It is the most common malignant tumor of Liver; Occur after the age of 50 year and incidence is more common in male patient; In 80% of cases it occur under the background of chronic liver disease while in another 20% it occur in normal Liver; The common causes of chronic liver disease in these patients are Alcohol, Hepatitis B & C infection and Fatty liver; Common causes of fatty liver are Obesity, Diabetes and Hyperlipidemia
Hepatocellular Cancer or Liver Cancer can be one of the reason for decompensation in patients of chronic liver disease or cirrhosis; Otherwise these patients present with features of chronic liver disease like ascites/jaundice and when investigated are found to have Liver Cancer
Pain right upper abdomen along with anorexia and weight loss are common
Imaging modality of choice for diagnosis of Hepatocellular Carcinoma is triple phase CT abdomen which reveals typical feature of HCC that is arterial enhancement and portal venous phase washout; Tumor marker for Liver cancer is alpha-fetoprotein; Typical feature on CT along with raised alpha-fetoprotein is sufficient for diagnosis of Liver Cancer; FNAC is not done because of risk of seedling of needle tract
Surgical resection is the treatment of choice; When Liver Cancer occur under the background of chronic liver disease and if it comes under the criteria of Liver transplant and if donor is available it should be the treatment of choice
If Surgical resection is not possible or patient is not fit for surgery then there are various non-surgical methods available which should be done according to the criteria fulfilled
The most common lesion seen in liver on ultrasound is hemangioma; Whenever in doubt of the diagnosis triple phase CT abdomen should be done to confirm it; Patient symptoms should not be related to hemangioma because it is seen on ultrasound until and unless other pathologies is ruled out, It is a benign condition and usually does not require any intervention; Only large symptomatic hemangiomas require intervention.
Liver abscess is generally of two types one is pyogenic and other is Amoebic, Most commonly patients present with fever and right-sided upper abdomen pain; Ultrasound abdomen is the first investigation in pain abdomen which will suggest the diagnosis, it will tell number and size of the abscess, whenever in doubt triple phase CT abdomen should be done because many times other liver pathology may be misdiagnosed as liver abscess, Once diagnosed appropriate antibiotics should be started, At initial stage abscess are solidified so Percutaneous drainage will not be effective, so in case of large abscess once it is liquified PCD can be done, Sometimes patient present with features of ruptured liver abscess such as diffuse pain abdomen, high grade fever in these cases Laparoscopic peritoneal lavage with liver abscess drainage should be done.