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SOL Liver

SOL Liver. Common liver lesions. Approach to liver SOL. History Clinical examination Lab – Hemogram, LFT, Albumin,INR Serology – ALA , Hydatid Tumor markers – AFP,CEA, CA 19-9. Presentation. Asymptomatic Nodule on screening in cirrhotic patients Presenting with pain and fever

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SOL Liver

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  1. SOL Liver

  2. Common liver lesions

  3. Approach to liver SOL • History • Clinical examination • Lab – Hemogram, LFT, Albumin,INR • Serology – ALA , Hydatid • Tumor markers – AFP,CEA, CA 19-9

  4. Presentation • Asymptomatic • Nodule on screening in cirrhotic patients • Presenting with pain and fever • SOL in a known patient of extrahepatic malignancy

  5. Algorithm for Solitary SOL of Liver on USG Nagral S , Clinics in GI Surgery

  6. Algorithm for Solid lesions on USG Nagral S , Clinics in GI Surgery

  7. Algorithm for Multiple Liver SOLs on USG Nagral S , Clinics in GI Surgery

  8. Beyond USG – CT • Symptomatic lesions – no response to treatment • Alterations in LFT • Underlying liver disease

  9. When MRI ----- HCC vs regenerating nodule vs dysplastic nodule atypical lesions

  10. Role of Biopsy Usually not required Diagnostic uncertainty

  11. Screening strategy

  12. BCLC staging

  13. CASE CAPSULE

  14. HISTORY • 54 yrs gentleman, no comorbidities • Frequency, urgency, in • complete evacuation • No other GI symptoms • USG abdomen – hypo echoic liver lesions • Lab - normal

  15. Colonoscopy • Ulcero proliferative lesion in sigmoid colon • No synchronous lesions/polyps • Biopsy - adenocarcinoma

  16. What next ?

  17. Chemotherapy • FOLFOX + bevaxizumab – 7 cycles • FOLFOX – 5 cycles

  18. PET CT

  19. Surgery • Sigmoid colectomy + left lateral segmentectomy + metastectomy (seg 4b, seg 5, seg 7)

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