed to evaluate the safety and efficacy of STRIVE. METHODS: Eligible wer ... Full text Link to item Cite

Identifying an Optimal Liver Frailty Index Cutoff to Predict Waitlist Mortality in Liver Transplant Candidates.

Journal Article Hepatology · March 2021 BACKGROUND AND AIMS: Frailty, as measured by the Liver Frailty Index (LFI), is associated with liver transplant (LT) waitlist mortality. We sought to identify an optimal LFI cutoff that predicts waitlist mortality. APPROACH AND RESULTS: Adults with cirrhos ... Full text Link to item Cite

Association of Frailty and Sex With Wait List Mortality in Liver Transplant Candidates in the Multicenter Functional Assessment in Liver Transplantation (FrAILT) Study.

Journal Article JAMA Surg · March 1, 2021 IMPORTANCE: Female liver transplant candidates experience higher rates of wait list mortality than male candidates. Frailty is a critical determinant of mortality in patients with cirrhosis, but how frailty differs between women and men is unknown. OBJECTI ... Full text Link to item Cite

Direct-Acting Antivirals and Organ Transplantation: Is There Anything We Can't Do?

Journal Article J Infect Dis · November 27, 2020 The opioid epidemic has resulted in an increase in organ donors with hepatitis C virus (HCV) infection in the United States. With the development of direct-acting antiviral regimens that offer high sustained virologic response rates even in the setting of ... Full text Link to item Cite

Impact of Malnutrition on Outcomes in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunt Insertion.

Journal Article Dig Dis Sci · November 2020 BACKGROUND: Malnutrition is common in patients with cirrhosis and is associated with poor outcomes after hepatic resection and liver transplantation. Transjugular intrahepatic portosystemic shunt (TIPS) is performed for complications of cirrhosis. AIM: To ... Full text Link to item Cite

Outcomes of Liver Transplantation Among Older Recipients With Nonalcoholic Steatohepatitis in a Large Multicenter US Cohort: the Re-Evaluating Age Limits in Transplantation Consortium.

Journal Article Liver Transpl · November 2020 The liver transplantation (LT) population is aging, with the need for transplant being driven by the growing prevalence of nonalcoholic steatohepatitis (NASH). Older LT recipients with NASH may be at an increased risk for adverse outcomes after LT. Our obj ... Full text Link to item Cite

Use of Skeletal Muscle Index as a Predictor of Wait-List Mortality in Patients With End-Stage Liver Disease.

Conference Liver Transpl · September 2020 The aim of this study is to validate a proposed definition of sarcopenia in predicting wait-list mortality. We retrospectively evaluated 355 adults (age ≥18 years) with cirrhosis listed for first-time LT from January 1, 2010, to April 1, 2018 from our cent ... Full text Link to item Cite

Changes in frailty are associated with waitlist mortality in patients with cirrhosis.

Journal Article J Hepatol · September 2020 BACKGROUND & AIMS: To date, studies evaluating the association between frailty and mortality in patients with cirrhosis have been limited to assessments of frailty at a single time point. We aimed to evaluate changes in frailty over time and their associat ... Full text Link to item Cite

Transplant Outcomes in Older Patients With Nonalcoholic Steatohepatitis Compared to Alcohol-related Liver Disease and Hepatitis C.

Journal Article Transplantation · June 2020 BACKGROUND: Patients with nonalcoholic steatohepatitis (NASH) are waitlisted at older ages than individuals with other liver diseases, but the effect of age on liver transplantation (LT) outcomes in this population and whether it differs from other etiolog ... Full text Link to item Cite

A Comprehensive Review of Outcome Predictors in Low MELD Patients.

Journal Article Transplantation · February 2020 Risk scoring for patients with cirrhosis has evolved greatly over the past several decades. However, patients with low Model for End-Stage Liver Disease-Sodium scores still suffer from liver-related morbidity and mortality. Unfortunately, it is not clear w ... Full text Link to item Cite

Acute Hepatic Failure and Nutrition.

Journal Article Nutr Clin Pract · February 2020 Malnutrition is prevalent in patients with hepatic failure and remains an independent risk factor for morbidity and mortality in these patients. Factors that contribute to malnutrition in this patient population include altered metabolic rate, fat malabsor ... Full text Link to item Cite

Relative Sarcopenia With Excess Adiposity Predicts Survival After Transjugular Intrahepatic Portosystemic Shunt Creation.

Journal Article AJR Am J Roentgenol · January 2020 OBJECTIVE. The purpose of this study was to assess the impact of relative sarcopenia with excess adiposity on mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS. In this single-institution retrospective stu ... Full text Link to item Cite

Assessment of interstitial lung disease among black rheumatoid arthritis patients.

Journal Article Clin Rheumatol · December 2019 BACKGROUND: Conflicting reports exist regarding the racial and the gender distribution of rheumatoid arthritis-related interstitial lung disease (RA-ILD). In a major population study of predominately Whites, RA-ILD was reported mainly among smoker middle-a ... Full text Link to item Cite

Association Between Liver Transplant Wait-list Mortality and Frailty Based on Body Mass Index.

