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Ablation for liver tumours Ablative therapies destroy tumour by the direct application of energy or toxic substances to discrete lesions. The basic tech - nique for RFA was described in 1891 by d’Arsonval, who first - demonstrated that heat was produced when ra...

Acute liver failure Causes of acute liver failure Acute liver failure is the development of sudden, severe hepatic dysfunction from an acute insult associated with the onset of hepatic encephalopathy and coagulation abnormalities. The most widely accepted defi...

Ascites Accumulation of ascites is a common feature of advanced liver disease irrespective of the aetiology . Development is usually insidious and fluid accumulation is associated with abdominal discomfort and a dragging sensation. CT will confirm the aeti -...

Benign tumours A number of pathologies produce focal liver lesions, and the three most common benign hepatic tumours are haemangio - mas, focal nodular hyperplasia (FNH) and hepatic adenomas. These lesions are common and often discovered incidentally on cross...

Biopsy of liver lesions Liver biopsy is generally considered a safe procedure but is not without risk of mechanical complications, which although minor (pain and subcapsular or intrahepatic haematoma) occur in 6–25% of patients. Significant complications, inc...

Blood loss and transfusion The reduction of blood loss during liver surgery has developed such that resection is often possible without blood transfusion. Better understanding of the segmental anatomy of the liver and patient selection, low central venous p...

Budd–Chiari syndrome The Budd–Chiari syndrome a ff ects 1/1 /uni00A0 000 /uni00A0 000 adults and is a collective term for conditions that impede hepatic venous outflow at any level from the small hepatic veins to the junction of the IVC with the right atrium. C...

Caroli’s disease Caroli’s disease is a rare congenital dilatation of the intra- - hepatic biliary tree with an incidence of <1/100 /uni00A0 000. It is often complicated by intrahepatic stone formation and presentation is usually with abdominal pain or sepsis...

Chronic liver disease Liver disease is the third leading cause of premature death in the UK, and since 1970 deaths have increased by 400%. Liver - disease is potentially preventable in 90% of cases, and 75% of patients present with late-stage disease. Lethar...

Clinical signs Depending on the severity of liver dysfunction, the aetiology and acute or chronic development, symptoms vary and combi nations occur. The most common include jaundice, drowsiness, abdominal pain/swelling, nausea, tremors, vomiting, malaise, co...

Colorectal liver metastases Worldwide colorectal cancer (CRC) is the third most common solid organ malignancy and the fourth most common cause of cancer-related deaths. Up to 70% of patients with CRC develop synchronous (15–25%) or metachronous (20–45%) liver ...

Complications of liver trauma A subcapsular or intrahepatic haematoma requires no specific intervention and should be allowed to resolve spontaneously . Abscesses may form as a result of secondary infection of an area of parenchymal ischaemia and treatment i...

Cystic lesions Simple liver cysts Simple cysts of the liver are usually asymptomatic and were thought to be uncommon before the routine use of ultra - sonography . The exact prevalence and incidence are not known but they are estimated to occur in 5% of the...

Diagnosis and grading of liver injury The liver is an extremely well-vascularised organ and blood loss is the major early complication following injury . A high index of suspicion is essential with any chest or upper abdominal stab wound, especially where sig...

Endoscopic retrograde cholangiopancreatography Endoscopic retrograde cholangiopancreatography (ERCP) is performed in patients with obstructive jaundice when a thera - peutic endoscopic procedure is indicated (see Chapter 9 ). It provides definitive views of K...

FURTHER READING Banale JM, Cardinale V , Carpino G et al. Expert consensus document: Cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA). Nat Rev Gastroenter...

Follow-up Optimal follow-up remains controversial, and protocols vary . Close observation will identify patients who may benefit from further surgery and at least a yearly scan should be performed for the first 5 years. Tumour markers are measured if initially ...

Hepatobiliary iminodiacetic acid Hepatobiliary iminodiacetic acid (HIDA) labelled with tech - 99m netium-99m ( Tc-HIDA) is concentrated by hepatocytes and excreted with bile, visualising intrahepatic uptake, the extrahepatic biliary system and the gallbladder....