Sunday, November 11, 2012

Tumors of the liver

Liver tumors can be non-cancerous (benign) or cancerous (malignant). Cancer tumors can occur in the liver and can spread to the liver (metastasize) from other parts of the body. Cancer that occurs in the liver is called primary liver cancer, cancer that arises elsewhere in the body is called metastatic cancer. The vast majority of cancers are metastatic liver tumors. 


Metastatic tumors of the liver
Non-cancerous liver tumors are relatively common but usually cause no symptoms. Most of them can detect when people do for some other reason, a search-imaging such as ultrasound, computed tomogranja (CT) or magnetic resonance imaging (MRI). However, some of these tumors leads to an increase in liver or bleeding into the abdominal cavity. Liver function is usually normal and blood tests show normal or only mildly elevated levels of liver enzymes.


Hepatocellular adenoma

Hepatocellular adenoma is a common non-cancerous tumor of the liver.

Hepatocellular adenomas occur mainly in women of childbearing age, probably because oral contraceptives increase the risk of this type of neoplasm. These tumors usually cause no symptoms, so most of them remain undetected.

There was rarely an adenoma suddenly bursts and bleeds into the abdominal cavity, which requires an urgent surgical procedure. Adenomas that cause oral contraceptives often disappear when a woman stops taking the drug.In extremely rare cases, an adenoma can become cancerous tumor.




Hemangioma


Hemangion a non-cancerous liver tumor composed of clusters of abnormal blood vessels.

It is estimated that 1% - 5% of adults have small liver hemangiomas that cause no symptoms. These tumors are usually discovered only if the person happens to be subjected to search UZ-mail or CT. Not require treatment. In young children a large hemangioma sometimes cause symptoms that are detected, such as widespread (diffuse) clotting and heart failure. May require surgery.




HEPATO


Hepatotoxicity (hepatocellular carcinoma) is cancer that begins in cells of the liver.


Hepatoma are the most common type of cancer that originates in the liver (primary liver cancer). In some areas of Africa and Southeast Asia hepatoma are even more common than metastatic liver cancer and highlight the cause of death. In these areas there is a high prevalence of chronic infection with hepatitis B, which increases the risk of hepatoma in more than 100 times.


Chronic infection with hepatitis C also increases the risk of hepatoma. Finally some substances that cause cancer (carcinogens) created hepatoma. In subtropical areas in which the hepatoma tissue, food is often contaminated with carcinogens called aflatoxins, substances produced by certain types of fungi.


In North America, Europe and other regions of the world, in which the hepatoma rare, most people with hepatoma were alcoholics with liver cirrhosis, long-term. Additional types of cirrhosis are also associated with hepatoma, although in conjunction with primary biliary cirrhosis risk is lower than with other types of cirrhosis.


Fibrolamelarni carcinoma is a rare type of hepatoma, which usually affects young adults. It is not caused by the preceding cirrhosis, hepatitis B or C or other known risk factors.


Symptoms

Usually the first symptoms of hepatoma abdominal pain, weight loss and large clusters that can be felt in the upper abdomen. Another possibility is that a person who has long had cirrhosis may unexpectedly become sick. It is a common fever. Sometimes the first symptoms of acute abdominal pain and shock caused by rupture or bleeding of the tumor.



Diagnosis

In people with hepatoma are typically elevated levels of alpha-fetoprotein levels. Sometimes blood tests show low levels of glucose or high levels of calcium, lipid, or an increased number of red blood cells.


Initially, the symptoms do not give the key to diagnosis. However, once the liver is increased enough to be felt, the doctor may suspect the diagnosis, especially if a person has long-term cirrhosis. Sometimes the doctor may hear loud sounds (hepatic noises) and the sounds of reefs (friction due to rubbing or crepitation) stethoscope placed over the liver.


Ultrasound and CT of the abdomen above can sometimes detect cancer that has not yet caused symptoms. In some countries where hepatitis B virus is common, such as Japan, ultrasound is used for the examinations for the purpose of sifting (screening, screening) infection in people with liver cancer. Hepatic arteriography (Elo made after the hepatic artery radiokonstrastne injectable substances) may indicate the hepatoma. Arteriography of the liver is especially useful prior to surgical removal of hepatoma, because it shows the surgeon the exact accommodation blood vessels of the liver.


