Overview of molecular etiology Recent advances in molecular genetics have emphasized the multistep process of tumorigenesis. It is evident that cancer is a genetic disease involving aberrant chromosome rearrangements, genetic mutations, and epigenetic silencing of tumor suppressor genes. Independent of…
Introduction In recent years, there has been an increased understanding of the molecular and cellular processes that govern hepatopancreatobiliary (HPB) diseases. These processes, which include those that are immune-mediated, involve chronic inflammation or processes of neoplastic transformation and are driven…
Overview Bile secretion is one of the major functions of the liver, which serves two major purposes: (1) the excretion of hepatic metabolites—including bilirubin, cholesterol, drugs, and toxins—and (2) the facilitation of intestinal absorption of lipids and fat-soluble vitamins. More…
Liver fibrosis represents a scarring response to either acute or chronic liver injury. After acute liver injury, parenchymal cells regenerate to successfully preserve hepatocellular mass and function. This acute process is associated with an inflammatory and fibrogenic response but with…
Introduction to liver regeneration The ability of the liver to regenerate was recognized by the Greeks in the ancient myth of Prometheus, the Titan god of forethought, who gave fire to the mortals and angered Zeus. Prometheus was chained to…
Circulation in the liver is unique because of a dual afferent blood supply, derived from the hepatic artery (HA) and the portal vein (PV; see Chapter 2 ). The oxygen-rich arterial blood and the nutrient-rich PV blood merge in the…
The limits of hepatic resectability are constantly expanding with our increased understanding of hepatic anatomy and refinements in surgical technique (see Chapters 2 , 102 , and 118B ). In past years, partial hepatectomy was limited to anatomic resection and…
The pancreas is a complex retroperitoneal gland with both endocrine (e.g., glucose homeostasis) and exocrine (e.g., nutrient digestion) functions. An adult human pancreas measures approximately 15 cm in length and weighs between 60 to 100 g; however, its size can…
Anatomy overview Precise knowledge of the architecture of the liver, biliary tract, and pancreas and the related blood vessels and lymphatic drainage is essential for the successful performance of hepatopancreaticobiliary surgical operations. Liver The liver lies protected under the lower…
Introduction The liver’s essential structure is one of layers of metabolically active hepatocytes arrayed along and around a vascular network carrying nutrient-rich blood derived from the products of intestinal absorption, otherwise semi-isolated from the systemic circulation. The biliary ducts are…