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LIVERDISEASESZhengrongshi
DepartmentofHepatobiliarySurgery
TheFirstAffiliatedHospital
ChongqingMedicalUniversity
LIVERDISEASESZhengrongshi
DeAnatomyAnatomy肝脏疾病英文版课件AnatomicfeaturesAdualbloodsupply:PortalVein(PV)andHepaticArtery(HA)Aspecificarchitecturalarrangementofsinglecellsandcellmassesthatfacilitatesexchangebetweenbloodandhapatocytes.AnatomicfeaturesAdualblood肝脏疾病英文版课件VenkateshMurthyShashidharAssociateProfessorofPathologyFijiSchoolofMedicineLiverFunctionsMetabolism
–
changeCarbohydrate,Fat&ProteintoGlycogenSecretory
–
bile,Bileacids,saltsExcretory
–
Bilirubin,drugs,toxinsSynthesis
–
Albumin,coagulationfactorsStorage
–
Vitamins,carbohydratesetc.Detoxification
–
toxins,ammonia,etc.VenkateshMurthyShashidharLivLIVERABSCESSBacterialliverabscessPyogenicabscessLIVERABSCESSBacterialliveraHEPATICABSCESSMaybebacterial,parasitic,orfungalinorigin.InChina,pyogenicabscessesarethemostcommon.HEPATICABSCESSMaybebacteriaSpreadoforganismtolivermayoccurthrough:ThepotalsystemAscensionfromthebiliarytreeThehepaticarteryduringgeneralizedsepticemiaDirectextensionfromsubhepaticorsubdiaphragmaticinfectionAdirectroutefollowingtraumaSpreadoforganismtolivermaClassificationSingleabscess90%:rightlobe10%:leftlobeMutipleabscessClassificationSingleabscessClinicalManifestationsFever(90%)39-41℃epigastricpainhepatomegalyChillsJaundiceWeightlossNausea,vomitingWeaknessClinicalManifestationsFever(Ultrasound:85%-95%Ultrasound:85%-95%CTscanCTisthemostsensitiveoftheimagingprocedures:95%-100%.Theappearanceisvariable,andlesionsmayappearcysticorisodense,withsolidmetastaticlesions.Aminorityofhepaticlesionscontaingas.CTscanCTisthemostsensitiv肝脏疾病英文版课件肝脏疾病英文版课件DiagnosissymptomImagingUltrasoundCTMicrobialculturesAspirationSerology:WBCDiagnosissymptom肝脏疾病英文版课件DifferentialDiagnosisSimplecyst–noelements/strandinginwallsMalignancy(tumor)–solidAmebicabscess–cannotbedistinguishedbyimagingRightsubphrenicabscessBiliaryinfection,cholangitisDifferentialDiagnosisSimplecTreatment1.Antibiotics:2.Drainage:>3cm(1).Percutaneousbyimaging;(2).drainagelaparoscope(3).drainagebytraditionalwayTreatment1.Antibiotics:DrainageDrainagebypercutaneouslyunderultrasoundorCT80%canbeadequatelytreatedbysuctioncathetersinsertedpercutaneouslyunderultrasoundorCTguidance.DrainageDrainagebypercutaneoSurgicaloperation1.drainagelaparoscope2.drainagebytraditionalwaysometimeslobectomyNoclinicalresponsetoPercutaneousdrainagewithin4-7daysMultiple,largeorloculatedabscessesconfinedtoasinglelobeAssociateddisease(e.g.,biliarytract)Surgicaloperation1.drainagelPrognosisOverallmortalityrateis15%Themortalityrateisabout40%inpatientswithmalignantdisease.Hugeabscessmayrupture.PrognosisOverallmortalityratcancerofliver
Zhengrongshi
DepartmentofHepatobiliarySurgery
TheFirstAffiliatedHospital
ChongqingMedicalUniversity
cancerofliver
ZhengrongshPrimarylivercancerisquitecommoninworld,andthenumberisincreasing.Approximately250000peoplearediagnosedwiththistypeofcancereachyearintheChina.PrimarylivercancerisquiteTypesofprimarylivercancer.
