Hepatic hemangioma(HH)is the most common benign liver tumor and it is usually found incidentally during radiological studies.This tumor arises from a vascular malformation;however,the pathophysiology has not been clea...Hepatic hemangioma(HH)is the most common benign liver tumor and it is usually found incidentally during radiological studies.This tumor arises from a vascular malformation;however,the pathophysiology has not been clearly elucidated.Symptoms usually correlate with the size and location of the tumor.Less commonly the presence of a large HH may cause life-threatening conditions.The diagnosis can be established by the identification of HH hallmarks in several imaging studies.In patients that present with abdominal symptoms other etiologies should be excluded first before attributing HH as the cause.In asymptomatic patient’s treatment is not required and follow up is usually reserved for HH of more than 5 cm.Symptomatic patients can be managed surgically or with other non-surgical modalities such as transcatheter arterial embolization or radiofrequency ablation.Enucleation surgery has shown to have fewer complications as compared to hepatectomy or other surgical techniques.Progression of the tumor is seen in less than 40%.Hormone stimulation may play a role in HH growth;however,there are no contraindications for hormonal therapy in patients with HH due to the lack of concrete evidence.When clinicians encounter this condition,they should discern between observation and surgical or non-surgical management based on the clinical presentation.展开更多
Liver biochemical tests are some of the most commonly ordered routine tests in the inpatient and outpatient setting,especially with the automatization of testing in this technological era.These tests include aminotran...Liver biochemical tests are some of the most commonly ordered routine tests in the inpatient and outpatient setting,especially with the automatization of testing in this technological era.These tests include aminotransferases,alkaline phosphatase,gamma-glutamyl transferase,bilirubin,albumin,prothrombin time and international normalized ratio(INR).Abnormal liver biochemical tests can be categorized based on the pattern and the magnitude of aminotransferases elevation.Generally,abnormalities in aminotransferases can be classified into a hepatocellular pattern or cholestatic pattern and can be further sub-classified based on the magnitude of aminotransferase elevation to mild[<5×upper limit of normal(ULN)],moderate(>5-<15×ULN)and severe(>15×ULN).Hepatocellular pattern causes include but are not limited to;non-alcoholic fatty liver disease/non-alcoholic steatohepatitis,alcohol use,chronic viral hepatitis,liver cirrhosis(variable),autoimmune hepatitis,hemochromatosis,Wilson’s disease,alpha-1 antitrypsin deficiency,celiac disease,medication-induced and ischemic hepatitis.Cholestatic pattern causes include but is not limited to;biliary pathology(obstruction,autoimmune),other conditions with hyperbilirubinemia(conjugated and unconjugated).It is crucial to interpret these commonly ordered tests accurately as appropriate further workup,treatment and referral can greatly benefit the patient due to prompt treatment which can improve the natural history of several of the diseases mentioned and possibly reduce the risk of progression to the liver cirrhosis.展开更多
Abdominal compartment syndrome(ACS)develops when organ failure arises secondary to an increase in intraabdominal pressure.The abdominal pressure is determined by multiple factors such as blood pressure,abdominal compl...Abdominal compartment syndrome(ACS)develops when organ failure arises secondary to an increase in intraabdominal pressure.The abdominal pressure is determined by multiple factors such as blood pressure,abdominal compliance,and other factors that exert a constant pressure within the abdominal cavity.Several conditions in the critically ill may increase abdominal pressure compromising organ perfusion that may lead to renal and respiratory dysfunction.Among surgical and trauma patients,aggressive fluid resuscitation is the most commonly reported risk factor to develop ACS.Other conditions that have also been identified as risk factors are ascites,hemoperitoneum,bowel distention,and large tumors.All patients with abdominal trauma possess a higher risk of developing intra-abdominal hypertension(IAH).Certain surgical interventions are reported to have a higher risk to develop IAH such as damage control surgery,abdominal aortic aneurysm repair,and liver transplantation among others.Close monitoring of organ function and intra-abdominal pressure(IAP)allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP.Surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction.There is still a great need for more studies to determine the adequate timing for interventions to improve patient outcomes.展开更多
文摘Hepatic hemangioma(HH)is the most common benign liver tumor and it is usually found incidentally during radiological studies.This tumor arises from a vascular malformation;however,the pathophysiology has not been clearly elucidated.Symptoms usually correlate with the size and location of the tumor.Less commonly the presence of a large HH may cause life-threatening conditions.The diagnosis can be established by the identification of HH hallmarks in several imaging studies.In patients that present with abdominal symptoms other etiologies should be excluded first before attributing HH as the cause.In asymptomatic patient’s treatment is not required and follow up is usually reserved for HH of more than 5 cm.Symptomatic patients can be managed surgically or with other non-surgical modalities such as transcatheter arterial embolization or radiofrequency ablation.Enucleation surgery has shown to have fewer complications as compared to hepatectomy or other surgical techniques.Progression of the tumor is seen in less than 40%.Hormone stimulation may play a role in HH growth;however,there are no contraindications for hormonal therapy in patients with HH due to the lack of concrete evidence.When clinicians encounter this condition,they should discern between observation and surgical or non-surgical management based on the clinical presentation.
文摘Liver biochemical tests are some of the most commonly ordered routine tests in the inpatient and outpatient setting,especially with the automatization of testing in this technological era.These tests include aminotransferases,alkaline phosphatase,gamma-glutamyl transferase,bilirubin,albumin,prothrombin time and international normalized ratio(INR).Abnormal liver biochemical tests can be categorized based on the pattern and the magnitude of aminotransferases elevation.Generally,abnormalities in aminotransferases can be classified into a hepatocellular pattern or cholestatic pattern and can be further sub-classified based on the magnitude of aminotransferase elevation to mild[<5×upper limit of normal(ULN)],moderate(>5-<15×ULN)and severe(>15×ULN).Hepatocellular pattern causes include but are not limited to;non-alcoholic fatty liver disease/non-alcoholic steatohepatitis,alcohol use,chronic viral hepatitis,liver cirrhosis(variable),autoimmune hepatitis,hemochromatosis,Wilson’s disease,alpha-1 antitrypsin deficiency,celiac disease,medication-induced and ischemic hepatitis.Cholestatic pattern causes include but is not limited to;biliary pathology(obstruction,autoimmune),other conditions with hyperbilirubinemia(conjugated and unconjugated).It is crucial to interpret these commonly ordered tests accurately as appropriate further workup,treatment and referral can greatly benefit the patient due to prompt treatment which can improve the natural history of several of the diseases mentioned and possibly reduce the risk of progression to the liver cirrhosis.
文摘Abdominal compartment syndrome(ACS)develops when organ failure arises secondary to an increase in intraabdominal pressure.The abdominal pressure is determined by multiple factors such as blood pressure,abdominal compliance,and other factors that exert a constant pressure within the abdominal cavity.Several conditions in the critically ill may increase abdominal pressure compromising organ perfusion that may lead to renal and respiratory dysfunction.Among surgical and trauma patients,aggressive fluid resuscitation is the most commonly reported risk factor to develop ACS.Other conditions that have also been identified as risk factors are ascites,hemoperitoneum,bowel distention,and large tumors.All patients with abdominal trauma possess a higher risk of developing intra-abdominal hypertension(IAH).Certain surgical interventions are reported to have a higher risk to develop IAH such as damage control surgery,abdominal aortic aneurysm repair,and liver transplantation among others.Close monitoring of organ function and intra-abdominal pressure(IAP)allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP.Surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction.There is still a great need for more studies to determine the adequate timing for interventions to improve patient outcomes.
