NMS. Surgery

200 Part IV ♦ Gastrointestinal Disorders III. Clinical presentation: RUQ pain, jaundice, hepatomegaly, palpable mass. IV. Diagnosis A. Cholangiography B. Endoscopic retrograde cholangiopancreatography with biopsy C. MRI D. Serum tumor marker: CA 19-9. V. Treatment: Surgery A. Intrahepatic 1. Only effective therapy is surgery. 2. It is difficult to achieve complete resection; transplant is an option. B. Extrahepatic 1. Proximal lesions: Primary biliary resection with roux-en-Y reconstruction or right hepatectomy. 2. Distal tumors: Whipple. VI. Prognosis A. Resectable disease: 5-year survival <50%. B. Non-resectable or metastatic disease: <6-month survival. METASTATIC MALIGNANT TUMORS I. Etiology: The liver is a very common site of metastasis (exceeded only by regional lymph nodes). IV. Treatment: Several types of metastatic tumors (such as colorectal) can be considered for resection. Transplantation is also an option. Other options include chemoembolization, radiation, and cryoablation. V. Prognosis: A. Typically poor, due to overall advanced disease status. B. May be resected in some circumstances with reasonable results. Quick Cuts • Hepatocellular carcinoma (HCC) is treated with surgery, chemoembolization, ablation, or liver transplant. • The ratio of metastatic to primary liver tumors is 20:1. • Cholangiocarcinoma is often fatal due to late presentation and limited therapy aside from surgical resection. PYOGENIC LIVER ABSCESS I. Etiology: A. Typically secondary to intra-abdominal infections such as diverticulitis, appendicitis, and cholangitis. B. Common organisms: Escherichia coli , Bacteroides , Streptococcus , and Enterococcus . II. Clinical presentation: Often asymptomatic. III. Diagnosis: Based on primary tumor type.