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دانلود کتاب BLUMGART’S Surgery of the Liver, Biliary Tract, and Pancreas
دانلود کتاب جراحی کبد، مجاری صفراوی و پانکراس توسط بلومگارت
مشخصات کتاب
BLUMGART’S Surgery of the Liver, Biliary Tract, and Pancreas
ویرایش: 6
نویسندگان: William R. Jarnagin (ed.)
سری:
ISBN (شابک) : 9780323340625, 2016013975
ناشر: Elsevier
سال نشر: 2017
تعداد صفحات: 2401
زبان: English
فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود)
حجم فایل: 543 مگابایت
قیمت کتاب (تومان) : 53,000
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Frontispiece BLUMGART’S Surgery of the Liver, Biliary Tract, and Pancreas Copyright Page Dedication Editors Contributors Preface Acknowledgments Video contents Techniques of Hepatic Resection Introduction Hepatobiliary and pancreatic surgery Ancient History Until the Eighteenth Century Eighteenth Century to Modern Times Imaging in Hepatobiliary and Pancreatic Surgery Surgery of the Biliary Tract and Pancreas Biliary Tract Pancreas Liver Surgery Major Hepatic Resection Liver Tumors Liver Transplantation References 1 Embryologic development of the liver, biliary tract, and pancreas Overview of Liver and Biliary Tract Development Endodermal Patterning Hepatic Competence Hepatic Induction Morphogenesis of the Hepatic Bud Liver Bud Growth Overview of Hepatoblast Differentiation Biliary Epithelial Cell Differentiation and Formation of the Ductal Plate Remodeling of the Ductal Plate Developmental Relationship Between the Ducts, Vessels and Mesenchyme of the Portal Tract Hepatocyte Differentiation Pancreas Overview of Pancreatic Development Basic Pancreatic Embryology Endodermal Patterning of the Pancreas Dorsal and Ventral Pancreatic Bud Development Pancreatic Mesenchyme TGF-β Signaling NOTCH Signaling HEDGEHOG Signaling WNT Endothelial Cells Glucagon Extracellular Matrix Transcription Factors PTF1a. NEUROG3. RFX6. PAX6. PAX4/ARX NKX2.2. NKX6.1 and NKX6.2. MAFA and MAFB. HNF Cascade. SRY Sex-Determining Region Y-Box: SOX9 References 2 Surgical and radiologic anatomy of the liver, biliary tract, and pancreas Anatomy Overview Liver Retrohepatic Inferior Vena Cava Hepatic Veins Functional Surgical Anatomy Surgical Implications and Exposure Biliary Tract Intrahepatic Bile Duct Anatomy Extrahepatic Biliary Anatomy and Vascular Anatomy of the Liver and Pancreas Main Bile Duct and Sphincter of Oddi Gallbladder and Cystic Duct Biliary Ductal Anomalies Anomalies of the Gallbladder and Cystic Duct Bile Duct Blood Supply Anatomy of Biliary Exposure Biliary-Vascular Sheaths and Exposure of the Hepatic Bile Duct Confluence Umbilical Fissure and Segment III Ligamentum Teres Approach Surgical Approaches to the Right Hepatic Biliary Ductal System Exposure of the Bile Ducts by Liver Resection Extrahepatic Vasculature Celiac Axis and Blood Supply of Liver, Biliary Tract, and Pancreas Variations in the Hepatic Artery Portal Vein Pancreas Pancreatic Duct Annular Pancreas Lymphatic Drainage Liver and Pancreas Nerve Supply to the Liver and Pancreas References 3 Assessment of hepatic function Preoperative Considerations Volumetric Assessment of Liver Remnant Techniques of Volumetric Assessment Volumetric Thresholds Response to Portal Vein Embolization Functional Assessment of Liver Remnant Clinical Scoring Systems Measurement of Hepatic Uptake, Metabolism, and Elimination Indocyanine Green Clearance Nuclear Imaging Techniques Other Measures of Metabolic Function Magnetic Resonance Imaging Hepatic Agents Transient Elastography Texture Analysis Conclusion References 4 Pancreatic Physiology and Functional Assessment Endocrine Pancreas Structure Synthesis and Storage Of Insulin Stimulus-Secretion Coupling for Insulin Secretion Glucagon and Other Islet Hormones Pancreatitis Consequences on Endocrine Pancreas Function Exocrine Pancreas Exocrine Pancreas Structure Acinus The Ductal Network Centroacinar Cells Ductal Epithelial Compartment Neurohormonal Regulation of Exocrine Pancreatic Function Digestive and Interdigestive Periods of Pancreatic Secretion Water, Bicarbonate, and Ion Secretion From the Ductal Network Regulation of Exocrine Secretion Feedback Inhibitory Regulation Digestive Enzymes Stimulus-Secretion Coupling in Acinar Cell Stimulus-Secretion Coupling in the Ductal Cell Functional Assessment Assessment of Endocrine Function