Screening for Hepatocellular carcinoma

Q) Which of the following is true about screening in hepatocellular carcinoma

a) Alpha feto protein should be done 6 monthly

b) Ultrasound abdomen should be done 6 monthly

c) Candidates for liver transplant should be screened every 3 months

d) Nodules more than 2 cm should be followed up  more regularly

Answer b

In a cirrhotic liver tumors can develop any time and a stringent screening protocol has to be followed. Earlier ultrasound of liver and alpha feto protein were both used as tumor markers. However in 2009 Marrero et al demonstrated the suboptimal accuracy of AFP and after that it has been removed from the screening protocol and now only ultrasound is being done.

The screening recommendation is not for those patients with severe Read More ...

TACE in liver tumors

Q) What is true about trans arterial chemoebolization (TACE) for liver tumors

a) Arterio portal shunt is not an issue in TACE

b) Hypervascular liver tumors can be effectively managed with TACE

c) Extent of tumor necrosis is in the tune of 20-40%

d) TACE is almost at par with resection for cure in HCC

Answer b

Explanation is for premium members

 

Arterio portal shunting is important to be evaluated in TACE because if too much shunting is present blood will be directed from hepatic artery to portal vein which can eventually lead to bleeding from varices. A large shunt should be embolized 1st before TACE in HCC.

Liver tumors are extensively supplied by hepatic artery. The type of tumor can also determine the blood supply to the lesion. Encapsular nodular tumor is extensively supplied by hepatic artery where as well differentiated and infiltrating

edge of HCC is supplied by portal vein or both portal vein and hepatic artery. Doxorubicin is the most common chemotherapeutic drug which is mixed with lipiodol.

When lipiodol is injected in hepatic artery, it is preferentially accumulated in tumor and not in liver parenchyma. Read More ...

USMLE Liver

Q) A 50 year old lady with right renal cell carcinoma presents with acute pain in right upper abdomen. She has acute tenderness in right upper abdomen with palpable edge of liver.
She is afebrile and has normal liver functions and normal TLC. CECT Abdomen shows extensive web of collterals in the liver. What is the next step in management.
Portal Cavernoma
                          Portal Cavernoma
 
a) Cholecystectomy
b) Beta blockers
c) Tissue plasminogen activator followed with anticoagulation
d) ERCP and stenting
Answer for premium only