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INFECTIVE CONDITIONS OF THE LIVER Ascending cholangitis Ascending cholangitis is a potentially life-threatening emergency associated with infection of the biliary tree and usually associated with obstruction. It presents with clinical jaundice, rigors and a ...

INVESTIGATING LIVER DISEASE Imaging modalities Major advances in surgical approaches to the liver required improvements in preoperative imaging. The choice of imaging modality is determined by the likely pathology and locally available equipment and expertise...

Intrahepatic cholangiocarcinoma Cholangiocarcinomas develop in the bile duct and demonstrate considerable variation in origin, behaviour and pathophysiol ogy . Twenty per cent of cholangiocarcinomas are intrahepatic (ICC), representing 5–30% of primary liver...

INTRODUCTION The liver is a highly complex organ found only in vertebrates that is responsible for over 500 individual functions. It is located in the right upper quadrant, protected by the ribs, and weighs on average 1.5 /uni00A0 kg (970–1860 /uni00A0 g). It ...

LIVER TRAUMA Liver injury due to blunt or penetrating abdominal trauma is second in frequency only to that of the spleen. Blunt injury produces contusion, laceration and avulsion, often associated with splenic, mesenteric or renal injuries. Penetrating injurie...

LIVER TUMOURS Liver resection continues to evolve, and the safety has been established with a mortality of 1–2% and a 5-year survival following resection of colorectal metastases of 50%. Early surgical approaches involved a formal left or right hepatectomy ...

Learning objectives To understand: The anatomy of the liver • The signs of acute and chronic liver disease • The investigation of liver disease • The management of liver trauma • The management of liver infections •

Ligaments and peritoneal reflections The liver is covered by visceral peritoneum (serosa), with a layer of connective tissue, the Glisson capsule, underneath. At the porta hepatis, the capsule envelops and travels along the portal tracts (triads) into the live...

Liver transplantation Liver transplantation is the only therapy that treats portal hypertension and the underlying liver disease and may ulti mately be required in patents with variceal bleeding. Previous surgical shunts increase the complexity and morbidity o...

Liver-first approach The traditional surgical strategy for resectable synchronous colorectal liver metastases (CRLMs) is colonic resection followed by chemotherapy and a delayed liver resection. This may allow progression of the liver disease and render the CR...

Long-term problems following liver trauma and their management Late complications are rare, but biliary strictures occur many years after liver trauma and treatment depends on the extent and site of stricturing. A segmental or lobar stricture with atrophy of ...

Malignant liver tumours Neuroendocrine/carcinoid tumours Carcinoids are the most common NETs a ff ecting men and women equally . The overall incidence is steadily increasing, estimated at 1.5–1.9 clinical cases per 100 /uni00A0 000 population, although in autop...

Management of variceal bleeding Resuscitation Varices are ubiquitous in patients with portal hypertension irrespective of the aetiology and usually present with an acute, and significant mortality . The lower oesophagus is the most common site and the diagnosi...

Methods of parenchymal transection An array of techniques and technologies have been developed to aid parenchymal dissection by facilitating identification of vascular and biliary structures to enable accurate diathermy , ligation or clipping. They also allow ...

Microscopic anatomy and structure The liver comprises approximately 100 /uni00A0 000 hexagonal func tional units known as lobules with a central vein surrounded Summary box 69.1 Liver anatomy /uni25CF /uni25CF /uni25CF /uni25CF Karl Wilhelm von Kup ff er , 1829...

Mobilisation of the liver Incision A roof top incision is performed 2–3 /uni00A0 cm below the costal margin ( Figure 69.19 ) with a vertical extension (Mercedes-Benz) if required. Fixed retraction under the ribs provides adequate access and thoracoabdominal i...

Non-alcoholic steatohepatitis, non - alcoholic fatty liver disease and chemotherapy-associated hepatitis Non-alcoholic steatohepatitis (NASH) is the inflammatory subtype of non-alcoholic fatty liver disease (NAFLD) and is associated with disease progression, th...

Parasitic diseases of the liver The liver is frequently a ff ected by parasitic infections, which, owing to the worldwide prevalence of these organisms, are responsible for considerable morbidity and mortality (see Chapter 6 ). Hydatid disease Human echinococc...