NeoplasmsPortal Hypertension

Francisco Javier Robles Saucedo

Clinical Surgery DepartmentDr. Benjamin Robles MadrigalDr. Hector Manuel Vírgen Ayala

Neoplasms

BeningMalignantMetastaticCyst

Liver Cell Adenomawomen (11:1)20-40 years oldOCPs70% lonely

SoftYellow2-15cmGlycogen & Fat (intracellular)

Liver Cell Adenoma

Abdominal pain(hemorrhage or

compresion)

Dx.MRICTBiopsy

TxResectionResection + Embolization

(Hemorrhage)

Focal Nodular Hyperplasia

Women 40 years old80% lonely5 – 10 cmCentral Star-Shaped Scar

Focal Nodular Hyperplasia

Abdominal pain (rarely)

Dx.CTMRI

TxResection

Hemangioma

Most commonWomen 3:1 (45 years old)Cavernous.< 5cm Asyntomatic

DxCT + ContrastMRI

TxResectionRadiotherapyEmbolization

Hepatocellular Carcinoma

1-3:100,000Men (2-8:1) 50-60 years old

Risk Factors:CirrhosisSmokingAlcoholContraceptivesVHB & VHC

Hepatocellular Carcinoma

SymtompsAbdominal painweight lossAnorexyNauseaBudd-Chiari SyndromeJaundiceHemobilia

Hepatocellular Carcinoma

Dx.CTMRIECOAngyographyAFPBx

Hepatocellular Carcinoma

Tx.Qx

HepatectomyAblative

Ethanol InyectionThermal Ablation

TransarterialEmbolization

CombinatedExternal RadiationSistemic

ChemotherapyInmunotherapy

Portal Hypertension

Portal Vein Pressure > 10 mm Hg

Flow Resistance Pre - Hepatic (Obstruction)Hepatic (Cirrhosis, Hepatitis)Post – Hepatic (Sx. Budd – Chiari)

Portal Circulation (>1350 ml/min)Porto-arterial FistulaSplenic circulation increment

(Sx. Banti)

Portal Hypertension

Tx.

ShuntsBallon TamponandeTIPS (Transjugular intrahepatic portosystemic shunt)VasopressinLiver TransplantEndoscopic Schlerotherapy.