A liver biopsy can confirm the diagnosis. The risk of bleeding or other injuries in liver biopsies are generally low.


Prognosis and treatment

Usually the prognosis for people with hepatoma weak, because the tumor is detected too late. Sometimes people with small tumors recovered after the tumor is surgically removed.




Second primary liver cancer


• cholangio cancer that arises from the lining of bile ducts in the liver or bile ducts. In the Orient, infestation of parasitic worms called the liver, may be partly responsible for this cancer. People with long-term ulcerative colitis and sclerosing cholangitis occasionally develop cholangio.


• hepatoblastoma is one of the more common cancers in young children. Sometimes it occurs in older children and can produce hormones called gonadotropins, which results in an early (premature) puberty. Hepatoblastoma is usually detected because of the general deterioration of health and large clusters (formation) in the upper right abdomen.


• angiosarcoma is a rare cancer that occurs in blood vessels of the liver. Angiosarcoma can arise from exposure to vinyl chloride in the workplace.



Diagnosis and Treatment

Holangiokarcinomi, hepatoblastoma and angiosarkomi can be diagnosed only by biopsy of the liver with a needle to take a sample of liver tissue for examination under a microscope.

Usually the treatment is of little value, and most people die within a few months since the discovery of the tumor.However, if cancer is detected very early, the tumor can be surgically removed with the hope of long-term survival.



METASTATIC LIVER CANCER


Metastatic liver cancer is cancer that has spread to the liver from elsewhere in the body.


Metastatic liver cancer most commonly occurs in the lung, breast, colon, pancreas and stomach. Can affect the liver and leukemia and other blood cell cancers such as lymphoma. Sometimes the discovery of metastatic liver tumors first indication that a person has cancer.


Symptoms

Often the first symptoms include weight loss and poor appetite. Typically, the liver is enlarged and hard, and may be sensitive to the touch. There may be an increased body temperature. Sometimes the enlarged spleen, especially if the cancer comes from the pancreas. Abdominal cavity can be expanded due to the presence of free fluid, a condition called ascites.

Initially there is mild jaundice or until the cancer is not clogged bile ducts. For weeks before his death, jaundice becomes stronger. A person can also become confused and sleepy with an accumulation of toxins in the brain, a condition called hepatic encephalopathy. ®



Diagnosis

In later stages of the disease, the doctor can usually diagnose metastatic liver cancer rather easily, but the diagnosis is difficult in the early stages. Cancer may indicate U.S., CT and MRI, but these imaging results can not always detect small tumors or to distinguish tumor from liver and other abnormalities.

Tumors often cause poor liver function that can detect a blood test.

Liver biopsy confirmed the diagnosis in 75% of cases. A biopsy can be performed under control with a chance to get to the cancerous tissue was higher. Another way of taking a biopsy sample is laparoscopy (fiber optic viewing tube that is inserted into the abdominal wall).

Leukemia is usually diagnosed based on results of blood tests and bone marrow. Typically, liver biopsy is not needed.



Treatment

Depending on the type (type) of cancer, cancer drugs can temporarily reduce the tumor and prolong life, but they do not cure cancer. Drugs against cancer can be injected into the hepatic artery, which then dispatches a high concentration of drugs directly into cancer cells in the liver. This technique will likely reduce the tumor and produce fewer side effects, but has not been proven to prolong life. Radiation therapy of the liver can sometimes reduce the severe pain, but brings little improvement.

If the liver is found in only one tumor, the surgeon can remove it, especially if it stems from colon cancer. However, not all experts believe such an operation worth taking.

For most people with varicose cancer, all the doctor can do is relieve the symptoms,

Laboratory tests in liver disease

Laboratories can conduct various tests that assist physicians in evaluating disorders of the liver, gallbladder and biliary system. Among the most important group of blood tests known as liver function tests. Depending on the problem of patients who are suspected, the doctor may request an image search, such as ultrasound, computed tomography and magnetic resonance imaging. The doctor may take a sample of liver tissue under a microscope for the search, the procedure is called a liver biopsy. 



Laboratory tests of liver function

Liver function tests are done on blood samples. Most of the tests determines the level of enzymes or other substances in the blood, and thus to diagnose liver problems. One of the tests determined the blood clotting time.



