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Case 1 OSS

Case 1 OSS. Background. 82 years old BGD: HTN, NIDDM, IHD Meds: Aspirin, Clopidogrel & Bisoprolol. Hb 10.1. WBC 16. Cre 142. AST 54. Hb 7.7. Hepatocellular Carcinoma: Fifth & sixth decade Wide geographical variation commonest in Africa & Asia 3:1 male predominance. Risk Factors.

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Case 1 OSS

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  1. Case 1 OSS

  2. Background • 82 years old • BGD: HTN, NIDDM, IHD • Meds: Aspirin, Clopidogrel & Bisoprolol

  3. Hb 10.1 WBC 16 Cre 142 AST 54

  4. Hb 7.7

  5. Hepatocellular Carcinoma: • Fifth & sixth decade • Wide geographical variation commonest in Africa & Asia • 3:1 male predominance.

  6. Risk Factors • Cirrhosis (4.5% of cirrhotic pts 10% when haemochromotosis is inciting factor) • 70-85% of HCC arises in setting of cirrhosis • Viral hepatitis – hep B & C (C weaker) • Polyvinylchloride • Parasitic infection • Anabolic steroids • Alpha1 antitrypsin deficiency

  7. Presentation: • Weight loss & weakness • Dull persistent epigastric /RUQ pain (50%) • Haemorrhage 10% (necrotic nodule or erosion into blood vessel – frequently lethal)

  8. Investigations: • Usually rise in ALP, & transaminases • Ascites (50%) • Bilirubin normal • AFP elevated in 75% of African but only 30% of western patients

  9. Treatment: • Surgical resection – only curative treatment • Liver transplantation – Only option in unresectable disease • Radiotherapy or Chemotherapy are not curative • Ablation for unresectable lesions – Ethanol injection/Chemo embolisation/ RTA

  10. Prognosis: • Pts rarely survive 4 months post diagnosis • 5 year survival after resection is 35-50% • Indicators of poor outcomes are larger tumours/ vascular invasion/ serum AFP >2,000/ cirrhosis

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