Journal Article JAMA Surg · December 1, 2019 IMPORTANCE: Among liver transplant candidates, obesity and frailty are associated with increased risk of death while they are on the wait-list. However, use of body mass index (BMI) may not detect candidates at a higher risk of death owing to the fact that ... Full text Link to item Cite

A North American Expert Opinion Statement on Sarcopenia in Liver Transplantation.

Journal Article Hepatology · November 2019 Loss of muscle mass and function, or sarcopenia, is a common feature of cirrhosis and contributes significantly to morbidity and mortality in this population. Sarcopenia is a main indicator of adverse outcomes in this population, including poor quality of ... Full text Link to item Cite

1089 Hypophosphatemia in Patients With Alcoholic Hepatitis

Conference American Journal of Gastroenterology · October 2019 INTRODUCTION:Patients with alcoholic hepatitis suffer from high rates of malnutrition and are at risk for hypophosphatemia due to poor dietary intake, renal wasting, and refeeding syndrom ... Full text Cite

Implications of the Opioid Epidemic for the Clinical Gastroenterology Practice.

Journal Article Curr Gastroenterol Rep · July 25, 2019 PURPOSE OF REVIEW: The opioid epidemic in the USA has led to a rise in opioid-related gastrointestinal (GI) side effects that are often difficult to diagnose and treat. The aim of this report is to discuss opioid pathophysiology, opioid-related GI side eff ... Full text Link to item Cite

Frailty in liver transplantation: An expert opinion statement from the American Society of Transplantation Liver and Intestinal Community of Practice.

Journal Article Am J Transplant · July 2019 Frailty has emerged as a powerful predictor of outcomes in patients with cirrhosis and has inevitably made its way into decision making within liver transplantation. In an effort to harmonize integration of the concept of frailty among transplant centers, ... Full text Link to item Cite

No Increased Mortality After TIPS Compared with Serial Large Volume Paracenteses in Patients with Higher Model for End-Stage Liver Disease Score and Refractory Ascites.

Journal Article Cardiovasc Intervent Radiol · May 2019 PURPOSE: To compare survival after transjugular intrahepatic portosystemic shunt (TIPS) creation versus serial large volume paracenteses (LVP) in patients with refractory ascites and higher Model for End-Stage Liver Disease (MELD) scores. MATERIALS AND MET ... Full text Link to item Cite

Frailty Associated With Waitlist Mortality Independent of Ascites and Hepatic Encephalopathy in a Multicenter Study.

Journal Article Gastroenterology · May 2019 BACKGROUND & AIMS: Frailty is associated with mortality in patients with cirrhosis. We measured frailty using 3 simple tests and calculated Liver Frailty Index (LFI) scores for patients at multiple ambulatory centers. We investigated associations between L ... Full text Link to item Cite

Hepatitis and Thoracic Transplantation - No More Virus Non-Grata

Conference The Journal of Heart and Lung Transplantation · April 2019 Full text Cite

Donor derived HSV hepatitis in a kidney transplant recipient leading to liver fibrosis and portal hypertension.

Journal Article Transpl Infect Dis · February 2019 The unexpected transmission of donor-derived infection through organ transplantation is a rare event with current donor screening practices. In this case report we describe a probable donor-derived transmission of Herpes Simplex Virus (HSV)-2 via deceased ... Full text Link to item Cite

Muscle mass versus muscle strength and performance: Is muscle mass measurement alone enough?

Chapter · January 1, 2019 In the world of advanced liver disease, no person can deny the loss of physical function that occurs to patients with cirrhosis. As the disease progresses, the physical manifestations of muscle mass loss and reduced physical function are apparent. Provider ... Full text Cite

Patient and Caregiver Attitudes and Practices of Exercise in Candidates Listed for Liver Transplantation.

Journal Article Dig Dis Sci · December 2018 BACKGROUND: Impaired physical capacity increases peri-liver transplant complications. Patient perceptions regarding exercise prior to transplantation are not known. AIMS: This study aimed to assess patient and caregiver activity levels, perceptions of will ... Full text Link to item Cite

Poor performance of psoas muscle index for identification of patients with higher waitlist mortality risk in cirrhosis.

Journal Article J Cachexia Sarcopenia Muscle · December 2018 BACKGROUND: Sarcopenia, characterized by low muscle mass, associates with mortality in patients with cirrhosis. Skeletal muscle area in a single computed tomography image at the level of the third lumbar vertebrate (L3) is a valid representative of whole b ... Full text Link to item Cite

Disseminated Adenovirus Infection After Combined Liver-Kidney Transplantation.

Journal Article Front Cell Infect Microbiol · 2018 Human adenovirus (HAdV) infections are well-described after hematopoietic stem cell transplantation but less well understood in solid organ transplantation (SOT). We describe a case of disseminated HAdV type 21 infection 5 months after combined liver-kidne ... Full text Open Access Link to item Cite

De Novo and Recurrence of Nonalcoholic Steatohepatitis After Liver Transplantation.

