NMS. Casos Clínicos

210

Part II ♦ Specific Disorders

Q: What are the basic principles of hepatic resection? A: The basic principles of hepatic resection are complete removal of the lesion without patient death. Figure 7-32 shows the hepatic sectional and segmental anatomy. The hepatic inflow and outflow are isolated and occluded to the resected segment. Liver tissue is then transected in a location where a 1-cm margin is obtained, maintaining hemostasis while crossing the liver. In the hands of experienced surgeons, otherwise healthy patients tolerate the procedure well. Case 7.18 Fever and Pain in the Right Upper Quadrant A 37-year-old patient with a history of IV drug abuse is hospitalized for an extensive upper extremity abscess. The patient receives treatment incision and drainage and IV antibiotics. Despite 3 days of IV antibiotics, the patient remains febrile (temperature to 103°F). Q: What are the possible causes of this patient’s fever? A: Other processes that may cause fever in IV drug abusers are endocarditis, intra-abdominal abscess, pancreatitis, pneumonia, UTI, or infected indwelling catheters. HIV-related in- fections are also a possibility in IV drug users who share needles. You should examine the patient for these possibilities and send blood cultures. On examination, the patient’s abdomen is tender in the RUQ. Laboratory studies reveal that the WBC count is 24,000/mm 3 and the alkaline phosphatase is elevated. Table 7-2: Prognostic Factors in Resectable Colorectal Metastasis to the Liver Factors that Influence Resectability of Liver Tumors Factor Positive Influence Negative Influence Number of lobes Single lobe Bilobar Extrahepatic metastasis No Yes Medical condition Good Poor Cirrhosis No Yes Factors that Influence the Prognosis of Resected Liver Lesions Factor Positive Influence Negative Influence Number Solitary Multiple Size of lesions Small (≤5 cm) Large (>5 cm) Chronicity Metachronous with primary tumor Synchronous with primary tumor Surgical margin >1 cm <1 cm Stage (primary tumor) I or II III Location of primary tumor Colon primary Rectal primary SAMPLE