TypesofprimarylivercancerPathology
grossclassification
massivemultinodulardiffused
microscopicclassification
hepatocellularcarcinoma(HCC)cholangiocellularcarcinomamixedtype肝脏疾病英文版课件Hepatomaorhepatocellularcarcinoma(HCC)isusuallyconfinedtotheliver,althoughoccasionallyitspreadstootherorgans.Itismorecommoninmenandoccursmostlyinpeoplewithaliverdiseasecalledcirrhosis(肝硬化).HepatomaorhepatocellularcarThreemaincellulartypesof
primarylivercancerHepatocellularcarcinoma----hepatomaCholangiocellularcarcinoma----cholangiocarcinomaAmixedform----hepatocholangiomaThreemaincellulartypesof
ThreetypesofgrossmorphologyAmassiveform:asinglepredominantmassclearlydemarcatedfromthesurroundingliver,occasionallywithsmallsatellitenodulesAnodularform:multiplenodulars,oftendistributedthroughouttheliverAdiffusevariety:infiltrationoftumorthroughouttheremainingparenchymaThreetypesofgrossmorphologSymptomsandsignsRightupperquadrantpainWeightlossJaundiceHepatomegalyIntermittentfeverAscitesorgastrointestinalbleedingindicatesadvanceddiseaseNoclinicalfindingsSymptomsandsignsRightupperHOWISCANCEROFTHELIVERFOUND?
Bloodtestsofliverfunction.AFPbloodtest
BloodtestsforHepatitisBandCHBV-DNAcopies
Ultrasoundoftheliver.CTscanorMRIscanofliver
Biopsy
Angiogram
LaparoscopyHOWISCANCEROFTHELIVERFOUValueofAFPAlpha-fetoprotein(AFP):normalypretentonlyinthefetalcirculation.Elevatedintheserumofmanypatientswithprimaryhepatomasandtesticulartumors.Normaly﹤20ng/mL;﹥200ng/mL→hepatoma.TheprognosisisworsewhenAFPlevaelsarehigh.ValueofAFPAlpha-fetoprotein(ComplicationSpontaneousbleeding:rupture,intra-abdominalhemorrhagePortalhypertension:obstructionoftheportalveinBudd-Chiarisyndrome:obstructionofthehepaticveinLiverfailureComplicationSpontaneousbleediTreatmentPartialhepatectomyLivertransplantationEthanolinjectionRadiofrequencyablationArterialchemoembolizationTreatmentPartialhepatectomy肝脏疾病英文版课件Hepatectomy
Resectionofthetumorofferstheonlypossibilityofcure.Thecriteriaofrespectablityare:----thetumormustbeconfinedtotheliver.----thelesionmustbeentirelyencompassedbylocalexcision,lobectomy,orextendedlobrctomy.Therateofrecurrenceisabout50%The5-yearsurvivalrateisabout40%forthosewithoutcirrhosis,butisclosetozeroforthosewithcirrhosis.HepatectomyResectionofthet肝脏疾病英文版课件肝脏疾病英文版课件LivertransplantationTheoreticadvantage:----lesionsthatareunresectablebecauseofsizeormultifocaldistribution----theinabilityofacirrhoticlivertotolerateanybutthemostlimitedresection----thelikehoodinmanycasesthatanundectablesecondtumorislocatedremotefromtheindexlesionLivertransplantationTheoreticLivertransplantation5-yearsurvivalisabout35%Forsmallhepatoma,5-yearsurvivalismorethan75%NeedimmunosuppressivetherapySafe,good,butexpensiveandlongwaitingtimeLivertransplantation5-yearsuEthanolinjectionContraindicationforoperationLessthan3cm95%ethanol5-20mL1,2,3yearsaftertreatmentwas90%,80%,and63%,respectivelyEthanolinjectionContraindicatRadiofrenquencyablationUsingultrasoundguidance,aradiofrenquencyablationprobeisintroducedintothelivrtumorpercuteaneously,atlaparotomyorlaparoscopy.Electtricalenergyisusedtodestroythelesionbyproducingheat.Resultinginnecrosis.Itisagoodpalliativetreatment.RadiofrenquencyablationUsingArterialchemoembolizationSystemicchemotherapy:Poorsensitivity(5-Fu,cisplatin,EPI,Dox)Drugsgivenbyhepaticarteryinfusion:Highconcentrationinliver,continuousinfusioncausechemicalhepatitisDrugsgivenbychemoembolization.