Assessment of Exocrine Function Indirect Pancreatic Test Direct Pancreatic Function Test References 5 Liver blood flow Physiology Liver Blood Supply Hepatic Artery Portal Vein Hepatic Veins Hepatic Microcirculation Control of Liver Blood Flow Liver-Intrinsic Blood Flow Regulation The Hepatic Arterial Buffer Response. The Hepatic Inflow Is Not Controlled by Liver-Intrinsic Metabolic Needs. Regulation of Intrahepatic Resistance at the Sinusoidal Level. Liver-Extrinsic Factors Affecting Liver Inflow Endogenous Factors Blood Gas Tensions. Sympathetic Nervous System. Other Endogenous Vasoactive Agents. Exogenous Factors Anesthetic Agents. Measurement of Liver Blood Flow and Perfusion Flow in Single Vessels and Assessment of Portal Hypertension Invasive Techniques Electromagnetic Flowmeter. Transjugular Hepatic Venous Pressure Measurement. Noninvasive Techniques Doppler Ultrasound. Total Blood Flow Clearance Techniques Other Techniques of Physiologic Interest Indicator Dilution. Indicator Fractionation. Hepatic Tissue Perfusion Inert Gas Clearance Laser Doppler Flowmetry In Vivo Fluorescent Microscopy Near-Infrared Spectroscopy Investigational Techniques Clinical Relevance Hemorrhagic Shock, Hypoperfusion, and Ischemia-Reperfusion Injury Liver Atrophy Impact of Acute and Chronic Bile Duct Obstruction on Liver Blood Flow Liver Resection and Regeneration Liver Blood Flow and Hemodynamic Studies in Liver Transplantation Small-for-Size Syndrome Portal Hypertension Hemodynamics Treatments Prevention of Variceal Bleeding. Treatment of Acute Bleeding See Chapter 83. Blood Flow in Hepatic Tumors Effect of Laparoscopy on Liver Blood Flow Acknowledgements References 6 Liver regeneration: mechanisms and clinical relevance Clinical Relevance of Liver Regeneration Basic Characteristics of Liver Regeneration Models of Liver Regeneration General Features of Liver Regeneration Liver Stem Cells Induction of Proliferation: Priming and Cell-Cycle Progression Distinct Intracellular Pathways in Liver Regeneration Remodeling of the Liver Maintaining Liver Function During Regeneration Termination of Proliferation Liver Atrophy Mechanisms of Liver Atrophy Portal Vein?Induced Hepatic Atrophy Biliary-Induced Hepatic Atrophy Clinical Causes of Atrophy Compensatory Regeneration Triggered by Atrophy Factors Influencing Liver Regeneration Patient-Related Factors Age Biliary Obstruction Diabetes Mellitus Nutritional Status Gender Intrinsic Liver Disease: Steatohepatitis Pharmacologic Therapy Liver Transplantation Ischemic Injury Minimal Liver Mass Effect of Immunosuppression Donor Age Inflammation: Viral Hepatitis and Bacterial Infections Other Factors Experimental Strategies to Promote Liver Regeneration Clinical Implications When to Stimulate Liver Regeneration Preoperatively The Use of Portal Vein Embolization to Promote Regeneration Associating Liver Partition With Portal Vein Ligation for Staged Hepatectomy ALPPS Ischemic Preconditioning IPC to Stimulate Regeneration Regenerative Potential of the Liver After Chemotherapy New Horizons and Future Perspectives Therapeutic Use of Stem Cells Decellularized Hepatic Matrix and Hepatic Tissue Engineering The Role of miRNA in Liver Regeneration Summary References 7 Liver fibrogenesis Molecular and Cellular Mechanisms of Fibrosis Common Triggers of Hepatic Fibrogenesis Hepatic Stellate Cell Activation: Hepatic Myofibroblasts Functions of Hepatic Myofibroblasts Fibrogenesis Proliferation Immunoregulation Vasoregulation Structural Features of Hepatic Fibrogenesis Regulation of Collagen Deposition and Degradation Diagnosis and Clinical Monitoring of Hepatic Fibrosis Biochemical Tests Serum Assays of Extracellular Matrix Molecules Cytokines and Chemokines Associated with Hepatic Fibrosis Proteomics and Glycomics Stiffness Assessments Therapeutic Strategies Reversibility of Fibrosis: “Point of No Return? Prevention of Hepatocyte Apoptosis in Liver Injury Caspase Inhibitors Inhibition of Hepatic Stellate Cells Activation or Inactivation of Myofibroblasts Induction of Myofibroblast Apoptosis Blocking Myofibroblast?Extracellular Matrix Interactions Antagonizing Compounds That Mediate Inflammation Selectively Antagonizing Pathways of Hepatic Stellate Cell Activation Enhancing Extracellular Matrix Degradation References 8 Bile secretion and pathophysiology of biliary tract