Journal Article Clin Liver Dis · May 2017 Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in developing countries. Approximately 25% of patients with NAFLD develop nonalcoholic steatohepatitis (NASH). NASH-related cirrhosis is now a leading listing indica ... Full text Link to item Cite

Repeatability of Computerized Tomography-Based Anthropomorphic Measurements of Frailty in Patients With Pulmonary Fibrosis Undergoing Lung Transplantation.

Journal Article Curr Probl Diagn Radiol · 2017 PURPOSE: To determine interreader and intrareader repeatability and correlations among measurements of computerized tomography-based anthropomorphic measurements in patients with pulmonary fibrosis undergoing lung transplantation. METHODS: This was an inst ... Full text Link to item Cite

Anemia in Liver Disease

Chapter · January 1, 2017 Multiple different types of anemia are associated with liver disease. Portal hypertension related to chronic or acute liver disease may cause gastrointestinal bleeding, which is predisposed by coagulopathy related to liver dysfunction. Acute blood loss ane ... Full text Cite

Malnutrition and Nutritional Support in Alcoholic Liver Disease: a Review.

Journal Article Curr Gastroenterol Rep · December 2016 Malnutrition is associated with alcoholic liver disease (ALD) and related complications such as hepatic encephalopathy and increased rate of infections. Avoidance of prolonged fasting and overly restrictive diets is important to avoid poor nutrition. Adequ ... Full text Link to item Cite

Intestinal Failure: New Definition and Clinical Implications.

Journal Article Curr Gastroenterol Rep · September 2016 Intestinal failure (IF) is a state in which the nutritional demands of the body are not met by the gastrointestinal absorptive surface. It is a long-recognized complication associated with short bowel syndrome, which results in malabsorption after signific ... Full text Link to item Cite

Comparative Measures of Lean Body Tissues in the Clinical Setting

Journal Article Current Nutrition Reports · September 1, 2016 Age-related decreases in muscle mass and function, known as sarcopenia, have been shown to be related to functional limitation, frailty, and an increase in morbidity and mortality. While the most accurate method to assess muscle mass is biopsy, this is imp ... Full text Cite

Sarcopenia in Patients with Chronic Liver Disease: Can It Be Altered by Diet and Exercise?

Journal Article Curr Gastroenterol Rep · August 2016 Sarcopenia, a loss of muscle mass, is being increasingly recognized to have a deleterious effect on outcomes in patients with chronic liver disease. Factors related to diet and the inflammatory nature of chronic liver disease contribute to the occurrence o ... Full text Link to item Cite

Amiodarone-Induced Liver Injury and Cirrhosis.

Journal Article ACG Case Rep J · January 2015 We present a case report of an 80-year-old woman with volume overload thought initially to be secondary to heart failure, but determined to be amiodarone-induced acute and chronic liver injury leading to submassive necrosis and bridging fibrosis consistent ... Full text Open Access Link to item Cite

Effect of obstructive sleep apnea on the sleep architecture in cirrhosis.

Journal Article J Clin Sleep Med · March 15, 2013 STUDY OBJECTIVES: Sleep disturbances in cirrhosis are assumed to be due to hepatic encephalopathy (HE). The interaction between cirrhosis, prior HE, and obstructive sleep apnea (OSA) has not been evaluated. We aimed to evaluate the additional effect of cir ... Full text Link to item Cite

Extrahepatic manifestations of acute hepatitis B virus infection

Journal Article Gastroenterology and Hepatology · February 1, 2013 Cite

Tetomilast: new promise for phosphodiesterase-4 inhibitors?

Journal Article Expert Opin Investig Drugs · December 2012 INTRODUCTION: Tetomilast is a novel thiazole phosphodiesterase-4 (PDE-4) inhibitor, which may prove useful in both the treatment of inflammatory bowel disease (IBD) and chronic obstructive pulmonary disease (COPD). Here, the authors review the pharmacology ... Full text Link to item Cite

Covert hepatic encephalopathy: not as minimal as you might think.

Journal Article Clin Gastroenterol Hepatol · November 2012 Hepatic encephalopathy (HE) is a serious neuropsychiatric and neurocognitive complication of acute and chronic liver disease. Symptoms are often overt (confusion, disorientation, ataxia, or coma) but can also be subtle (difficulty with cognitive abilities ... Full text Link to item Cite

Assessment of minimal hepatic encephalopathy (with emphasis on computerized psychometric tests).

Journal Article Clin Liver Dis · February 2012 Minimal hepatic encephalopathy (MHE) is associated with a high risk of development of overt hepatic encephalopathy, impaired quality of life, and driving accidents. The detection of MHE requires specialized testing because it cannot, by definition, be diag ... Full text Link to item Cite

Coagulopathy: Pathophysiology, evaluation, and treatment

Chapter · January 1, 2012 For centuries from Hippocrates and Galen to Virchow and Morawitz, the process of hemostasis and its pathways has mystified us, and Roman numerals have comprised our understanding of hemostasis and coagulation. The reassuring “cascade” of events that has re ... Full text Cite