الفهرس Only 14 pages are availabe for public view
 |  | from | 187 |  |  |
| | | from | 187 | | |
Abstract
he liver constitutes the single largest gland in the body and the single largest organ following the skin. It posseses both a visceral and diaphragmatic surface and several associated peritoneal ligaments, with the porta hepatis being the point of entry of all its vessels. The liver has a dual blood supply from the hepatic artery and portal vein. It may be subdivided either functionally or anatomically, the former being the basis of hepatic resection.Hepatic malignancy may be classified into primary and metastases. Primary liver malignancy may be classified into hepatocellular carcinoma, intrahepatic cholangiocarcinoma and neoplasms from mesenchymal elements such as angiosarcoma and hemangioendothelioma.The main risk factor for HCC is underlying chronic liver disease and cirrhosis, particularly that associated with hepatitis B infection.Fibrolamellar HCC is a distinct histologic variant of HCC with a better prognosis and cure rates of 50% after resection.The triad of liver mass, positive hepatitis serology and high AFP levels is diagnostic of HCC, with other clinical findings related to underlying chronic liver disease and their severity being related to the stage of the tumor.In diagnosing liver malignancy, ultrasound is the least expensive and the most widely available imaging technique, more appealing because it is non invasive.Other imaging modalities include CT scanning and MRI, both of which can establish a reliable noninvasive diagnosis of HCC in nodules more than 2cm in diameter.Needle biopsy is rarely indicated for diagnosis; preoperative confirmation of HCC by histopathology is not needed in most cases particularly if AFP levels are very high or if the clinical setting is highly suspicious in a patient with a new nodule.Laboratory evaluation is essential to confirm the diagnosis and estimate the degree of underlying liver impairment; and tests performed should include liver function tests, complete blood picture, serum electrolytes and creatinine, coagulation profile, serological tests for hepatitis and alpha fetoprotein.The most commonly used systems to assess hepatic functional reserve are the Child-Pugh score and the Paul Brosse hospital classification.Surgical resection of HCC is done according to the principles of anatomic resction, use of vascular inflow occlusion, and low central venous pressure anaesthesia.Alternative methods of management rely mainly on percutaneous methods for the ablation of hepatic neoplasms, and include transarterial chemoembolization, radiofrequency, and percutaneous ethanol injection.
Liver transplantation is a very important method of management, but since donors are in short supply the application of the model for end stage liver disease (MELD) provides sound means of allocating a limited resource.