obstruction Overview Bile Secretion Bile Formation Bile Composition Bile Salt Secretion Biliary Lipid Secretion Bilirubin Secretion Bile Flow Enterohepatic Circulation Biliary Obstruction Causes of Jaundice Pathophysiology Hepatobiliary Cardiovascular Renal Coagulation Immune System Wound Healing Other Factors Management Cardiopulmonary Renal Nutrition Coagulation Pruritus Cholangitis Preoperative Drainage Summary References 9A Advances in the molecular characterization of liver tumors Overview Molecular Alterations in Cholangiocarcinoma Chromosomal Aberrations Detection of Somatic Mutations Following the Era of Deep Sequencing Translocations Consequence of Epigenetic Alterations Aberrant DNA Cytosine-Guanine Dinucleotide CpG Methylation Alterations in the Noncoding RNA Landscape Future Directions for Molecular Analysis of CCA Implementation of Next-Generation Sequencing to the Clinic References 9B Molecular pathology of pancreatic cancer and premalignant tumors Pancreatic Cancer Overview Progression Model of Pancreatic Ductal Adenocarcinoma Intraductal Papillary Mucinous Neoplasm Genetics of Pancreatic Ductal Adenocarcinoma Genomic DNA Alterations in Pancreatic Cancer Copy-Number Aberrations Specific Gene Mutations Oncogenes Tumor Suppressor Genes Other Caretaker Genes Telomere Length Abnormalities Alternative Genetic Silencing: Epigenetic Abnormalities Core Signaling Pathways Disrupted in Pancreatic Cancer Familial Pancreatic Cancer Transcriptomic RNA Abnormalities in Pancreatic Cancer Posttranscriptional Regulation MicroRNAs Molecular Genetics of Other Pancreatic Neoplasms Acinar Cell Carcinoma Pancreatic Neuroendocrine Tumors Final Thoughts and Perspectives References 9C Molecular pathogenesis of biliary tract cancer Biliary Tract Cancers Classification Epidemiology Chronic Biliary Inflammation and Cholestasis Clinical Risk Factors Biology of Clinical Risk Factors Bile Content and Deconjugation of Xenobiotics DNA Mutagens Inherited Syndrome Molecular Pathogenesis Biology of Biliary Epithelial Injury and Repair Genetic Polymorphism at Cytochrome P450 MRP2/ABCC2 MUTYH and NEIL1 Activation-Induced Cytidine Deaminase Human CYP1A2 and Arylamine N-Acteyltransferases NAT1 and NAT2 Trefoil Factor Family Biliary Epithelial Proliferation Mitogenic Factors Malignant Transformation Gene Expression Analysis Copy-Number Alterations Pre?Next-Generation Sequencing Post?Next-Generation Sequencing Epigenetic Alterations MicroRNA Alterations Tumor Growth and Metastasis Dysregulated Signaling Pathways Embryonic Signaling Epidermal Growth Factor Receptor Hepatocyte Growth Factor HGF/MET Vascular Endothelial Growth Factor and Angiogenic Signaling IL-6/JAK/STAT Cytokine Signaling Polo-Like Kinases Epithelial-to-Mesenchymal Transition Tumor-Stromal Interactions Summary References 9D Molecular biology of liver carcinogenesis and hepatitis Overview of Molecular Etiology Epidemiology Risk Factors Genetic and Epigenetic Alterations Signal Transduction Pathways Liver Cancer Stem Cells Hepatitis B Virus Hepatitis C Virus Future Directions References 10 Liver immunology Fundamentals of Immunology Anatomic Considerations Tolerance and Immunosuppression Liver Immune Cells Antigen-Presenting Cells Dendritic Cells Kupffer Cells Liver Sinusoidal Endothelial Cells Effector Cells T Cells γδ T Cells Natural Killer T Cells Natural Killer Cells B Cells Immunoinhibitory Pathways and Suppressor Cells Cytokines Tumor Necrosis Factor-α Interleukin-6 Type I Interferons Type II Interferons Immune System in Benign Liver Diseases Transplantation Hepatitis Autoimmune Hepatitis Primary Biliary Cirrhosis Primary Sclerosing Cholangitis Ischemia/Reperfusion Injury Obstructive Jaundice Partial Hepatectomy Drug-Induced Liver Disease Bacterial and Parasitic Liver Disease Immune System in Malignant Liver Diseases Immune Response to Primary Liver Cancer Immune Response to Metastatic Liver Cancer Immunotherapy for Liver Cancer Summary References 11 Cytokines in liver, biliary, and pancreatic disease Overview Cytokines, Stimuli, and Signaling Immune Recognition and Toll-Like Receptors Endotoxin and the Immune Response Tumor Necrosis Superfamily Interleukin-1 Interleukin-6 FAS Ligand Transforming Growth Factor-β Cytokines in the Liver and Pancreas Regulation of Cytokine Expression in the Liver Cytokines and the Hepatic