A overview of clinical and surgical difficulties affecting the liver, pancreas and biliary approach. This booklet presents the fundamental details for clinical and nursing scholars, GPs and junior medical institution medical professionals usually scientific and surgical education. It offers algorhithms for diagnosing and treating universal ailments (e.g. gallstones, hepatitis) in addition to details for referring, and permitting trained dialogue with sufferers relating to remedy and analysis of rarer stipulations similar to malignancies and transplantation.
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Additional resources for ABC of Liver, Pancreas and Gall Bladder (ABC Series)
Cystic liver lesions Cystic lesions of the liver are easily identified by ultrasonography. Over 95% are simple cysts. Asymptomatic cysts are regarded as congenital malformations and require no further investigation or treatment as complications are rare. Aspiration and injection of sclerosants should be avoided as it may cause bleeding and infection and does not resolve the cyst. Rarely, simple cysts can grow very large and produce compressive symptoms. These are managed by limited surgical excision of the cyst wall (cyst fenestration), which can usually be done laparoscopically.
The diagnosis of hepatorenal syndrome is one of exclusion, and it should not be diagnosed until all potentially reversible causes of renal failure have been excluded. The common potentially reversible causes are sepsis, excessive diuresis or paracentesis, and nephrotoxic drugs. All patients suspected to have hepatorenal syndrome should be given an intravenous colloid infusion to exclude intravascular hypovolaemia as a cause of prerenal azotaemia. Liver transplantation, if otherwise appropriate and feasible, is the only truly effective treatment, and patients have a poor prognosis.
Most patients need dietary restrictions combined with diuretics. The usual diuretic regimen comprises single morning doses of oral spironolactone (an aldosterone antagonist), increasing the dose as necessary to a maximum of 400 mg/day. Dietary sodium restriction and dual diuretic therapy is effective in 90% of patients. The patient’s weight, electrolyte concentrations, and renal function should be carefully monitored. Treatment should be cautious because of the dangers of iatrogenic complications from aggressive treatment.