TACE:TransArteryChemotherapyEmbolizationArterialchemoembolizationSystLIVERDISEASESZhengrongshi
DepartmentofHepatobiliarySurgery
TheFirstAffiliatedHospital
ChongqingMedicalUniversity
LIVERDISEASESZhengrongshi
DeAnatomyAnatomy肝脏疾病英文版课件AnatomicfeaturesAdualbloodsupply:PortalVein(PV)andHepaticArtery(HA)Aspecificarchitecturalarrangementofsinglecellsandcellmassesthatfacilitatesexchangebetweenbloodandhapatocytes.AnatomicfeaturesAdualblood肝脏疾病英文版课件VenkateshMurthyShashidharAssociateProfessorofPathologyFijiSchoolofMedicineLiverFunctionsMetabolism
–
changeCarbohydrate,Fat&ProteintoGlycogenSecretory
–
bile,Bileacids,saltsExcretory
–
Bilirubin,drugs,toxinsSynthesis
–
Albumin,coagulationfactorsStorage
–
Vitamins,carbohydratesetc.Detoxification
–
toxins,ammonia,etc.VenkateshMurthyShashidharLivLIVERABSCESSBacterialliverabscessPyogenicabscessLIVERABSCESSBacterialliveraHEPATICABSCESSMaybebacterial,parasitic,orfungalinorigin.InChina,pyogenicabscessesarethemostcommon.HEPATICABSCESSMaybebacteriaSpreadoforganismtolivermayoccurthrough:ThepotalsystemAscensionfromthebiliarytreeThehepaticarteryduringgeneralizedsepticemiaDirectextensionfromsubhepaticorsubdiaphragmaticinfectionAdirectroutefollowingtraumaSpreadoforganismtolivermaClassificationSingleabscess90%:rightlobe10%:leftlobeMutipleabscessClassificationSingleabscessClinicalManifestationsFever(90%)39-41℃epigastricpainhepatomegalyChillsJaundiceWeightlossNausea,vomitingWeaknessClinicalManifestationsFever(Ultrasound:85%-95%Ultrasound:85%-95%CTscanCTisthemostsensitiveoftheimagingprocedures:95%-100%.Theappearanceisvariable,andlesionsmayappearcysticorisodense,withsolidmetastaticlesions.Aminorityofhepaticlesionscontaingas.CTscanCTisthemostsensitiv肝脏疾病英文版课件肝脏疾病英文版课件DiagnosissymptomImagingUltrasoundCTMicrobialculturesAspirationSerology:WBCDiagnosissymptom肝脏疾病英文版课件DifferentialDiagnosisSimplecyst–noelements/strandinginwallsMalignancy(tumor)–solidAmebicabscess–cannotbedistinguishedbyimagingRightsubphrenicabscessBiliaryinfection,cholangitisDifferentialDiagnosisSimplecTreatment1.Antibiotics:2.Drainage:>3cm(1).Percutaneousbyimaging;(2).drainagelaparoscope(3).drainagebytraditionalwayTreatment1.Antibiotics:DrainageDrainagebypercutaneouslyunderultrasoundorCT80%canbeadequatelytreatedbysuctioncathetersinsertedpercutaneouslyunderultrasoundorCTguidance.DrainageDrainagebypercutaneoSurgicaloperation1.drainagelaparoscope2.drainagebytraditionalwaysometimeslobectomyNoclinicalresponsetoPercutaneousdrainagewithin4-7daysMultiple,largeorloculatedabscessesconfinedtoasinglelobeAssociateddisease(e.g.,biliarytract)Surgicaloperation1.drainagelPrognosisOverallmortalityrateis15%Themortalityrateisabout40%inpatientswithmalignantdisease.Hugeabscessmayrupture.PrognosisOverallmortalityratcancerofliver
Zhengrongshi
DepartmentofHepatobiliarySurgery
TheFirstAffiliatedHospital
ChongqingMedicalUniversity
cancerofliver
ZhengrongshPrimarylivercancerisquitecommoninworld,andthenumberisincreasing.Approximately250000peoplearediagnosedwiththistypeofcancereachyearintheChina.PrimarylivercancerisquiteTypesofprimarylivercancer.