TEST The test may indicate what

Alkaline phosphatase enzyme that is produced in the liver, bone, and placenta. Released when

damage or activity, such as bone growth and pregnancy.

Obstacle in water gall, liver damage and some types of cancer.


ALT enzyme that is produced in the liver and released into the blood when the liver

damaged cells.

Damage to liver cells (as in hepatitis).


AST enzyme that is released into the blood when the damaged liver, heart, muscles or

brain.

Damage to the liver, heart, muscle or brain.


Bilirubin integral component of bile that is produced in the liver.

Obstacle to the flow of bile, liver damage, a breakdown of red blood cells (one of which is made of bilirubin).


GGT enzyme produced by the liver, pancreas and kidneys, and is present in the blood when

these organs were damaged.

Organ damage, drug toxicity, alcohol abuse, pancreatic disease.


LDH enzyme found in blood when certain organs are damaged.

Damage to the liver, lungs or brain and excessive breakdown of red blood cells.

5-nucleotidase enzyme containing only the liver and occurs in the blood when its damage. Obstacle in water or damaged gall bile flow.


Albumin protein generated by the normal liver and released into the blood. One of

Albumin is a task that keeps fluid inside the blood vessels. Liver damage


Alpha-fetoprotein protein generated by the fetal liver and testes.

Severe hepatitis, liver cancer or testicular


Mitochondrial antibodies against mitochondrial antibodies in the blood circulation, the internal component

station

Primary biliary cirrhosis and some autoimmune diseases (such as chronic active hepatitis)


PV or PT time required for blood clotting (coagulation needed for

vitamin K and substances that the liver produces)

Liver damage or poor absorption of vitamin K deficiency caused by gallstones.




Respiratory tests

Respiratory tests measure the ability of the liver to process (metabolize) various drugs. The drug, labeled with radioactive compound, can be given by mouth or vein. The amount of radioactivity in the breath of a person is a measure of the amount of drugs processed by the liver.



UZ

Ultrasound use sound waves to create a picture of the liver, gallbladder and biliary system. The test is better for the detection of structural abnormalities such as tumors, but widespread (diffuse) abnormalities, such as cirrhosis.Cheapest, safest and most sensitive technique for imaging the gallbladder and biliary system.



Use With a doctor can easily detect gallstones in the gall bladder. Ultrasound easily distinguished jaundice caused by a water barrier in the gall of jaundice caused by poor function of liver cells. Type of ultrasound, Doppler ultrasound of vessels, can be used to show blood flow in blood vessels of the liver. The doctor may also use TO as a guide when penetrating needle to obtain tissue samples for biopsy.



Radionuclide (radioisotopic) show

Use of substances containing the radioactive compound is injected into the body, it takes a certain organ.Radioactivity is measured by gamma-camera attached to a computer that creates the image.



Scintigraphy of the liver

This is the kind of display that uses a radionuclide radioactive compound that is absorbed by the liver cells.



Holescintigrafija

This radionuclide is another type of display, uses a radioactive compound that is excreted from the liver into the biliary system, is used to detect acute inflammation of the gallbladder (cholecystitis).



CT (computed tomography)

CT can provide excellent images of the liver and is particularly useful for detecting tumors. It can detect widespread (diffuse) disorders, such as fatty liver and abnormal liver tissue density due to excessive accumulation of iron (hemochromatosis). However, since the CT radiological examinations (X-ray radiation is dangerous) that it is also expensive, not so much used as an ultrasound.



MRI (magnetic resonance)

MRI provides excellent images, similar to those obtained by CT. However, there are drawbacks: more expensive than CT, takes longer than other imaging methods and requires lying in a narrow chamber, which in some people causes claustrophobia.



Endoscopic retrograde cholangiopancreatography

This is a search for which an endoscope (a flexible viewing tube) is placed in the mouth through the stomach and duodenum (duodenum) and the biliary system. Radiocontrast material is then injected into the bile ducts of the system and make radiographs. In 3% - 5% of the test causes inflammation of the pancreas (pancreatitis).



Percutaneous cholangiography transhepatična

This method involves the penetration of a long needle through the skin into the liver, followed by injection of radiocontrast agents in one of the liver bile ducts. To specify the doctor may use a needle UZ. Radiographs clearly show biliary system, especially the blockage in the liver.



