By Ian Beckingham
Queen's scientific Centre, Nottingham, united kingdom. presents an outline of the ailments of the liver, pancreas, and gall bladder. For citizens, clinical scholars, and basic practitioners. Covers universal and infrequent stipulations and contains algorithms for analysis and therapy. colour illustrations. Softcover.
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Additional resources for ABC of liver, pancreas and gall bladder
Fibrolamellar carcinoma is an important subtype of hepatocellular carcinoma. It occurs in patients without cirrhosis or previous hepatitis infection. It accounts for 15% of hepatocellular carcinoma in the Western hemisphere. The prognosis is better than for other hepatocellular carcinomas, with a five year survival of 40-50% after resection. 6 Inoperable extensive liver metastases Metastatic tumours Liver metastases are common and are found in 40% of all patients dying from cancer. They are most frequently associated with carcinomas of the gastrointestinal tract (colorectal, pancreas, and stomach) but are nearly as common in carcinomas of the bronchus, breast, ovary, and lymphoma.
In practical terms a “no added salt” diet with levels of 80 mmol/day is the lowest that is generally sustainable. Fluid restriction is not needed for patients with cirrhotic ascites unless they have severe hyponatraemia (serum sodium < 120 mmol/l). Although conventional recommendations suggest bed rest, its value is not supported by controlled trials. Most patients need dietary restrictions combined with diuretics. The usual diuretic regimen comprises single morning doses of oral spironolactone (an aldosterone antagonist), increasing the dose as necessary to a maximum of 400 mg/day.
Surgical procedures Patients with good liver function in whom endoscopic management fails or who live far from centres where endoscopic sclerotherapy services are available are candidates for surgical shunt procedures. A successful portosystemic shunt prevents recurrent variceal bleeding but is a major operation that may cause further impairment of liver function. Partial portacaval shunts with 8 mm interposition grafts are equally effective to other shunts in preventing rebleeding and have a low rate of encephalopathy.
ABC of liver, pancreas and gall bladder by Ian Beckingham