0071643192.pdf

■ Liver transplant or surgical resection can be curative for limited stages
without extrahepatic metastasis.
■ Systemic chemotherapy is used for palliation only.
■ Without liver transplantation or surgical resection the prognosis is poor,
with 1- and 5-year survival rates of 25% and 5%, respectively.

Benign Liver Neoplasms

HEMANGIOMA

■ Most common benign neoplasm
■ More common in females
■ Increases in size with use of exogenous hormones
■ Biopsy may be needed to rule out malignancy.

FOCALNODULARHYPERPLASIA

■ Asymptomatic
■ Hypervascular mass
■ Only symptomatic patients undergo resection.

HEPATICADENOMA

■ Common in women in their 30s and 40s
■ Increased size with hormone use
■ May cause pain if necrosis develops
■ Resection advised to prevent necrosis.

A 36-year-old woman presents with sharp abdominal pain. She reports

that she ate a fatty meal 2 hours before symptom onset and has had three

previous episodes of similar pain. She does not drink alcohol. On exam,

she has epigastric abdominal tenderness. Labs show a lipase of 4400. What is

the most likely cause of her pancreatitis?

Gallstones.

GALLBLADDER AND BILIARY TRACT DISEASES

Cholelithiasis

Colic results from transient cystic duct blockage from impacted stones. Risk
factors include the 4 Fs:female,fat, fertile, and forty,but the disorder is
common and can occur in any patient. Other risk factors include OCP use,
rapid weight loss, a +family history, chronic hemolysis (pigment stones), small
bowel resection, and TPN.

SYMPTOMS/EXAM

■ Patients present with postprandial abdominal pain (usually in the RUQ)
that radiates to the right subscapular area or the epigastrum.
■ Pain is abrupt, lasting minutes to hours, followed by gradual relief, often
associated with nausea and vomiting, fatty-food intolerance, dyspepsia, and
flatulence.
■ Gallstones may be asymptomatic in up to 80% of patients.
■ Exam may reveal RUQ tenderness and a palpable gallbladder.

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

Eighty percent of

hepatocellular carcinoma is

associated with cirrhosis.

Risk factors for

gallstones—

The4 Fs

Fat

Female

Fertile

Forty years old