LiverDAMRA B. HASSAN

LIVER

Largest organ

What does Liver do???It removes harmful substances from the blood.It makes enzymes and bile that help digest food.It also converts food into substances needed for life and growth.

NORMAL LIVER CT SCAN

Liver Metastasis

What is Liver Metastasis?

>Liver metastases are cancerous tumors that have spread to the

liver from somewhere else in the body such as

Breast cancer

Colorectal cancer

Esophageal cancer

Lung cancer

Melanoma

Pancreatic cancer

Stomach cancer

>The risk of cancer spreading to the liver depends on the site of

the original cancer. A liver metastasis may be present when the

original (primary) cancer is diagnosed, or it may occur months or

years after the primary tumor is removed.

Liver metastasis shown on CT scan

Pathophysiology

• Metastasis from other primary sites, particularly the digestive system, breast and lungs are likely to reach the liver by way of portal system or lymphatic channels or by direct extension from the abdominal tumor.

• A continuous dull ache in the right upper quadrant, epigastrium, or back, weight loss, loss of strength, anorexia, and anemia may occur.

• Liver may be enlarged and irregular on palpation. Jaundice is present only if the larger bile ducts are occluded by the pressure of malignant nodules in the hilum of the liver.

• Ascites develops if such nodules obstruct the portal veins or if tumor tissue is seeded in the peritoneal cavity

• Death may occur if left untreated

Liver Abscess

What is Liver Abscess?

> A liver abscess is a pus-filled cavity within the

liver, usually caused by a biliary tract source;

occasionally, multiple cavities are seen

Two categories: Amoebic and Pyogenic

Amoebic liver abscess are most commonly caused

by Entamoeba histolytica.

Liver Abscess on CT Scan

Pathophysiology

• Whenever an infection develops anywhere along the biliary or GI tract, infecting organisms may reach the liver through the biliary system, portal venous system, or hepatic arterial or lymphatic system. Most bacteria are destroyed promptly, but occasionally some gain a foothold. The bacterial toxins destroy the neighbouring liver cells, and the resulting necrotic tissue serves as protective wall for the organisms.

• Meanwhile, leukocytes migrate into the infected area. The result is an abscess cavity full of a liquid containing living and dead leukocytes, liquefied liver cells, ,and bacteria pyogenic abscesses of this type may be either single or multiple and small. Examples of causes of pyogenic liver abscess include cholangitis (usually related to benign or malignant obstruction of the biliary tree) and abdominal trauma.

Liver Transplantation

Liver trasplantation

Is used to treat life-threatening ESLD for which no other form of

treatment is available.

- involves total removal of the diseased liver and replacement with a

healthy liver in the same anatomic location (orthotropic liver

transplantation [OLT])

- success depends on successful immunosuppression.

- general indications for liver transplantation include irreversible

advanced chronic liver disease, fulminant hepatic failure, metabolic

liver diseases, and some hepatic malignancies.

- transplant recipient must go through a rigorous selection and

preparation process that includes counselling and education to aid

them in making critical choices for their improved health.

REFERENCES

Abscess, Liver

Ferri: Ferri's Clinical Advisor 2013, 1st ed.

Liver Abscess (includes Tables and Images)

Feldman: Sleisenger & Fordtran's

Gastrointestinal and Liver Disease, 9th ed.

Hepatic cysts and liver abscess (includes

Image)

Reid-Lombardo KM - Surg Clin North Am -

August, 2010; 90(4); 679-697

Etiology of Liver Abscess

Mandell: Principles & Practice of Infectious

Diseases, 7th ed.

Etiology of Liver Abscess

Ferri: Ferri's Clinical Advisor 2013, 1st ed.

Clinical Presentation of Liver Abscess

(includes Table)

Mandell: Principles & Practice of Infectious

Diseases, 7th ed.

Clinical Features of Pyogenic Liver Abscess

(includes Tables and Image)

Townsend: Sabiston Textbook of Surgery,

19th ed.

Clinical Features and Diagnosis of Pyogenic

Liver Abscess (includes Image)

Feldman: Sleisenger & Fordtran's

Gastrointestinal and Liver Disease, 9th ed.

Laboratory Findings of Amebic Liver

Abscess (includes Image)

Kliegman: Nelson Textbook of Pediatrics,

19th ed.

Sepsis and cholestasis

Fuchs M - Clin Liver Dis - 01-FEB-2008;

12(1): 151-72, ix

Hepatic cysts and liver abscess

Reid-Lombardo KM - Surg Clin North Am -

01-AUG-2010; 90(4): 679-97

An unusual presentation of amebic liver

abscesses

Broz P - CMAJ - 9-NOV-2010; 182(16): 1755-

7

Treatment of Pyogenic Liver Abscess

Feldman: Sleisenger & Fordtran's

Gastrointestinal and Liver Disease, 9th ed.

Treatment of Amebic Liver Abscess

Long: Principles & Practice of Pediatric

Infectious Diseases, 3rd ed., Revised

Reprint

Hepatic cysts and liver abscess

Reid-Lombardo KM - Surg Clin North Am -

August, 2010; 90(4); 679-697

Disposition of Liver Abscess

Ferri: Ferri's Clinical Advisor 2013, 1st ed.

Outcome of Pyogenic Liver Abscess

Townsend: Sabiston Textbook of Surgery,

19th ed.

Prevention of Pyogenic Liver Abscess

Feldman: Sleisenger & Fordtran's

Gastrointestinal and Liver Disease, 9th ed.

Prevention of Amebic Liver Abscess

Long: Principles & Practice of Pediatric

Infectious Diseases, 3rd ed., Revised

Reprint

REFERENCES

Garden OJ, Rees M, Poston GJ, Mirza D, Saunders M, Ledermann J, Primrose JN, Parks RW. Guidelines for resection of

colorectal cancer liver metastases. Gut. 2006 Aug;55 Suppl 3:iii1-8.

Brown DB, Geschwind JF, Soulen MC, Millward SF, Sacks D. Society of Interventional Radiology position statement on

chemoembolization of hepatic malignancies. J Vasc Interv Radiol. 2006 Feb;17(2 Pt 1):217-23.

Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of

hepatocellular carcinoma. Hepatology. 2005 Nov;42(5):1208-36.

Medically Reviewed by Paul Oneill, MD, Board Certified Oncology

Last Editorial Review: 4/13/2007\

Suzanne C. Smeltzer, Brenda G. Bare, Janice L. Hinkle, Kerry H. Cheever,(2010) Brunner & Suddarth’s textbook of Medical-

Surgical Nursing (12th edition), Lippincott-Raven Publisher

National Cancer Institute. Adult primary liver cancer treatment PDQ. Updated July 8, 2010.

National Comprehensive Cancer Network. Hepatobiliary cancers: Pancreatic adenocarcinoma. 2011. Version 2.2011.

Roberts LR. Liver and biliary tract tumors. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa:

Saunders Elsevier; 2011:chap 202.

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