Acute-Phase Response Cytokines and the Pancreas Cytokines and Apoptosis Nitric Oxide Liver Regeneration Pathogenesis of Endotoxin and Cytokines in Liver, Biliary, and Pancreatic Disease Pathogenesis of Proinflammatory Cytokines Cytokines in Ischemia-Reperfusion Injury Cytokines in Hepatic Tumor Ablation Future Directions References 12 Infections in hepatic, biliary, and pancreatic surgery Normal Host Defenses Defining Infectious Complications Surgical-Site Infection Remote-Site Infections General Risk Factors for the Development of Surgical-Site Infection Patient-Related Risk Procedure-Related Risk Discussion of Surgery-Specific Risk Factors for Postoperative Infectious Complications Hepatic Resection Preoperative Risk Mitigation Operative Risk Mitigation Perioperative Antibiotics Drains Postoperative Risk Mitigation Nasogastric Decompression Early Enteral Nutrition and Synbiotics Blood Glucose Control Preoperative Biliary Drainage in the Hilar Cholangiocarcinoma Patient See Chapters 27 and 51 Pancreatic Resection Preoperative Risk Mitigation Body Mass Index and Nutritional Status Preoperative Biliary Drainage Operative Risk Mitigation Preoperative Antibiotics Other Operative Risk Factors Postoperative Risk Mitigation References 13 Clinical investigation of hepatopancreatobiliary disease Clinical History Examination of the Abdomen Portal Hypertension Alcoholic Liver Disease Primary Biliary Cirrhosis Primary Sclerosing Cholangitis Budd-Chiari Syndrome Hemochromatosis Polycystic Disease and Large Liver Cysts Autoimmune Hepatitis Liver Disease in Pregnancy Acute Liver Failure Liver Masses Gallbladder and Biliary Tract Disease Gallbladder Acute Cholecystitis Biliary Colic Cholelithiasis Gallstones in the Bariatric Population Biliary Obstruction Asymptomatic Bile Duct Dilatation Bile Duct Stones Cholangitis Acalculous “Functional? Biliary Pain Sphincter of Oddi Dysfunction Pancreas Acute Pancreatitis Diagnosis and Severity Scoring Chronic Pancreatitis Pancreatic Cancer Investigation of Patients with Pancreatic Disease Assessment of Fitness for Major Hepatopancreatobiliary Surgery References 14 Emerging techniques in diagnostic imaging Dual-Energy Computed Tomography Functional Imaging with Magnetic Resonance Imaging Diagnostic Criteria Radiomics Summary References 15 Ultrasound of the liver, biliary tract, and pancreas Ultrasound Basics Principles of Ultrasound Interpretation Gray Scale Ultrasound Terminology and Artifacts Doppler Ultrasound Liver Ultrasound Normal Liver Anatomy Hepatic Masses Liver Mass Detection and Characterization Role of Contrast-Enhanced Ultrasound in Evaluation of Focal Liver Lesions Benign Liver Lesions Cystic Masses Hepatic Hemangioma Focal Nodular Hyperplasia Hepatic Adenoma Malignant Liver Neoplasms Hepatocellular Carcinoma Liver Metastases Sonography of Diffuse Liver Disease Fatty Liver Disease Viral Hepatitis Cirrhosis Role of Sonoelastography Vascular Evaluation Portal Vein Thrombosis and Cavernous Transformation Budd-Chiari Syndrome and Venoocclusive Disease Liver Transplant Evaluation Transjugular Intrahepatic Portosystemic Shunt Evaluation Ultrasound of the Gallbladder and Biliary Tree Anatomy and Technique Gallbladder Gallstones and Biliary Sludge Cholecystitis Hyperplastic Cholecystoses and Gallbladder Polyps Gallbladder Carcinoma Biliary Ducts Choledochal Cysts Biliary Obstruction Cholangiocarcinoma Ultrasound of the Pancreas Anatomy and Technique Pancreatitis Pancreatic Neoplasms Solid Neoplasms of the Pancreas Cystic Neoplasms of the Pancreas Conclusion References 16 Endoscopic ultrasound of the biliary tract and pancreas Imaging and Diagnosis Endoscopic Ultrasound Technique Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Biopsy Endoscopic Ultrasound Fine Needle Aspiration Technique Diagnosis of Pancreatic Cancer Endoscopic Ultrasound Fine-Needle Aspiration of Solid Pancreatic Lesions Endoscopic Ultrasound Fine Needle Aspiration of Pancreatic Cystic Lesions Complications of Endoscopic Ultrasound Fine-Needle Aspiration Staging of Pancreatic Cancer Endoscopic Ultrasound Tumor-Node-Metastasis Staging Endoscopic Ultrasound Determination of Vascular Involvement Preoperative Reassessment after Neoadjuvant Chemoradiotherapy Diagnosis and Staging of Cholangiocarcinoma Endoscopic Ultrasound-Guided Therapy Celiac Plexus Neurolysis Drainage