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Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 30 year old female with a background of medullary sponge kidney presents with right upper quadrant pain. On examination blood tests show elevated bilirubin levels. A liver ultrasound demonstrates multiple, dilated cystic structures converging towards the porta hepatis. The cysts communicate with the bile ducts. No peripheral biliary duct dilatation is identified. MRCP shows ectatic intrahepatic ducts extending into the periphery. The common bile duct is dilated but no strictures are seen.
Biliary Atresia
Published in Gianfranco Alpini, Domenico Alvaro, Marco Marzioni, Gene LeSage, Nicholas LaRusso, The Pathophysiology of Biliary Epithelia, 2020
The size of prehilar bile duct structures with lumens having diameters greater than 150 μm,53 or 400 μm,54 has been considered a favorable prognostic indicator. Other indicators such as Caucasian race, presence of severe biliary cholangiopathy, and presence of cirrhosis have been considered poor prognostic indicators.55–60 In one study the absence of ductal remnants at the porta hepatis and the absence of portal inflammation were associated with worse prognosis as though there has been a “burnout” as the end result of the disease process.60 In one very interesting study, Nietgen compared the livers of several patients with BA from the time of diagnosis of BA to the time of the Kasai procedure and then to the time of liver transplantation and found that there was a progressive loss of intrahepatic bile ducts.61 Although the authors attributed this to a combination of progression of the disease with partial unrelieved obstruction and uneven obstruction due to portoenterostomy wound healing and scarring, they could not exclude the possibility that the initial needle and wedge biopsies gave a partial sampling error and that the natural history of this disease results in intrahepatic bile duct loss in the subgroup of infants which does not respond to portoenterostomy.
Hepatobiliary Surgery
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
➢ Post-hepatic (obstructive)Intraluminal.■ CholedocholithiasisMural abnormalities.■ Biliary stricture■ Primary sclerosing cholangitisExtrinsic compression of the bile ducts.■ Carcinoma of the head of pancreas, ampulla of Vater or bile duct.■ Chronic pancreatitis■ Enlarged lymph nodes in porta hepatis.■ Mirizzi’s syndrome: external biliary compression from a stone impacted in the neck of the gallbladder.
Treatment strategies for neuroendocrine liver metastases: an update
Published in Expert Opinion on Orphan Drugs, 2019
Diamantis I. Tsilimigras, Malcolm H. Squires, Jordan M. Cloyd, Timothy M. Pawlik
Several limitations should be taken into account regarding the use of RFA [25,29]. The presence of a lesion size of 5 cm or more makes RFA technically more difficult and less effective. In addition, a number of tumors (generally <5) and the relationship of the hepatic lesions with major structures, such as hepatic veins or porta hepatis also need to be considered before RFA is employed [28]. Nevertheless, the main advantage of RFA is that it can enable the treatment of NELM, particularly when combined with surgery, rendering surgery possible in a situation which otherwise may be inoperable. In fact, RFA may be performed as a supplement to surgery to eliminate multifocal disease or decrease the extent of hepatectomy and, thus, the postoperative risk of liver failure [25]. In addition, RFA may have a role in the treatment of recurrent disease when resection becomes limited after multiple operations [25].
Efficacy and safety of CT-guided percutaneous thermal ablation for hepatocellular carcinoma adjacent to the second porta hepatis
Published in International Journal of Hyperthermia, 2019
Lin Xie, Fei Cao, Han Qi, Ze Song, Lujun Shen, Shuanggang Chen, Yubin Hu, Chao Chen, Weijun Fan
Treatment for patients with tumors adjacent to the second porta hepatis was difficult. Traditional surgery involved the disadvantages of high morbidity and operation trauma. Recently, thermal ablation served with promising effect as a minimally invasive treatment for liver tumors. Several studies have reported it to be an effective alternative treatment for perivascular hepatic tumors. Kang et al. reported that the outcomes of RFA for small perivascular HCC were similar to those for nonperivascular HCC [20]. However, the notable heat-sink effects that influenced our outcomes were also reported in previous studies [14–16]. Due to concerns of limited efficacy and severe complications, the location of tumors near the second porta hepatis used to be regarded as a contraindication for ablation; until now, no research has been reported in this area. Results of the present study show that thermal ablation is a safe and feasible treatment for tumors adjacent to second porta hepatis.
Surgical approaches for the treatment of perihilar cholangiocarcinoma
Published in Expert Review of Anticancer Therapy, 2018
Charles W. Kimbrough, Jordan M. Cloyd, Timothy M. Pawlik
The principal difference in performing liver resections for pCCA is management of the biliary tree. This typically requires extrahepatic dissection of the porta hepatis to ensure resectability, followed by intrahepatic bile duct resection with parenychmal transection. Division of the biliary tree varies by the location of the tumor and planned extent of hepatic resection (Figure 2). For right hepatectomy, the proximal left duct is transected to the right of the umbilical portion of the left portal vein. Division occurs to the left of the umbilical portion of the left portal vein for a right trisectionectomy that includes segment 4. For left hepatectomy or left trisectionectomy, the right duct is divided either at the level of the right portal pedicle or right posterior sectoral pedicle, respectively (Figure 3). To restore drainage, an enteric-biliary anastomosis is necessary.