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Recalls from another friend 5-4-17 Sydney. Please pray for her Lots of surgery based questions asked
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1- CT of liver ca h/o wt loss. Next appropriate treatment asked
a) cholecystectomy
b) per cutaneous hepatojejunostomy ans
2-The major indications for hepaticojejunostomy are as follows:
Benign or iatrogenic strictures
Injuries to the biliary system
[7, 8, 9, 10]
Additionally, obstruction from malignancies of the biliary system caused by pancreatic or
duct wall tumors may necessitate this operation. Rare indications are trauma and dilated
areas occurring in sclerosing cholangitis. In the pediatric population, choledochal cysts are
also an indication for reconstruction with hepaticojejunostomy.
[11]
Because
each unsuccessful attempt at repair can cause increased morbidity for the patient,
providing long-term functional and anatomic stability is paramount during the
reconstruction
Hepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in the setting of chronic liver
disease and cirrhosis (see "Epidemiology and etiologic associations of hepatocellular carcinoma" ). It is
typically diagnosed late in its course, and the median survival following diagnosis is approximately 6 to 20
months [1]. Although the mainstay of therapy is surgical resection, the majority of patients are not eligible
because of tumor extent or underlying liver dysfunction.
Several other treatment modalities are available, including:
●Liver transplantation
●Radiofrequency ablation (RFA) and microwave ablation
●Percutaneous ethanol or acetic acid ablation
Overall, transplantation remains the best option for patients with HCC. Unfortunately,
there is a limited supply of good-quality deceased donor organs. Thus, alternative
Page 2of 146
treatments, including resection, radiofrequency ablation (RFA), and, potentially, systemic
therapy with sorafenib (or, if sorafenib fails, regorafenib), should be used to bridge
patients to transplant or to delay recurrence if possible. In patients who experience a
recurrence following resection or transplantation, aggressive surgical treatment appears
to be associated with the best possible outcome.
...
1- CT of liver ca h/o wt loss. Next appropriate treatment asked
a) cholecystectomy
b) per cutaneous hepatojejunostomy ans
2-The major indications for hepaticojejunostomy are as follows:
Benign or iatrogenic strictures
Injuries to the biliary system
[7, 8, 9, 10]
Additionally, obstruction from malignancies of the biliary system caused by pancreatic or
duct wall tumors may necessitate this operation. Rare indications are trauma and dilated
areas occurring in sclerosing cholangitis. In the pediatric population, choledochal cysts are
also an indication for reconstruction with hepaticojejunostomy.
[11]
Because
each unsuccessful attempt at repair can cause increased morbidity for the patient,
providing long-term functional and anatomic stability is paramount during the
reconstruction
Hepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in the setting of chronic liver
disease and cirrhosis (see "Epidemiology and etiologic associations of hepatocellular carcinoma" ). It is
typically diagnosed late in its course, and the median survival following diagnosis is approximately 6 to 20
months [1]. Although the mainstay of therapy is surgical resection, the majority of patients are not eligible
because of tumor extent or underlying liver dysfunction.
Several other treatment modalities are available, including:
●Liver transplantation
●Radiofrequency ablation (RFA) and microwave ablation
●Percutaneous ethanol or acetic acid ablation
Overall, transplantation remains the best option for patients with HCC. Unfortunately,
there is a limited supply of good-quality deceased donor organs. Thus, alternative
Page 2of 146
treatments, including resection, radiofrequency ablation (RFA), and, potentially, systemic
therapy with sorafenib (or, if sorafenib fails, regorafenib), should be used to bridge
patients to transplant or to delay recurrence if possible. In patients who experience a
recurrence following resection or transplantation, aggressive surgical treatment appears
to be associated with the best possible outcome.
...
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