Overview The vast majority of nonparasitic cystic lesions of the liver are simple cysts. They are unilocular, do not communicate with the biliary tree, have a serous content, and although the epithelium does divide to account for volume expansion, they…
The widespread use of medical imaging (see Chapter 14 ), such as hepatic ultrasonography (US), computed tomography (CT) scan, and magnetic resonance imaging (MRI), has led to the increased detection of asymptomatic tumors. In the absence of underlying chronic liver…
Liver tumors encompass a large spectrum of benign and malignant neoplasms, both primary and metastatic. In addition, a variety of nonneoplastic tumor-like masses deserve attention because they can simulate neoplasms. Despite the major advances in imaging procedures, the definitive diagnosis…
Among the etiologies of portal hypertension, those caused by postsinusoidal obstruction are seen infrequently by most clinicians. Nonetheless, these disease processes represent complex clinical challenges and require a thorough knowledge of the available diagnostic and treatment modalities. Included in this…
Introduction Besides the well-established role of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of portal hypertension, additional indications in noncirrhotic, presurgical, and oncologic patients, as well as portal vein thrombosis, have evolved over the past several years. In presurgical…
Introduction Surgical shunts for portal hypertension and variceal bleeding are rarely undertaken today, making this chapter either irrelevant or more important than ever. I believe the latter. The decline in surgical shunting is generally a consequence of the perceived outcomes…
Overview Esophageal varices develop in patients with portal hypertension, most commonly secondary to hepatic cirrhosis (see Chapters 74 , 76 , and 80 ). They occur most frequently in the distal esophagus, although they may be accompanied by gastric varices.…
Treatment of esophagogastric varices This chapter addresses the role of devascularization procedures in the management of portal hypertensive bleeding. The management of variceal bleeding is based on the underlying cause, liver function, presentation, and the patient’s clinical condition. Several nonsurgical…
Overview The most important aspect of care in patients with suspected variceal or other portal hypertensive hemorrhage is adequate resuscitation and stabilization while directed diagnostic maneuvers and therapies are being coordinated (see Chapters 26 and 80 ). Although this chapter…
Introduction The presence of portal hypertension is a prerequisite for the development of, and bleeding from, varices. Portal hypertension is defined by a portal venous pressure exceeding the inferior vena cava pressure by more than 5 mm Hg (see Chapters…