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Background/objectives Severity classification systems of acute pancreatitis (AP) assess inpatient morbidity and mortality without predicting outpatient course of AP. To provide appropriate outpatient care, determinants of long-term prognosis must also be identified. The aim of this study was to define clinical groups that carry long-term prognostic significance in AP. Methods A retrospective study that included patients admitted with AP was conducted. Determinants of long-term prognosis were extracted: These included Revised Atlanta and Determinant Based Classification (RAC), Charlson Comorbidity Index (CCI), Modified CT Severity Index (MCTSI), etiology, and local complications (LCs). Seven surrogates of morbidity up to 1 year after discharge were also collected and subsequently imputed into a clustering algorithm. The algorithm was set to produce three categories and multinomial regression analysis was performed. Results 281 patients were included. The incidences of morbidity endpoints were similar among the 3 RAC categories. Three clusters were identified that carried long-term prognostic significance. Each cluster was given a name to reflect prognosis. The limited AP had the best prognosis and included patients without LCs with a low co-morbidity burden. The brittle AP had a low co-morbidity burden and high MCTSI (LCs 94%). It ran a very morbid course but had excellent survival. The high-risk AP had the worst prognosis with the highest mortality rate (28%). They had a high co-morbidity burden without local complications. Conclusion Categories that carry long-term prognostic significance in AP have been developed. This study could help formulate appropriate follow-up and ultimately improve AP outcomes.

Background The use of Model for End Stage Liver Disease (MELD) score for liver allocation has resulted in transplanting sicker patients. As such, it is unclear if the risk factors and severity of acute cellular rejection (ACR) have changed. Aim To identify ACR characteristics where average MELD score at transplant is higher than previously published studies. Methods This is a single‐center, retrospective study designed to assess risk factors associated with ACR after adult orthotopic liver transplant (OLT) using a steroid sparing regimen. This study included 174 OLT patients transplanted from 2008 to 2013 at a single tertiary care center. Recipient demographics, preoperative clinical and laboratory data were recorded for each transplant. Univariate and multivariate regression analyses were performed to identify variables that are significant predictors for ACR. Results The median MELD at transplantation was 29.5. The average time from transplant to ACR diagnosis was 283.9 days and a majority of ACR episodes were mild to moderate. Serum creatinine, primary sclerosing cholangitis etiology and tacrolimus use were significant predictors for ACR (P

Intrahepatic cholestasis, or impaired bile flow, of pregnancy is the most common pregnancy-related liver disease and is characterized by elevated bile acids and pruritus. This typically develops late in the second trimester and in the third trimester. Following delivery, signs and symptoms resolve quickly. It is diagnosed clinically, with rare need for liver biopsy to confirm. There are numerous epidemiologic factors that can be associated with developing intrahepatic cholestasis of pregnancy, including ethnicity, geography, season, and multiple gestations in addition to family history and age.

Nontoxic adenomatous multinodular goiter (AMNG) in infants is a rare condition. We discuss an extremely rare case of a nontoxic AMNG in a 3-month-old female presenting with airway obstruction. Surgical resection of the mass was performed to reduce the burden on the airway and for diagnosis. The literature is reviewed, and the clinical characteristics, pathology, and surgical treatment are discussed. Laryngoscope, 124:2636–2639, 2014