Operations cholangiography

This method uses a radio-contrast material is visible on the Elo-in. The substance is injected directly into the bile ducts of the system during operation. Rtg then show a clear picture of the bile system.



Plain X-ray

This method can often demonstrate calcified gallstones.



A liver biopsy

A sample of the liver can be obtained during surgery in order to search, but more often gets the penetration of the needle through the skin into the liver. Before the procedure, the patient receives local anesthesia. Accommodation irregular areas where the sample is taken can be ordered with or with-CT. In most medical centers, liver biopsy is performed as an outpatient procedure.



After sampling a person remains in hospital for 3-4 hours, as there is a small risk of complications. The liver can be zaderana and can cause bleeding in the stomach. Bile may leak into the abdomen and lead to inflammation of the abdominal lining (peritonitis). Because bleeding may begin after 15 days, a person needs at that time remain within the hospital up to one hour. In about 2% of people making serious complications and problems of a process is killed 1:10.000. After a liver biopsy is a common mild pain in the upper right abdomen that spreads to the right armpit, and usually relieve analgesics.



In transvenske liver biopsy in the neck vein catheter to put the slips into the heart and placed into one of the hepatic veins coming from the liver. A needle catheter is placed through the vein wall to the liver. This technique is less likely to damage the liver than percutaneous liver biopsy and can be applied even in people who bleed easily.

Symptoms of liver disease


Liver disease is expressed in many different ways. Indicators of liver diseases that are of particular importance as jaundice, cholestasis, increased liver, portal hypertension, ascites, hepatic encephalopathy and liver failure.


Liver disease doctor diagnosed based on symptoms described by patients and physical examination.

The main clinical symptoms of liver disease

Jaundice (icterus)

Enlarged liver (hepatomegaly)

The fluid in the abdomen (ascites)

Confusion because of encephalopathy

Gastrointestinal bleeding due to varices

Portaina hypertension

Skin

• Varicose veins like spider

• Red palms

• ruddy appearance

• Itching

Blood

• Reduced number of red blood cells (anemia)

• Reduced number of white blood cells (leukopenia)

• Reduced number of blood platelets (thrombocytopenia)

• A tendency to bleed (coagulopathy)

Hormones

• High levels of insulin, but the weak response to it

• Cessation of menstruation and decreased fertility (in women)

• Impotence and effeminate appearance (in men)

Heart and blood vessels

• The acceleration of heart rate and amount of blood ejected

• Reduced blood pressure (hypotension)

General symptoms

• Fatigue

• Weakness

• Weight loss

• Poor appetite

• Nausea

• Fever





Icterus

(Jaundice)

• Introduction • Symptoms • Diagnosis and Treatment



Introduction

Jaundice is a yellow discoloration of the skin and scleral (white of the eye) caused by abnormally high levels of bile pigment bilirubin in the blood stream.


Old or damaged red blood cells (erythrocytes) from the circulation largely removes the spleen. During this procedure, hemoglobin, red blood cells of which carries oxygen, is decomposed into

bilirubin. Bilirubin is transferred to the liver and excreted into the intestine as a component of bile. If the excretion of bilirubin is disabled, the excess bilirubin passes into the bloodstream, which results in the formation of jaundice.



High levels of bilirubin in the blood may be due to inflammation or other abnormalities of liver cells, which prevents the excretion of bilirubin in the bile. Alternatively, bile ducts outside the liver may be blocked gallstone or tumor. Less frequently high levels of bilirubin may result from destruction of a large number of red blood cells, as sometimes occurs in newborns with jaundice.



In Gilbert's syndrome, the bilirubin level was slightly elevated, but usually not enough to cause jaundice. It is sometimes hereditary condition usually discovered during a routine search results (screening) of liver function, the state has no other symptoms or causes problems.



Symptoms

In jaundice the skin and whites of the eyes yellow. The urine is often dark because of bilirubin excretion by the kidneys. There are also other symptoms depending on the cause of jaundice, for example. liver inflammation (hepatitis) can cause loss of appetite, nausea and vomiting, and fever. Stopping the bile can cause symptoms of cholestasis.



