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The Gastroenterology Training Handbook
For Specialist Registrars
HOME
OESOPHAGUS
•Gastro Oesophageal Reflux Disease
•Oesophageal Cancer
•Oesophageal Dysmotility
•Benign Oesophageal Lesions
•Miscellaneous
•Dysphagia
STOMACH
•Obesity Surgery
•Clinical Presentations of Gastric Conditions
•Gastric Cancer
•Gastric Polyps and Masses
•Peptic Ulcer Disease
•Gastritis and Gastropathy
•Miscellaneous
SMALL BOWEL
•Coeliac Disease
•Small Bowel Infections
•Small Bowel Masses
•Miscellaneous
COLON
•Colorectal and Anal Cancer
•Diagnostic Pathways for Colonic Disease
•Colonic Vascular Disorders
•Anal Diseases
•Various Colitides
•Colonic Motility Disorders
•Miscellaneous
•Colonic Infection
LIVER
•Alcohol
•Liver Failure
•Miscellaneous
•Ascites
•Bilirubin Metabolism
•Vascular Problems
•Clinical Presentations
•Liver Masses
•Hepatitis B
•Hepatitis C
•Autoimmune Conditions
•Metabolic Conditions
•Treatments
•Various Viruses
•Hepatopulmonary Disorders
•Liver Imaging
BILIARY
•Gallstone Disease
•Biliary Cancers
•Biliary Parasites
•Miscellaneous
NUTRITION
•Nutrition Therapy
•Minerals
•Proteins, Fats and Sugars
•Vitamins
•Clinical Conditions and Nutrition
PANCREAS
•Pancreatitis
•Pancreatic Masses and Cysts
•Pancreatic Cancers
•Other
IBD
•Epidemiology
•IBD Diagnosis
•Extra Intestinal Manifestations
•Surgery
•Treatment
MISCELLANEOUS
•Bleeding
•Rheumatological Disease
•Infection
•Vascular Lesions
•Other
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Liver -
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HCC Treament
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Written by Dr Sebastian Zeki
MCQs for this page
What the Curriculum Says
Knowledge
Recognises the importance of sepsis as a complication
Aware of the differential diagnosis and management of sepsis and its
possible sequelae
Knows the appropriate use of the appropriate antibiotics and their
complications Aware of prevention of nosocomial infection
Skills
Understands the principles and practice of diagnosis and treatment of
sepsis
Behaviours
Prepared to involve and liaise with specialist sepsis support
Also....
Knowledge
Knows the importance of clinical nutrition and its disturbances in
patients with acute and chronic liver disease
Appreciates indications for enteral or parenteral support and
understanding of limitations of these interventions
Skills
Shows ability to make careful nutritional assessment
Behaviours
Can liaise with nutritional support team where appropriate
Also...
Knowledge
Understands prognostic scoring systems including Child - Pugh
MELD UKELD Maddrey and disease-specific scoring systems where
they exist
Skills
Builds the use of accredited quantitative scoring systems into routine
clinical liver practice clinical colleagues and junior staff
Behaviours
Shows consistent application of evidence-based in the
evaluation of liver disease and the determination of prognosis
HCC Treament
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Median survival 3 months
5-year survival less than 3 cm - 50%
If AFP very raised (>4,000
and positive HbSAg
OR
AFP >400 and -ve HbSAg
AND
mass seen
If AFP not conclusive and
mass seen, biopsy (up to 30%
HCC have normal AFP
If resectable
If non resectable due to hepatic
reserve or tumour location
then
consider for tranplantation
If due to extensive disease or poor
candidate
consider localised therapy if
single lesion <5cm or systemic if
multiple and <4 lesions
Chemoembolization
Ablation
Chemotherapy with radio
Radiotherapy alone
Otherwise consider systemic therapy
:
Sorafenib
Criteria for transplantation:
The patient is not a resection candidate.
The tumour is >6cm or 2-3 tumours >3cm each.
There is no macrovascular involvement.
There is no extrahepatic tumour spread.
The patient has Child-Pugh C liver disease.
If AFP very raised and no
mass seen 3 monthly
surveillance
Resect and monitor every 3/12
If mets then consider sorafenib
Ablation or embolization options:
Radiofrequency.
Alcohol.
Cryotherapy.
Microwave.
Chemoembolization.
Radioembolization.
Bland embolization.
If non-resectable
Treatment of HCC
Consider bridging
RFA
prior to tranplantation.
Dont give adjuvant chemo as risk of HCC recur
-
rence and HCV proliferation
Written by Dr Sebastian Zeki