Hepatocellular carcinoma: Difference between revisions

Revision as of 23:01, 4 January 2026

Background

Anatomy of the anus.

Internal and external hemorrhoids divided by pectinate (dentate) line

Pathologic state cccurs when internal or external hemorrhoid plexus become engorged, prolapsed, or thrombosed
Bleeding is usually limited (surface of stool, on toilet tissue, at end of defecation)
- Passage of blood clots requires evaluation for colon lesions

Risk Factors

Constipation and straining at stool
Frequent diarrhea
Older age
IBD

Types

External hemorrhoid

Thrombosed external hemorrhoid

Internal hemorrhoid
- Originate above the dentate line
- Painless
External hemorrhoid
- Originate below the dentate line
- Painful

Internal hemorrhoid chart

Internal hemorrhoid grades
Grade	Description	Diagram	Picture
I	Luminal protrusion above dentate line No prolapse Painless bleeding
II	Prolapse with spontaneous reduction Prolapse during straining
III	Prolapse requires manual reduction Prolapse during straining
IV	Prolapse—nonreducible Can result in edema and strangulation

Treatment

Increase fiber
Sitz baths
Topical steroid - Hydrocortizone
Topical anti-spasmodic - Nifedipine
See also treatment by specific type:
- Internal hemorrhoid
- External hemorrhoid

References

Authors:

@@ Line 1: / Line 1: @@
+<languages/>
+<translate>
 ==Background==
-*Most common form of liver cancer<ref>Current status of surgery and transplantation in the management of hepatocellular carcinoma: an overview. Pal S, Pande GK. J Hepatobiliary Pancreat Surg. 2001; 8(4):323-36.</ref>
-**5 new cases per 100,000 in western countries
-**> 100 per 100,000 in Southeast Asia and sub-Saharan Africa
-*Mean survival of 6-20 months, steady over the years despite progress in diagnosis and therapies directed at HCC
-*Surgical resection with transplantation, remains the best chance for cure
-**However, < 20% of patients meet criteria for resection at time of diagnosis<ref>Liver transplantation for hepatocellular carcinoma. Bismuth H, Majno PE, Adam R. Semin Liver Dis. 1999; 19(3):311-22.</ref>
-**Thus, early diagnosis is the most important step in managing HCC
-==Clinical Features==
+</translate>
-*Risk factors include:
+{{Hemorrhoid background}}
-**[[viral hepatitis|Hepatitis]] B or C
+<translate>
-**Toxins ([[alcohol]] or aflatoxin)
-**Metabolic conditions ([[hemochromatosis]], [[alpha 1-antitrypsin deficiency]], [[non-alcoholic fatty liver disease]])
-==Differential Diagnosis==
-===Liver mass<ref>Helical CT screening for hepatocellular carcinoma in patients with cirrhosis: frequency and causes of false-positive interpretation. Brancatelli G, Baron RL, Peterson MS, Marsh W. AJR Am J Roentgenol. 2003 Apr; 180(4):1007-14.</ref>===
-*Regenerating nodule
-*Hemangioma
-*Focal fat
-*Dysplastic nodules
-*Peliosis
-{{Jaundice DDX}}
+==Types==
-==Evaluation==
+[[File:M 44 anus 22.jpg|thumb|[[Special:MyLanguage/External hemorrhoid|External hemorrhoid]]]]
-[[File:Triphasic CT scan of hepatocellular carcinoma.jpg|thumb|Triphasic contrast CT of hepatocellular carcinoma.]]
+[[File:Perianal thrombosis 01.jpg|thumb|Thrombosed [[Special:MyLanguage/external hemorrhoid|external hemorrhoid]]]]
-*[[LFTs]], CBC, BMP, GGT
+*[[Special:MyLanguage/Internal hemorrhoid|Internal hemorrhoid]]
-*[[RUQ Ultrasound|Ultrasound]]
+**Originate above the dentate line
-*Initial contrasted CT
+**Painless
-*Multiphasic contrasted CT and MRI non-emergently
+*[[Special:MyLanguage/External hemorrhoid|External hemorrhoid]]
-*Biopsy
+**Originate below the dentate line
-*Surveillance with alfa-fetoprotein (AFP > 400 ng/mL) in combination with US<ref>Bialecki ES and Di Bisceglie AM. Diagnosis of hepatocellular carcinoma. HPB (Oxford). 2005; 7(1): 26–34.</ref>
+**Painful
+</translate>
+{{Internal Hemorrhoid Chart}}
+<translate>
-==Management==
-*Supportive, symptomatic treatment for complications and comorbidities
-**Cirrhotic [[jaundice]]
-**[[Hepatic encephalopathy]]
-**[[Anasarca]]
-**[[Variceal bleeding]]
-**[[Renal failure]]
-**Extrahepatic metastases, most commonly bone, lung, abdominal viscera
-**[[Paraneoplastic]] processes, such as [[hypoglycemia]], [[hypocalcemia]], polycythemia, feminization syndrome
-**Watery [[diarrhea]], [[dehydration]] are common in HCC with cirrhosis versus cirrhosis alone
-==Disposition==
+==Treatment==
-*Discussion with oncologist for first time diagnosis
-*Dependent on complications and comorbidities
+*Increase fiber
+*Sitz baths
+*Topical steroid - Hydrocortizone
+*Topical anti-spasmodic - Nifedipine
+*See also treatment by specific type:
+**[[Special:MyLanguage/Internal hemorrhoid|Internal hemorrhoid]]
+**[[Special:MyLanguage/External hemorrhoid|External hemorrhoid]]
 ==See Also==
-==External Links==
+*[[Special:MyLanguage/Anorectal disorders|Anorectal disorders]]
 ==References==
 <references/>
 [[Category:GI]]
-[[Category:Heme/Onc]]
+</translate>