Diagnosis and management of common diseases of the liver

  Hepatic hemangiomas are benign tumors of the liver. Hepatic cavernous hemangiomas are the most common. Hemangiomas present in the liver as dark red, bluish-purple cystic elevations. They are lobulated or nodular, soft, compressible, and mostly clearly demarcated from adjacent tissues. Liver enlargement, masses and compression symptoms due to tumor enlargement are mostly asymptomatic in early stages. Diagnosis is mainly based on ultrasound, CT, nuclear scan and hepatic arteriography. Since this disease has no obvious symptoms and only manifests as intrahepatic occupying lesions, clinical attention should be paid to differentiate it from hepatocellular carcinoma. If left untreated, the tumor may compress and push neighboring organs when it increases in size, and various symptoms may occur. For example, compression of lower esophagus, stomach and duodenum may cause dysphagia, abdominal distension, abdominal pain and belching; compression of liver and bile duct may cause gallbladder effusion and obstructive jaundice, compression of portal vein may cause portal hypertension, compression of inferior vena cava may cause ascites and even tumor rupture and bleeding. The current treatment methods for hepatic hemangioma include hepatic lobectomy, hemangioma ligation, hepatic artery ligation, hepatic artery embolization cryotherapy, microwave curettage, intra-tumor sclerotherapy and radiation therapy. Hepatic lobectomy is still the best treatment for hemangioma but because of the rich blood supply of hemangioma, it is very easy to bleed during surgery, especially in huge hepatic cavernous hemangioma, how to control bleeding is the key to successful surgery. The disease develops slowly with good prognosis. Hepatic cavernous hemangioma in children should be treated as early as possible after diagnosis.  Liver cysts in general can be divided into non-parasitic and parasitic cysts and congenital hereditary, which usually have no obvious symptoms and are mostly found at some physical examination. Liver cysts are usually benign single or multiple, and small liver cysts without any symptoms may not require special treatment, but large ones with symptoms of compression should be treated appropriately. Treatment of liver cysts includes cyst puncture and aspiration, cyst windowing, cyst drainage or cystectomy. Usually, partial cyst wall resection, or “windowing”, can be performed to remove the superficial cyst wall while preserving the cyst wall in the liver parenchyma for clear fluid without bile, so that the cyst fluid can be drained into the abdominal cavity and absorbed by the peritoneum. The treatment of liver cyst should be early detection and early treatment, small size, fast treatment effect, no complication, better treatment, if the diameter is more than 5 cm and compression symptoms appear, or if there is cyst rupture, cyst torsion, intracapsular bleeding or huge cyst, surgical treatment is needed.  Hepatocellular carcinoma is a common malignant tumor of the liver. Early symptoms and signs are not obvious or lack of specificity. Some of them show swelling and pain in the liver area at the beginning of the disease, while others show acute abdominal pain, or the symptoms of metastases are the earliest manifestation. The etiology mostly develops in China against the background of viral hepatitis leading to cirrhosis, while others may be related to aflatoxin, genetics and other factors. According to the histogenesis, liver cancer can be divided into three major categories: hepatocellular carcinoma, bile duct epithelial carcinoma and mixed hepatocellular carcinoma. If left untreated there will be complications such as gastrointestinal bleeding, rupture of hepatocellular carcinoma nodes, liver failure, infection, etc. These complications are often the direct cause of death from hepatocellular carcinoma. Surgical treatment is the main way to cure, and early diagnosis should be made for early surgery. The indications for surgery are liver cancer limited to one or half lobes without obvious jaundice, ascites or metastasis elsewhere. Small hepatocellular carcinoma can be locally resected. Hepatocellular carcinoma located in the large vascular area of the hepatoportal can be resected bloodlessly by blocking the hepatic vessels with normothermic or cryogenic perfusion. For those who cannot be resected, liquid nitrogen cryotherapy, garnet laser treatment or laser resection can be performed to destroy most or all of the tumor. Cancer recurrence is the main cause of death in late stage after hepatectomy. Recurrence is commonly found in the liver, and a few are metastases from other sites such as lung and bone. The literature reports that the recurrence rate of large hepatocellular carcinoma at 5 years after radical resection is 61.5%, and that of small hepatocellular carcinoma is also 43.5%.