Diagnosis and Treatment

To determine the cause of jaundice doctor uses laboratory tests and imaging tests. If the problem is the disease of the liver, for example. viral hepatitis, jaundice will usually disappear as the state of liver repair. If the problem is in the common bile duct occlusion, it is usually as quickly as possible to do surgery or endoscopy (a procedure using flexible tubes to observe the surgical connections) to be blocked bile path to reopen.

Portal hypertension

Hypertensio PORTALIS

Introduction

Portal hypertension is abnormally high blood pressure in the portal vein, large vein that carries blood from the intestines to the liver.

The portal vein receives blood flowing out of the whole intestine and the spleen, pancreas and gall bladder. After entering the liver, blood, forming a small ducts circulating liver. When blood leaves the liver, flows back through the hepatic vein into the general circulation.


In the portal blood vessels can increase blood pressure, two factors: the volume of blood flowing through blood vessels and increased resistance to blood flow through the liver. In Western countries, the most common cause of portal hypertension is increased resistance to blood flow caused by cirrhosis.


Portal hypertension leads to the development of venous blood vessels (called collateral vessels) that connect the portal system to the general bloodstream, thus bypassing the liver. Because of this detour, the substances that are normally removed by the liver from the blood can enter the general circulation. Collateral vessels develop in special places, most of which is the lower end of the esophagus. There vessels become swollen and sinuous, ie.become varicose veins (called esophageal varices). These swollen veins are very fragile and sometimes prone to bleeding. The other collateral vessels can develop around the navel and the rectum.


Symptoms and diagnosis

When portal hypertension is often an enlarged spleen. The liquid can escape from the liver and expand the abdominal cavity, and that the free fluid in the abdomen called ascites. Varicose veins in the lower end of the esophagus and gastric mucosa bleed easily, sometimes a lot. Varicose veins in the rectum may also bleed, although this is much rarer.


The doctor can usually palpable spleen increased through the abdominal wall. The fluid in the abdominal cavity can be detected by observing and listening to the abdomen nateknutog muklih sounds during tapping (percussion) of the abdomen. Rtg UZ and provide considerable information on the portal hypertension. UZ can be used to examine blood flow in the portal blood vessels and can detect the presence of fluid in the abdomen.


To test the increased vein can be used, and CT. The pressure in the portal system can be directly measured with a needle which pierces the abdominal wall to the liver or spleen.



Treatment

In order to reduce the risk of bleeding from esophageal varices, the doctor tries to reduce the pressure in the portal vein. One way is by giving propranolol, a drug used to treat high blood pressure.



Bleeding from esophageal varices is a medical emergency. Drugs such as vasopressin or octreotide can be given intravenously to constrict the veins that bleed, and blood transfusions are given to replace blood lost.



Endoscopic examination is usually done to confirm bleeding varices. Veins can clog rubber bands or giving chemical substances through the endoscope. If bleeding continues, through the person's nose and down into the esophagus can be brought into the catheter with a balloon on the end. Balloon inflation pressures are varicose veins and usually stops the bleeding.



If bleeding continues or occurs again, we can make a surgical bypass procedure (called a shunt) between the portal venous system and the general (systemic) venous system. This lowers the pressure in the portal vein, because the pressure in the general venous circulation is much lower. There are different types of operations portal-systemic shunt, including those that can be done in the radiological department using special devices under the control of X-rays. Shunt surgery is usually successful in stopping the bleeding, but are relatively dangerous. They also increase the risk of disruption of brain function due to liver failure (hepatic encephalopathy). 

Deficit alpha 1 - antitrypsin

Introduction

Alpha1-antitrypsin deficiency is a hereditary disease in which lack of alpha1-antitrisina can cause lung disease and liver.



Alpha1-antitrypsin, an enzyme that produces the liver, is in saliva, duodenal fluid, lung secretions, tears, nose and recrement liquor. This slows the enzyme activity of other enzymes that break down proteins. Alpha1-antitrypsin deficiency to other enzymes that damage tissue in the lungs. Deficiency in the blood indicates liver failure to secrete the enzyme. Its retention in the liver cells can cause damage, fibrosis (scar changes) and cirrhosis.



