Kofi Clarke, MD
I am excited to join Penn State Health Milton S. Hershey Medical Center Division of Gastroenterology and Hepatology, and be part of a team of highly skilled colleagues who are greatly regarded for excellent clinical care and research.
As I transition to Hershey Medical Center, I’ve had the opportunity to reflect on today’s unique health care climate. It is marked by increased recognition of limited resources and an appropriate shift toward cost efficiency and quality of care outcomes. In this environment, we must be at the forefront of the discussion among stakeholders—patients, clinicians and payers. In line with national and global initiatives to provide more efficient and effective care, we will focus on creating technology-driven and evidence-based clinical care programs across our service region. We plan to develop new collaborative programs with community partners, broadening access to specialty GI care in areas not previously served. The key to the success of this plan is a better understanding of population characteristics influencing disease states and health care choices. Likewise, an integral part of this focus is to define clinical parameters and quality of care measures that accurately and meaningfully describe patient outcomes and the effectiveness of the care we provide in our specialty. Continue reading
- Male patient, 46 years-old
- Presented with abdominal pain, acute and progressive abdominal sepsis
- Poor response to treatment for sepsis; patient exhibited rapid decline, became gravely ill
- CT scan revealed massive hepatic abscesses (Figure):
- Solid necrotic debris
- Placement of two 24F multipurpose drains and one 28F drain.
- Repeat catheter exchanges and lavage protocols, limited progress in removal of necrosis
- For left hepatic abscess, replaced 28F drain with 9mm flexible endoscope:
- EUS-guided use of floppy endoscopic snare to removal of solid necrotic debris
- High-volume saline lavage
- Drain replacement
- Repeated procedure for right hepatic abscess
- Marked patient improvement; discharge
- Four procedures performed over ten days with full recovery by week ten
- Ongoing oral antibiotic treatment
Read more about the novel, minimally-invasive approach.
- Abdominal pain
- Hepatomegaly or hepatosplenomegaly (may be mild)
- Chronic diarrhea
- Elevated chitotriosidase
- Elevated triglycerides
- Low HDL-C and high LDL-C
- Accelerated atherosclerosis
- Elevated liver function tests (LFTs)
- Hepatic biopsy
- Bright yellow-orange tissue
- Steatosis (most often microvesicular)
- Enlarged, lipid-laden hepatocytes and Kupffer cells
Reference: Differential diagnosis of LAL-D. from: http://laldsource.com/diagnosis-and-testing/getting-to-a-diagnosis/ Accessed May 7, 2015.
Read more about Lysosomal Acid Lipase Deficiency (LAL-D) in Adults: Epidemiologic Multi-Center Study Underway.