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Approach to Liver Lesions: Diagnosis and Management Strategies

Learn about the evaluation of liver lesions, including history taking, clinical examination, lab tests, serology, tumor markers, and imaging techniques. Understand the presentation, algorithms for different types of liver lesions, and the role of biopsy and screening strategies. Includes a case study on treatment options for liver lesions.

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Approach to Liver Lesions: Diagnosis and Management Strategies

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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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