of Pseudocysts and Peripancreatic Collections Tumor Localization Novel Therapeutics Summary References 17 Role of nuclear medicine in diagnosis and management of hepatopancreatobiliary disease Radiopharmaceuticals Diagnostic Imaging in Nuclear Medicine “Can I Order Two Nuclear Medicine Scans on the Same Day?? Advantages of Positron Emission Versus Single-Photon Imaging Fusion Imaging “Are All PET and SPECT Scanners Created Equal?? Pharmacology and Biology in Radiopharmaceutical Imaging Radiation Dose in Nuclear Medicine Diagnostic Nuclear Imaging in Hepatopancreatobiliary Oncology Nuclear Oncology Fluorodeoxyglucose Positron Emission Tomography Colorectal Cancer Metastasis to Liver Unresectable Liver Cancer Management of Patients With Hepatocellular Carcinoma Initial Presentation See Chapter 91 Tumor-Response Evaluation Recurrence Cholangiocarcinoma See Chapters 50 and 51 Focal Liver Lesions Diagnosis and Follow-Up of Pancreatic Diseases Pancreatic Cancer See Chapters 59 and 62 Detection Staging See Chapter 62 Pancreatic Tumor Response and Recurrence Assessment of Pancreatic Function See Chapter 4 Gastroenteropancreatic Neuroendocrine Tumors See Chapter 65 Peptide Receptor Radionuclide Imaging and Therapy Hepatobiliary Scintigraphy Normal Hepatobiliary IDA Radiotracer Scan Augmented Hepatobiliary Scintigraphy Right Upper Quadrant Pain Acute Cholecystitis See Chapter 33 Chronic Cholecystitis See Chapter 33 Extrahepatic Bile Duct Obstruction Postcholecystectomy Syndrome and Sphincter of Oddi Dysfunction See Chapter 38 Biliary Tract Complications After Surgery Liver Transplantation Pediatric Imaging Neonatal Jaundice Biliary Atresia Role of General Nuclear Medicine in Assessment of Adults With Malignant Involvement of the Liver and Hepatobiliary Tree Sulfur Colloid Imaging Hepatic Arterial Perfusion Studies References 18 Computed tomography of the liver, biliary tract, and pancreas Imaging Overview and History Recent Technical Advances Role of Computed Tomography in Liver and Biliary Imaging Technique and Protocols Noncontrast Computed Tomography of the Liver Contrast-Enhanced Computed Tomography of the Liver Arterial Phase Imaging. Portal Venous Phase Imaging. Delayed Imaging Phases. Anatomy Gross Morphology Segmental Anatomy Vascular Anatomy Biliary Anatomy Lesion Evaluation Benign Tumors and Tumor-Like Conditions of the Liver Cyst See Chapters 75 and 90B Hemangioma See Chapter 90A Focal Nodular Hyperplasia See Chapter 90A Adenoma See Chapter 90A Biliary Hamartoma See Chapters 48 and 90A Bile Duct Adenoma See Chapters 48 and 90A Inflammatory Conditions Pyogenic Abscess See Chapter 72 Fungal Abscesses See Chapter 72 Echinococcus See Chapter 74 Amebic Abscess See Chapter 73 Diffuse Hepatocellular Diseases Fat Deposition See Chapter 71 Cirrhosis See Chapters 76 and 103D Budd-Chiari Syndrome See Chapter 88 Hepatic Infarction Malignant Lesions of the Liver Hepatocellular Carcinoma See Chapter 91 Fibrolamellar Carcinoma See Chapter 91 Angiosarcoma See Chapter 89 Hepatic Lymphoma Hepatic Metastases See Chapters 92 to 94 Biliary System Gallstones Cholecystitis See Chapter 33 Mirizzi Syndrome See Chapter 33 Choledocholithiasis See Chapters 36 and 37 Gallbladder Carcinoma See Chapter 49 Cholangiocarcinoma See Chapters 50 and 51 Perihilar Cholangiocarcinoma See Chapter 5. Distal Cholangiocarcinoma See Chapter 59. Intrahepatic Peripheral Cholangiocarcinoma See Chapter 50. Biliary Cystic Tumors Cystadenoma and Cystadenocarcinoma See Chapter 90B Computed Tomography in Pancreatic Imaging: History and Role Technique and Protocols Anatomy of the Pancreas Tumors of the Pancreas Pancreatic Ductal Adenocarcinoma See Chapters 59 and 66 Pancreatic Endocrine Neoplasm See Chapter 65 Cystic Pancreatic Neoplasms See Chapter 60 Intraductal Papillary Mucinous Neoplasm See Chapter 60. Serous Cystadenoma See Chapter 60. Mucinous Cystic Neoplasms See Chapter 60. Solid Pseudopapillary Neoplasm See Chapters 59 and 60. Other Cystic Pancreatic Lesions. Metastatic Disease to the Pancreas See Chapter 64 Acinar Cell Carcinoma of the Pancreas See Chapter 59 Inflammatory Diseases of the Pancreas Pancreatitis See Chapters 54 to 58 Lymphoplasmacytic Autoimmune Pancreatitis See Chapter 59 Groove Pancreatitis Other Nonneoplastic Pancreatic Masses: Ectopic Splenic Tissue References 19 Magnetic resonance imaging