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INFARCTION 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.

Hepatic infarction is an extremely rare situation because of the liver's dual blood supply by the hepatic artery and portal vein. Hepatic infarction can occur when there is both hepatic arterial and portal vein flow compromise but most cases are due to acute portal venous flow compromise. Most of the time, infarction is a peripherally located wedge shape area however it can be centrally or round or oval shaped.

UNDERSTANDING WHO SUFFERS

Hepatic infarction is uncommon, occurring at any age, without sex predilection. Hepatic artery thrombosis leading to infarction most often occurs after hepatic transplantation and has been reported in 3% of adult transplant recipients and 12% of pediatric transplant recipients.

Hepatic infarcts can occur at all stages of pregnancy from the 7th week to postpartum. Hepatic infarcts in pregnancy are mostly secondary to APS (Anti-Phospholipid Syndrome), HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) and preeclampsia. Both hepatic arteries and portal veins may be involved in APS. Arterial thromboses of both large and small hepatic arteries are seen. Intrahepatic haemorrhages/infarctions develop in pre-eclampsia/HELLP syndrome, typically in the late third trimester or postpartum interval in 1 per 45,000-2 per 25,000 pregnancies with a maternal mortality of 50%.

Most cases are seen after liver transplantation or hepatobiliary surgery. Non-transplant cases are mostly caused by:

  • hepatic artery occlusion due to:
    • arteriosclerosis
    • thrombosis or emboli
    • hepatic artery aneurysm
    • polyarteritis nodosa
    • sickle-cell disease
  • infarction without hepatic artery occlusion is mainly caused by:
    • acute shock state
    • trauma
    • hypercoagulable state
    • preeclampsia, eclampsia and post-partum HELLP syndrome 4-10.
    • complication of anesthesia
POTENTIAL SIGNS AND SYMPTOMS

Patients with hepatic infarction may be asymptomatic or experience some of the following symptoms:

  • Abdominal pain
  • Nausea & vomiting
  • In some cases Jaundice
  • Abnormal liver function tests
EXAMINATIONS USUALLY REQUIRED
  • CT scan shows the wedge-shaped, rounded or irregular lesions of hepatic infarction as hypodense areas. In the presence of secondary infection gas can be seen around the area of infarction. It may also be able to suggest the possible etiology and guide appropriate management.
  • Ultrasound can be requested in both acute and chronic stages of infraction. Ultrasound scan of the liver shows areas of decreased echogenicity. When combined with Doppler scans ultrasound scan is helpful in in detecting obliterated vessel
  • On MRI imaging, regions of hepatic infarction appear. Ischemic and necrosed areas of the liver paranchyma can be illustrated with the use of nuclear imaging.
  • Angiogram can localize the obliterated vessel which is responsible for the development of hepatic infarction.
  • Blood tests that maybe required include Hepatic transaminases and Liver function test
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:
  • The differential diagnoses of intra hepatic infarction include intrahepatic abscess, acute fatty liver of pregnancy, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, ruptured hepatic adenoma, hepatocellular carcinoma and hemangioma.
  • Preservation of portal tracts helps in differentiating infarction from other causes of hypo-attenuating lesions in the liver. Laboratory findings include anemia, thrombocytopenia, leucocytosis, marked aminotransferase elevation and azotemia. Changes are typically found in right lobe. Treatment includes urgent delivery. Patients with infarct can be managed conservatively and transfused. They are at risk of intrahepatic infection.
FURTHER INFORMATION ON INCREASED RISK GROUPS
  • History of liver biopsy - Development of hepatic artery pseudoaneurysms (HAP) is a complication of liver biopsy. Patients with HAP can be asymptomatic or present with abdominal pain, hematemesis, anemia, hypovolemia, massive gastrointestinal bleeding and jaundice after the liver biopsy.
  • Treatment of hepatocellular carcinoma (HCC)- among the options of treatment for HCC percutaneous ethanol injection and percutaneous arterial embolization carries a risk of hepatic infarction. Although rare, RFA also carries a small risk of hepatic infarction.
  • History of laparoscopic abdominal surgery -patients, who have undergone laparoscopic abdominal surgery, can develop hepatic necrosis as a complication of the procedure. Aesthetic agents, accidental ligation or cutting of the vessels can be the causative factors.
  • History of pre-eclampsia -Pre-eclampsia is a complication of pregnancy induced hypertension (PIH). PIH occurs in the second trimester of the pregnancy. Females present with high blood pressure, generalized edema and in severe cases seizures can develop.
  • History of antiphospholipid syndrome (APS) - Patients with APS are at risk of hepatic infarction due to thrombosis of vessels.
FURTHER EXAMINATION THAT MAYBE REQUIRED OR REQUESTED

Further testing to evaluate may include:

  • Liver function tests (LFTs or LFs) are groups of blood tests that give information about the state of a liver. These tests include prothrombin time (PT/INR), aPTT, albumin, bilirubin (direct and indirect), and others.
  • Renal function tests including blood urea nitrogen (BUN) provides a rough measurement of the glomerular filtration rate, the rate at which blood is filtered in the kidneys, and Creatinine is a breakdown product of creatine, an important component of muscle.

General imaging differential considerations can include

  • Focal fatty infiltration - although focal fatty infiltration lacks pressure effect, vessels are seen crossing trough the lesion.
  • Hepatic abscess - typically shows pressure effect on adjacent structures and ring enhancement while hepatic infarction lacks pressure effect and any enhancement.
  • True hepatic masses - both pressure effect and enhancement differentiates from hepatic infarction. the clinical scenario is different
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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