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FOCAL NODULAR HYPERPLASIA OF LIVER

UNDERSTANDING THE PROBLEM

The liver is a large organ that sits on the right side of the belly. The liver has two large sections, called the right and the left lobes. The gallbladder sits under the liver, along with parts of the pancreas and intestines. The liver and these organs work together to digest, absorb, and process food. The liver's main job is to filter the blood coming from the digestive tract, before passing it to the rest of the body. The liver also detoxifies chemicals and metabolizes drugs. As it does so, the liver secretes bile that ends up back in the intestines. The liver also makes proteins important for blood clotting and other functions.

Focal nodular hyperplasia (FNH) is a benign tumor of the liver and is the second most common tumor of the liver after the benign liver tumor known as hemangioma. FNH does not turn into liver cancer and generally it does not grow in size, spread or bleed, and in most people it does not produce any symptoms. If the tumor grows and becomes large it can cause some symptoms.

UNDERSTANDING WHO SUFFERS

Focal Nodular Hyperplasia of the Liver, most commonly occurs in young adult women, between 20 and 30 years of age. Infrequently, men are also known to develop this condition.

FNH of the Liver is believed to be caused by congenital abnormalities in the liver blood vessels. Individuals, with such anomalies, have abnormal liver blood vessels from birth.

A presence of these ‘FNH-causing’ congenital abnormalities may cause some liver cells, to receive more blood, nutrients, and oxygen, than other cells. This causes them to grow into a tumor-like mass that are generally noticeable, when individuals are between 20-30 years of age.

Some researchers also consider that certain hormones may be involved in causing the liver condition. Reproductive hormones are believed to cause FNH tumors to grow larger.

POTENTIAL SIGNS AND SYMPTOMS

In a majority of cases condition is found accidentally when undertaking an imaging test for evaluation of another disease. Symptoms are usually rare and include the following:

  • Presence of tumor growth during physical exam in the liver; visible tumor during imaging procedures
  • Serum liver results that are abnormal
  • Fever
  • Abdominal enlargement (especially on the right side)
  • Palpable mass on the right upper abdomen
  • Hepatomegaly or enlargement of the liver
  • Weight loss
  • Occasional abdominal pain
  • Feeling of fullness, bloating (rare)
  • Bleeding into the abdomen (observed in rare cases)
EXAMINATIONS USUALLY REQUIRED

A diagnosis of Focal Nodular Hyperplasia of the Liver may involve:

  • Physical exam: If the physician notes any stiffness or hardness, when pressing upon the liver; then, a mass such as FNH is suspected. Furthermore, gathering information on the individual’s health and personal habits, serves as a good indicator to their risk of developing this benign liver tumor. If the risks are evident, then the physician may suspect Focal Nodular Hyperplasia.
  • Imaging studies: Such studies can confirm diagnosis. Using radiological tests, such as CT scan of the abdomen, MRI scan of abdomen, and abdominal ultrasound, the presence of a liver tumor can be imaged:
  • Color Doppler – Focal nodular hyperplasia (FNH) can be diagnosed with the use of imaging studies such as a color Doppler. Upon diagnosis a focal nodular hyperplasia would appear like a “comet tail”. This is because FNHs are hypervascular in nature; upon Doppler studies scattered veins and arteries are seen throughout the liver, giving a comet like appearance.
  • Ultrasound – Ultrasound can also diagnose focal nodular hyperplasia since these tumors are isoechoic. But ultrasound studies can only detect tumors that are already pressing on to the adjacent structures or liver vessels. Ultrasound can only detect tumors with exerting mass effects.
  • Ultrasound with Enhanced Contrast – This imaging study can help diagnose FNH by showing through contrast the classic sign of focal nodular hyperplasia: a central lesion that is non-enhancing and resembles a stellar shape.
  • Low Index Contrast Enhanced Sonography – This diagnostic procedure enables the clinician to differentiate the condition from hepatic adenoma or other liver conditions. Focal nodular hyperplasia usually masks other liver conditions that need immediate or prompt treatment. Differential diagnosis to rule out focal nodular hyperplasia from any other forms of liver tumor formations is a priority intervention.
  • Computed Tomography or CT Scan – A CT scan is usually done to point out the location, size and density of the tumor growth. A CT scan of a focal nodular dysplasia usually shows deformity in the contour of the liver, or a liver with a star shaped scar in the center. CT scans are often employed to give an overview of the growth but it doesn’t tell much about the characteristics of the tumor itself.
PROPOSING TREATMENT AND WHY AIMIS

Surgery for Liver Disorders

If your doctor recommends surgery for a disorder, you may be a candidate for a minimally invasive approach - da Vinci Surgery.

AIMIS is an expert in Robotic Surgery for Robotic Assisted Right & Left Liver Lobectomy, Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver, Left Lateral Sectionectomy of the Liver, Two Step Liver Resections and other minimal invasive procedures for the Liver involving the best American and International surgeons who are experts in the field including:

  • Hepatic fibrosis and sclerosis - Right & Left Liver Lobectomy, Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver, Left Lateral Sectionectomy of the Liver, Two Step Liver Resections
  • Central haemorrhagic necrosis of liver - Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver
  • Infarction of liver - Right & Left Liver Lobectomy, Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver, Left Lateral Sectionectomy of the Liver, Two Step Liver Resections
  • Hepatic veno-occlusive disease - Right & Left Liver Lobectomy, Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver, Left Lateral Sectionectomy of the Liver, Two Step Liver Resections
  • Liver Cysts - Right & Left Liver Lobectomy, Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver, Left Lateral Sectionectomy of the Liver, Two Step Liver Resections
  • Focal nodular hyperplasia of liver - Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver

Explanation of Surgery Types:

  • Large Liver Resection – Right Lob Removed plus Segmentectomy (segment number 4)
  • Right Liver Lobectomy- Removal of one of the two lobes of liver
  • Left Liver Lobectomy - Removal of one of the two lobes of liver
  • Segmentectomy - Removal of one of the eight segments of liver
  • Multiple Segmentectomies – Two or More removal of the segments of Liver
  • Complex Segmentectomies –Complex removal of the segments of Liver
  • Small Resections – Removal of small parts of Liver ( smaller than Segments)
  • Wedge resection, non-Anatomical - Tumor removal with portion of liver
  • Left Lateral Sectionectomy- Removal of the Left Lateral Segment/section of the Liver
  • Two Step Liver Resection- Liver Regeneration

To see the procedures we undertake with Robotic Xi Surgery, please click here

GETTING MORE INFORMATION BEFORE MOVING FORWARD
YOU MAY HAVE QUESTIONS LIKE:
  • Can I get more information before I commit to this?
  • Can I get a second opinion from you before I commit to this?
  • How can I find out the cost before I have any obligation?
WHAT AIMIS CAN DO:

AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide.

AIMIS’ mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.

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AFFORDABILITY

AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.

 

FURTHER INFORMATION ON THE PROBLEM:

Complications due to Focal Nodular Hyperplasia of the Liver are generally rare.
However, an excessive tumor growth and its subsequent rupturing may result in an internal bleeding. This usually requires urgent medical attention.

Treatment of Focal Nodular Hyperplasia of the Liver is typically planned on a case-by-case basis.

  • If the healthcare provider believes that the tumor is asymptomatic and does not pose a major health risk, they will often recommend that FNH be closely monitored, instead of a removal. In such cases, it is important to frequently follow-up with the physician and to also ensure that regular liver imaging is done, in order that the FNH growth is monitored and any change in its size observed.
  • On the other hand, some physicians may recommend the surgical removal of Focal Nodular Hyperplasia of the Liver. They usually recommend a surgery, if the tumor is symptomatic and poses a risk of developing into a cancer.
  • The individual may be advised to stop the use of oral contraceptives and hormone replacement medications, if they have FNH. Hormones are believed to cause tumors to grow larger, which increases their risk of rupture, leading to an internal bleeding.
FURTHER INFORMATION ON INCREASED RISK GROUPS

Common risk factors of Focal Nodular Hyperplasia of the Liver include:

  • Females, especially young adults, have a higher risk
  • Presence of congenital abnormalities in liver blood vessels
  • Smoking
  • Having an unbalanced diet, low in grains and vegetables
  • Abnormal reproductive hormone levels can increase the risk

Focal Nodular Hyperplasia of the Liver is thought to be caused by congenital blood vessel abnormalities of the liver. Since these abnormalities are present from birth, there are no preventative methods against FNH of the Liver.

It is however possible, to take some measures to reduce one’s risk of developing FNH

  • It is recommended not to use hormone replacement medications (hormonal replacement treatment - HRT)
  • It is also recommended to consult a healthcare provider before planning a pregnancy, if having other risk factors associated with FNH. A pregnancy may elevate many hormone levels, which may cause growth of a liver tumor.
FURTHER EXAMINATION THAT MAYBE REQUIRED OR REQUESTED

Imaging Studies that Reveal Characteristics of Focal Nodular Hyperplasia

  • Nuclear Scintigraphy – This imaging study uses Sulphur colloid scan. 60% of focal nodular hyperplasia lesions would uptake this radiotracer, which is frequently seen in hepatic adenomas.
  • MRI with Superparamagnetic Iron Oxide (SPIO) – MRI imaging enhanced with SPIO is used to determine the characteristics of focal nodular hyperplasia lesions. Since the lesions contain Kupffer cells, the contrast medium (SPIO) is greatly absorbed by the cells, indicating that the lesion is FNH in nature rather than an adenoma.

When, neither a physical examination nor an imaging study, can confirm the diagnosis of Focal Nodular Hyperplasia of the Liver, a biopsy may be conducted. During a biopsy, a sample of tissue from the suspected hepatic tumor is collected and sent for examination, to a laboratory. A pathologist studies the specimen under a microscope, in order to make a definitive diagnosis.

WHY AIMIS FOR THIS SURGERY

AIMIS is an expert in Robotic Surgery for Robotic Assisted Right & Left Liver Lobectomy, Multiple Liver Segmentectomies, Complex Liver Segmentectomies, Small Resections of the Liver, Wedge non anatomical Resection of the Liver, Segmentectomy of the Liver, Left Lateral Sectionectomy of the Liver, Two Step Liver Resections and other minimal invasive procedures for the Liver involving the best American and International surgeons who are experts in the field

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for the Liver and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Low rate of major complications
  • Low conversion rate to open surgery
  • Less scarring
  • High patient satisfaction
  • Minimal pain
  • More precise removal of cancerous tissue
  • Less risk of converting to open surgery
  • Reduced risk of blood loss
  • Shorter hospital stay

The advantage of robotic surgery is the avoidance of large incision, and also helps in removing complex or critical tumors which are otherwise, very hard to do with tradition open surgery methods. As the liver is one of the highly regenerating organ of our body, by employing robotic surgery techniques, one can easily remove complex tumors with minimal discomfort without affecting its regenerating power. Robotic technology has also been successfully used in liver transplantation, which has made liver transplantation simpler with fewer complications.

OTHER SERVICES PROVIDED BY AIMIS

In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.

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