of the liver, biliary tract, and pancreas Principles of Magnetic Resonance Imaging Magnetic Resonance Imaging Safety Magnetic Resonance Imaging Cholangiopancreatography Magnetic Resonance Imaging Contrast Agents Normal Hepatic Appearance on Magnetic Resonance Imaging Diffuse Hepatic Disease Fatty Liver Iron Deposition Disease Focal Hepatic Lesions Cysts Hemangioma Focal Nodular Hyperplasia Hepatic Adenoma Hepatic Abscess/Infection Hepatic Metastases Hepatocellular Carcinoma Fibrolamellar Carcinoma Less Common Hepatic Tumors Lymphoma Angiomyolipoma Mesenchymal Tumors Epithelioid Hemangioendothelioma Biliary Cystadenoma and Biliary Cystadenocarcinomas Biliary Tumors Gallbladder Carcinoma Bile Duct Cancer Benign Diseases of the Biliary Tract Cholelithiasis and Choledocholithiasis Choledochal Cysts Postoperative Biliary Complications Pancreas Solid Tumors of the Pancreas Pancreatic Cancer Cystic Lesions of the Pancreas Intraductal Papillary Mucinous Neoplasms Autoimmune Pancreatitis References 20 Direct cholangiography Direct Cholangiography Overview Percutaneous Transhepatic Cholangiography History Preprocedural Preparation Procedure Right-Sided Puncture Left-Sided Puncture Success Rate and Accuracy Pitfalls in Interpretation Lack of Opacification Ductal Dilatation Complications Endoscopic Retrograde Cholangiopancreatography History Indications Technique Pancreatography Cholangioscopy and Pancreatoscopy Complications Pancreatitis Infection Bleeding Perforation Direct Cholangiography and Pancreatography by Percutaneous Transhepatic Cholangiography OR Endoscopic Retrograde Cholangiopancreatography Interpretations Bile Leaks Filling Defects Air Bubbles, Blood Clots, Calculi, Primary and Secondary Bile Duct Cancers, and Parasitic Diseases Conclusion References 21 Diagnostic angiography in hepatobiliary and pancreatic disease Overview Angiography Technique Hepatobiliary and Pancreatic Arterial Anatomy Arterial Anatomy Venous Anatomy Angiography Indications Treatment of Bleeding/Hemorrhage Splenic Bleeding Hepatic Bleeding Pancreas Bleeding Diagnosis of Arterial Occlusive Disease Diagnosis and Treatment of Arterial Stenosis Treatment of Visceral Arterial Aneurysms Diagnosis of Vasculitis Vasculitis Diagnosis of Other Visceral Vascular Disease Segmental Arterial Mediolysis Hereditary Hemorrhagic Telangiectasia Peliosis Hepatitis Localization of Functional Pancreatic Neuroendocrine Tumors See Chapter 65 Insulinomas Gastrinomas Glucagonoma Venographic Technique References 22 Percutaneous biopsy Overview Biopsy Technique Fine Needle Aspiration Core Biopsy Imaging Guidance Ultrasound Computed Tomography Computed Tomographic Fluoroscopy Cone-Beam Computed Tomography Magnetic Resonance Imaging Positron-Emission Tomography Other Guidance Biopsy of Specific Sites Liver Biopsy Focal Liver Lesions Liver Parenchyma Biopsy Transvenous Biopsy Biopsy of Other Organs Adrenal Biopsy Pancreas Biopsy Retroperitoneal and Pelvic Biopsy Lung and Mediastinum Biopsy Bone Biopsy Complications of Percutaneous Biopsy Conclusion References 23 Intraoperative diagnostic techniques Overview Intraoperative Ultrasonography Hepatic Disease Evaluation of the Liver Technical Considerations Biliary Disease Evaluation of the Biliary Tree Technical Considerations Pancreatic Disease Evaluation of the Pancreas Technical Considerations Intraoperative Cholangiography Choledocholithiasis Biliary Injuries Controversies Technical Considerations Staging Laparoscopy Surgical Technique Technical Considerations Laparoscopic Ultrasound Complications Staging Laparoscopy for Potentially Resectable Disease Hepatobiliary Malignancy Pancreatic and Periampullary Malignancy Controversies References 24 Intraoperative and immediate postoperative management Overview Preoperative Evaluation Risk and Outcome Improvement Cardiac Evaluation Pulmonary Evaluation Hepatic Evaluation See Chapter 3 Alcohol Use Disorder Jaundice Bloodless Surgery: Blood Conservation Intraoperative Management Hepatic Blood Flow Volatile Anesthetics Anesthetic Hepatotoxicity Hemodynamics Intravenous Anesthetics and Muscle Relaxants Epidural Anesthesia EDA Special Anesthetic Considerations Anesthesia for Hepatectomy Low Central Venous Pressure Technique: General Anesthesia Phase 1: Prehepatic Postresection: Phase 2 Goal-Directed Individual Fluid Therapy Low Central