TypesofprimarylivercancerPathology
grossclassification
massivemultinodulardiffused
microscopicclassification
hepatocellularcarcinoma(HCC)cholangiocellularcarcinomamixedtype肝脏疾病英文版课件Hepatomaorhepatocellularcarcinoma(HCC)isusuallyconfinedtotheliver,althoughoccasionallyitspreadstootherorgans.Itismorecommoninmenandoccursmostlyinpeoplewithaliverdiseasecalledcirrhosis(肝硬化).HepatomaorhepatocellularcarThreemaincellulartypesof
primarylivercancerHepatocellularcarcinoma----hepatomaCholangiocellularcarcinoma----cholangiocarcinomaAmixedform----hepatocholangiomaThreemaincellulartypesof
ThreetypesofgrossmorphologyAmassiveform:asinglepredominantmassclearlydemarcatedfromthesurroundingliver,occasionallywithsmallsatellitenodulesAnodularform:multiplenodulars,oftendistributedthroughouttheliverAdiffusevariety:infiltrationoftumorthroughouttheremainingparenchymaThreetypesofgrossmorphologSymptomsandsignsRightupperquadrantpainWeightlossJaundiceHepatomegalyIntermittentfeverAscitesorgastrointestinalbleedingindicatesadvanceddiseaseNoclinicalfindingsSymptomsandsignsRightupperHOWISCANCEROFTHELIVERFOUND?
Bloodtestsofliverfunction.AFPbloodtest
BloodtestsforHepatitisBandCHBV-DNAcopies
Ultrasoundoftheliver.CTscanorMRIscanofliver
Biopsy
Angiogram
LaparoscopyHOWISCANCEROFTHELIVERFOUValueofAFPAlpha-fetoprotein(AFP):normalypretentonlyinthefetalcirculation.Elevatedintheserumofmanypatientswithprimaryhepatomasandtesticulartumors.Normaly﹤20ng/mL;﹥200ng/mL→hepatoma.TheprognosisisworsewhenAFPlevaelsarehigh.ValueofAFPAlpha-fetoprotein(ComplicationSpontaneousbleeding:rupture,intra-abdominalhemorrhagePortalhypertension:obstructionoftheportalveinBudd-Chiarisyndrome:obstructionofthehepaticveinLiverfailureComplicationSpontaneousbleediTreatmentPartialhepatectomyLivertransplantationEthanolinjectionRadiofrequencyablationArterialchemoembolizationTreatmentPartialhepatectomy肝脏疾病英文版课件Hepatectomy
Resectionofthetumorofferstheonlypossibilityofcure.Thecriteriaofrespectablityare:----thetumormustbeconfinedtotheliver.----thelesionmustbeentirelyencompassedbylocalexcision,lobectomy,orextendedlobrctomy.Therateofrecurrenceisabout50%The5-yearsurvivalrateisabo
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