1 / 50

LIVER

LIVER. By Michael Brillantes, MD, FPCS, FPSGS. Anatomy -1/50 of total body weight. Surgically divided into the right and left lobe by a line through the IVC and gallbladder (Cantlie’s line). -left lobe divided into medial and lateral segments by falciform ligament.

leyna
Télécharger la présentation

LIVER

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. LIVER By Michael Brillantes, MD, FPCS, FPSGS

  2. Anatomy • -1/50 of total body weight • Surgically divided into the right and • left lobe by a line through the IVC and • gallbladder (Cantlie’s line)

  3. -left lobe divided into medial and lateral segments by falciform ligament -blood supply  hepatic a. - 25% portal v – 75%

  4. II. Liver function • Circulatory function- material absorbed from the GI tract are brought to the liver through the dual blood supply to be used in the metabolic pool

  5. B. Biliary passages- channel of exit for materials secreted by the liver through the dual blood supply to be used in the metabolic pool

  6. C. Reticuloendohelial system- contains phagocytic Kupffer cells and endothelial cells D. Metabolic Activity- anabolic and catabolic activities

  7. III. Function Tests a. Albumin – half- life is 21 days; decrease means a chronic liver disease (more than 3 wks)

  8. B. Carbohydrates and Lipids- hepatic disease causes decrease in glycogenesis with resultant hyperglycemia

  9. C. Enzymes • Alkaline phospatase- increase indicates • an obstructive pathology

  10. 2. SGOT and SGPT- increase indicates liver cellular damage; SGPT more applicable for hepatic disease 3. Dye excretion

  11. 4. Coagulation factors a. Vit. K dependent clotting factors II, VII, IX, and X b. Inability to synthesize prothrombin

  12. IV. Special Studies A. Needle Biopsy- provides pathologic diagnosis B. Ultrasound, CT scan, MRI C. Angiography

  13. V. Pathology • Trauma- 2nd most commonly injured organ • 1. Clinical manifestation- shock, abdominal pain, spasm, and rigidity

  14. 2. Diagnostic- CT scan is the most useful - may also use ultrasound, paracentesis or peritoneal lavage

  15. 3. Treatment • Correct shock- IVF and blood • Surgery • Control bleeders- perihepatic packaging, ligation of bleeders, Pringle maneuver • Debridement • External drainage

  16. 4. Complications • Recurrent bleeding- inadequate homostasis or loss of coagulation factors secondary to massive transfusions • Intraabdominal sepsis

  17. C. Hematobilia- free communication between blood vessel and biliary tree - triad of abdominal pain, GI bleeding, and previous trauma - jaundice may be present

  18. B. Hepatic Absdess 1. Pyogenic- most commonly due to cholangitis secondary to CBD obstruction; septicemia second most common etiology

  19. - Fever with “picket fence” pattern, hepatomegally and tenderness -organism- usually e. coli -usually found in the right lobe, solitary or multiple

  20. Presents with hepatic tenderness and fever • Diagnostic • i. CBC- leukocytosis, with count up to 18-20,000

  21. ii. Radiograph- immobility or elevation of right hemidiaphragm iii. Ultrasound or CT scan

  22. b. Treatment I .Antibiotics- IV for 2 wks, followed by 1 month oral form II. Drainage- percutaneous under ultrasound or CT guidance, or open

  23. 2. Amebic- reaches the liver via the portal vein from an ulceration in the bowel wall -organism- e. histolytica -occurs in the right lobe, usually solitary, with characteristic “anchovy paste”

  24. Fever and liver pain, assoc. woth tender hepatomegally • 33% with antecedent diarrhea

  25. Diagnostic • i. CBC- leukocytosis • ii. Indirect heme agglutinstion test • iii. Ultrasound • iv. Aspiration of trophozoites

  26. b. Complications i. Secondary bacterial infection ii. rupture

  27. c. Treatment i. Amebicidal drugs- Metronidazole 500 mg TID ii. Surgery – indicated for persistence of abscess, secondary infection

  28. C. Cysts 1. Non- parasitic – usually solitary, found in the right lobe, watery content, with low internal pressure

  29. -polycystic liver assoc. with polycystic kiny in 51.6% of cases -usually presents as a RUQ mass

  30. Classification • Blood or degenerative • Dermoid • Lymphatic • Endothelial • Retention – polycystic liver • Proliferative cysts- cystadenomas

  31. b. Diagnostic – ultrasound, CT scan, arteriography, scintillography, peritoneoscopy c. Asymptomatic- no treatment Symptomatic- drainage with unroofing or sclerotherapy

  32. 2. Hydatid cysts- caused by Echinococcus granulosus - with high internal pressure, causing rupture and anaphylactic reaction

  33. Asymptomatic unless there are pressure symptoms on adjacent organs • Diagnostic- radiograph, ultrasound and CT scan • -Casoni’s skin test

  34. b. Treatment i. small calcified cyst- no treatment ii. Sterilizationof cyst prior to surgery with hypertonic saline or alcohol followed by surgical removal

  35. D. Benign Tumors 1. Classification a. Hamartomas- tissues normally found in the organ but arranged in a disorderly manner

  36. b. Adenoma- associated with contraceptive use; may transform into hepatocellular carcinoma; high rate of bleeding

  37. c. Focal nodular hyperplasia- reaction to injury or a response to a preexisting vascular malformation d. Hemangioma- most common nodule in the liver

  38. 2. Diagnostic- ultrasound, CT scan, angiography 3. Treatment- excision if symptomatic

  39. E. Malignant lesions 1. Primary carcinoma- from Aspergillus flavus, kwashiorkor

  40. Classification • hepatoblastoma- usually affects children less than 2 years old.

  41. ii. Fibrolamellar carcinoma- adolescent and young adults; large solitary lesion iii. Hepatocellular carcinoma- most common primary malignancy, usually follows postnecrotic cirrhosis (hepatitis B)

  42. Manifested by mass, weight loss, abdominal pain, or intraperitoneal hemorrhage

  43. b. Diagnostic i. Liver function test- alkaline phosphatase ii. Alpha Feto Protein

  44. iii. Angiography iv. Ultrasound, intraoperative ultrasound, CT scan, MRI

  45. c. Treatment- curative resection, chemotherapy with direct arterial infusion

  46. 2. Other Primary Neoplasms • Sacroma- angiosacroma most common • Mesenchymoma • Infantile hemangioendothelioma

  47. 3. Metastatic neoplasms - most common malignant tumor of the liver - reach the liver by portal vein, hepatic artery, lymphatics, direct extension

  48. Symptoms are usually referable to the liver (i.e. pain, ascites, weight loss, anorexia and jaundice

  49. Diagnostic • i. alkaline phosphatase • ii. Serum marker referable to the primary carcinoma • iii. SGOT • iv. CT scan, MRI

  50. b. Treatment • Control primary tumor • Check for other systemic metastases • Patient should be able to tolerate a major resection • Resection of metastasis should be feasible

More Related