Venous Pressure: Epidural Anesthesia Air Embolus Bloodless Surgery: Blood Conservation, Transfusion Minimally Invasive Liver Resection Ablation Postoperative Care Cardiopulmonary Cardiac Dysfunction Pulmonary Dysfunction Venous Thromboembolism Liver Dysfunction See Chapters 79 to 81 Jaundice Coagulation Ascites Renal Dysfunction Glucose Metabolism Analgesia Epidural Analgesia Intraabdominal Infection Delirium: Encephalopathy References 25 Perioperative critical care in hepatopancreatobiliary patients Introduction Preoperative Assessment and Care Hepatic Reserve with Child-Turcotte-Pugh and Model for End-Stage Liver Disease Scores Comorbid Conditions Ascites, Portal Hypertension, and Variceal Bleeding Nutrition Anemia Coagulopathy Cardiovascular and Respiratory Parameters Hepatopulmonary Syndrome and Portopulmonary Hypertension Electrolytes Infection Surgical Procedures Assessment for Pancreatobiliary Surgery Intraoperative Management Selection of Anesthetic, Narcotic, and Sedative Agents Management of Mechanical Ventilation Fluid/Blood Loss and Hemodynamic Parameters Correction of Electrolyte Abnormalities Improved Surgical Techniques Postoperative Management Postoperative Hepatic Failure Fluid Management and Abdominal Compartment Syndrome Acute Renal Failure and Hepatorenal Syndrome Anemia and Hemorrhage Sedative and Pain Management and Hepatic Encephalopathy Liver Regeneration, Hyperglycemia, and Nutrition Postoperative Care after Pancreaticoduodenectomy Venous Thromboembolism Prophylaxis References 26 Preoperative and postoperative nutrition in hepatobiliary surgery Goals of Nutritional Support in Hepatopancreatobiliary Surgery Alterations in Liver Metabolism That Affect Nutritional Status Antioxidant Nutrient Depletion in the Pathogenesis of Liver Injury Vitamin E Vitamin C Omega-3 Fatty Acids Obstructive Jaundice Cirrhosis and Liver Failure Liver Resection Transplantation Hepatocellular Carcinoma Nutritional Problems in Patients With Pancreatic Diseases Etiology of Malnutrition With Pancreatic Disease Pancreatic Cancer See Chapter 62 Pancreatic Exocrine Insufficiency Biliary Obstruction Pain Cancer-Related Effects on Metabolism Malnutrition and Pancreatic Resection Nutritional Implications of Pancreatic Resection Chylous Ascites Delayed Gastric Emptying Pancreatic Fistula Identification of Patients at Risk for Postoperative Complications Anthropometric Measurements Bioelectrical Impedance Sarcopenia Serum Biochemical Markers Albumin Prealbumin Nutritional Scoring Systems Nutritional Risk Index Nutritional Risk Score Subjective Global Assessment Malnutrition Universal Screening Tool Glasgow Prognostic Score Nutritional Support of Patients Undergoing Hepatopancreatobiliary Surgery Routes of Feeding Parenteral Nutrition Enteral and Parenteral Nutrition Nutritional Support as Part of Enhanced Recovery after Surgery Programs Immune-Modulating Nutrition Vitamins Probiotics and Synbiotics Appetite Stimulants Disease- and Condition-Specific Management Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis Cirrhosis and Hepatic Failure Liver Resection Liver Transplantation Pancreatic Cancer Summary References 27 Postoperative complications requiring intervention Overview Pancreatectomy Defining and Grading Complications After Pancreatectomy Postoperative Pancreatic Fistula: A Unifying System for Reporting Management of Postpancreatectomy Complications Postoperative Pancreatic Fistula Delayed Gastric Emptying Postpancreatectomy Hemorrhage Postpancreatectomy Hemorrhage: Definitions, Terminology, and Grading Postpancreatectomy Hemorrhage Validation Studies Imaging and Image-Guided Therapy of Complications After Pancreatectomy Imaging After Pancreatectomy Interventional Radiology Techniques After Pancreatectomy Image-Guided Abdominal Drainage Drain Management Interventional Management of Pancreaticocutaneous Fistulae Percutaneous Biliary Drainage Angiography, Embolization, and Covered Stent Placement See Chapters 21 and 30 Hepatectomy Complications Associated With Hepatic Resections Posthepatectomy Liver Failure Bile Leak Posthepatectomy Hemorrhage Techniques for Reducing Intraoperative Blood Loss Imaging and Image-Guided Therapy of Complications After Hepatectomy Imaging After Hepatectomy Interventional Radiology Procedures Posthepatectomy Intrahepatic Abscess Drainage