Symptoms and prognosis

Up to 25% of children with alpha1-antitrypsin deficiency will develop cirrhosis and the portal hypertension and died before he turns 12 years of age. About 25 to 20% die in the year. The remaining 25% had only minor abnormalities of liver and experience adulthood. The remaining 25% have disease that progresses.



In adults, alpha1-antitrypsin deficiency is not common and does not cause cirrhosis, even if it is present. More often than adults with this disorder get emphysema, lung disease that results in shortness of breath all the stronger.Finally, one can develop liver cancer.



Treatment

Some hope was given replacement therapy with synthetic alpha1-antitrypsin, but liver transplantation remains the only successful therapy. In the liver, which produces transplantiranoj alpha1-antitrypsin usually do not show damage.



Treatment for adults is usually focused on lung disease. Measures of treatment include prevention of infection and smoking cessation in smokers. 

Cholestasis

Cholestasis




Cholestasis is to reduce or halt the flow of bile. Obstruction of bile flow can lead to various factors.

The flow of bile can be weakened at any point between the liver cells and duodenum (upper small intestine). Even when the bile does not flow, the liver continues to adapt the bilirubin, which escapes into the bloodstream. Then the bilirubin deposited in the skin and comes into the urine, causing jaundice.

For the purpose of diagnosis and treatment of causes of cholestasis are divided into two groups: those originating from the liver and those who cause outside the liver.


Causes within the liver include hepatitis, alcoholic liver disease, primary biliary cirrhosis, the effects of drugs and the effects of hormonal changes during pregnancy (a condition called cholestasis maternity).



Causes outside the liver are gall stones in the water, a narrowing (stricture) duct, common bile duct cancer, pancreatic cancer and pancreatitis.



Symptoms

Jaundice and dark urine originate from the large amounts of bilirubin in the skin and urine. The chair is sometimes pale due to lack of bilirubin in the intestine. Stool may contain too much fat (a condition called steatorrhea) because bile in the intestine there to help digest fat from food.



Lack of bile in the intestine also means that calcium and vitamin D is not absorbed properly. If cholestasis persists, the lack of these nutrients can cause bone loss, which can lead to pain and fractures. Poorly absorbed substances that are necessary for blood clotting, which creates a tendency to bleed easily.



Retention of bile products in the circulation can cause itching (with resultant scratching and skin damage). Due to prolonged cholestatic jaundice created a dirty color and yellow fatty deposits in the skin. The causal agent of cholestasis determines whether people have other symptoms such as abdominal pain, loss of appetite, vomiting or fever.



Diagnosis

To determine whether the cause is within the liver, the doctor examines the symptoms of hepatitis, abundant intake of alcohol or taken drugs shortly that can lead to cholestasis. Small, spider-like blood vessels visible in the skin (called spider nevi), enlarged spleen and free fluid in the abdominal cavity (ascites) means the disease of liver cells.If the cause is outside the liver, the person may have chills, pain from the biliary system or pancreas, and gall bladder increased (the doctor can detect palpable or imaging tests).



For people with cholestasis is typical that their levels of an enzyme called alkaline phosphatase in the blood is very high. Blood test that measures the level of bilirubin indicates the severity of cholestasis, but not its cause.



If the results of blood tests were abnormal, almost always for U.S., CT, or both. This helps the doctor distinguish between liver disease and bile duct closure. If it appears that the cause in the liver, can do a liver biopsy (taking a sample of tissue for microscopic examination). Biopsy usually establishes the diagnosis. If it appears that the cause of the blockage of bile ducts, often this is an endoscopic procedure (using a flexible viewing tube) to clarify the nature of the blockade.



Treatment

The blockade outside the liver can usually be treated with surgery or therapeutic endoscopy (a procedure that involves the use of flexible pipe connections with surgery). Blockage within the liver can be treated in different ways depending on the cause. If the suspected cause of a medication, a person should stop taking it. If the blockade is responsible for hepatitis, then cholestasis and jaundice usually disappear when you stop hepatitis.



For the treatment of pruritus can be taken orally (by mouth) cholestyramine. This drug binds with certain bile products in the intestine, so they can re resorbirati and cause skin irritation.



As long as the liver is severely damaged by vitamin K intake can improve blood clotting. If cholestasis persists, often taking extra calcium and vitamin D, but they are not very effective in preventing bone disease. If too much fat in the stool extract, a person may give further triglycerides.