By Ian Beckingham
Queen's clinical Centre, Nottingham, united kingdom. offers an outline of the illnesses of the liver, pancreas, and gall bladder. For citizens, clinical scholars, and common practitioners. Covers universal and infrequent stipulations and contains algorithms for analysis and therapy. colour illustrations. Softcover.
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7 Surgical management of varices Portal hypertension—1: varices and splenic vein thrombosis who are unsuitable for shunt procedures and continue to have serious variceal bleeding despite endoscopic and drug treatment. Liver transplantation is the treatment of choice in advanced liver disease. Hepatic decompensation is the ultimate decompressive shunt for portal hypertension and also restores liver function. Transplantation treats other complications of portal hypertension and has one year and five year survival rates of 80% and 60% respectively.
Other commonly used systems are Ranson’s and the acute physiological and chronic health evaluation (APACHE II). Changes in C reactive protein concentration and APACHE II scores correlate well with the ongoing disease process. 0 mmol/l x Lactate dehydrogenase > 600 U/l Severe disease is present if >3 factors detected within 48 hours Radiology Chest and abdominal radiography are rarely diagnostic but are useful to exclude other acute abdominal conditions such as a perforated peptic ulcer. Abdominal ultrasonography is indicated at an early stage to identify gall stones and exclude biliary dilatation.
In African and Asian countries aflatoxin, produced as a result of contamination of imperfectly stored staple crops by Aspergillus flavus, seems to be an independent risk factor for the development of hepatocellular carcinoma, probably through mutation of the p53 suppressor gene. Seasonal variation in incidence is seen in these countries. In patients with cirrhosis, the diagnosis should be suspected when there is deterioration in liver function, an acute complication (ascites, encephalopathy, variceal bleed, jaundice), or development of upper abdominal pain and fever.