Interventional Management of Bilomas and Bile Leaks Interventional Management of Biliary Strictures Bleeding Complications References 28 Quality of life and hepatobiliary tumors Quality of Life and Health-Related Quality of Life: What Lies Beneath the Survival Curve? Health-Related Quality of Life as an Outcome Measure in Surgery: Why and When? Surgeon, Patient, or Caregiver: WHO Should Gather HRQoL Information? HRQoL Measurement Tools, Instruments, and Interpretation Health-Related Quality-of-Life Studies in Hepatobiliary Cancer Pancreatic Resection Hepatic Resection Locoregional Treatment of Hepatic Tumors Palliative Treatments Gastric Outlet Obstruction Malignant Biliary Obstruction Challenges in Health-Related Quality-of-Life Research and Future Directions References 29 Interventional endoscopy Overview Techniques for Biliary Access Endoscopic Retrograde Cholangopancreatography Standard Cannulation Technique Endoscopic Retrograde Cholangopancreatography Pancreatic Duct Wire or Stent Placement to Facilitate Biliary Access Access “Precut? Sphincterotomy for Biliary Access Transpancreatic Precut Sphincterotomy Goff Technique Techniques for the Management of Choledocholithiasis Biliary Sphincterotomy Biliary Sphincteroplasty Stone Extraction Lithotripsy Mechanical Lithotripsy Endoscopic Intraductal Lithotripsy Extracorporeal Shock-Wave Lithotripsy Techniques for the Management of Biliary Strictures Types of Biliary Stents Plastic Stents Self-Expandable Metal Stents Endoscopic Management of Benign Biliary Strictures Endoscopic Technique Efficacy and Outcomes of Endoscopic Stenting of Benign Biliary Strictures Endoscopic Management of Malignant Biliary Strictures Preoperative Biliary Drainage Palliative Biliary Drainage of Distal Bile Duct Obstruction Palliative Biliary Drainage of Proximal Bile Duct Obstruction Hilar Photodynamic Therapy Radiofrequency Ablation Techniques for the Management of Bile Leak Endoscopic Management of Ampullary Adenomas Diagnosis and Local Staging Endoscopic Therapy Advanced Techniques for Biliary Access Techniques for Biliary Access in Patients With Surgically Altered Anatomy Endoscopic Retrograde Cholangopancreatography in Patients With a Gastrojejunostomy Bilroth II Endoscopic Retrograde Cholangopancreatography in Patients With a Roux-en-Y Anatomy Endoscopic Ultrasound?Guided Biliary Drainage Endoscopic Ultrasound Rendezvous Technique Endoscopic Ultrasound?Guided Antegrade Biliary Drainage Endoscopic Ultrasound?Guided Transluminal Biliary Drainage Endoscopic Biliary Tissue Acquisition and Advanced Imaging Techniques Biliary Tissue Acquisition and Analysis Intraductal Brushings Biliary Intraductal Biopsies Molecular Analysis of Tissue Samples Advanced Endoscopic Biliary Imaging Peroral Cholangioscopy Endoscopic Intraductal Ultrasound Confocal Laser Endomicroscopy References 30 Radiologic hepatobiliary interventions Radiologic Hepatobiliary Interventions Vascular Procedures Portal Vein Hepatic Artery Hepatic Vein Biliary Intervention Bile Duct Biopsy Percutaneous Cholecystostomy Biliary Stone Disease Bile Duct Injury Hepatic Cysts Hepatic Abscess Amebic Abscess Echinococcal Cysts Hepatic Ablation Tumors Criteria for Treatment Results References 31 Bile duct exploration and biliary-enteric anastomosis Overview Anatomy Bile Duct Exploration Overview Incision and Exposure Supraduodenal Exploration Transduodenal Exploration T-Tubes Outcomes Biliary-Enteric Anastomosis Overview Incision and Exposure Hepaticojejunostomy Approach to Right Hepatic Duct Approach to Left Hepatic Duct Approach to Segment III Duct Construction of Anastomosis Choledochojejunostomy Choledochoduodenostomy Cholecystoduodenostomy and Cholecystojejunostomy Outcomes References 32 Natural history of gallstones and asymptomatic gallstones History Epidemiology Risk Factors for Gallstones Development Age Gender Obesity, Diet, Physical Activity, and Weight Loss Genetics Other Risk Factors Natural History of Gallstones Gallstones, Porcelain Gallbladder, and Gallbladder Carcinoma See Chapter 49 References 33 Cholecystitis Overview Acute Cholecystitis Pathogenesis Clinical Manifestations Differential Diagnosis Diagnostic Evaluation and Imaging Treatment Timing of Surgery Chronic Cholecystitis Pathogenesis and Clinical Manifestations Diagnostic Imaging Treatment Acute Acalculous Cholecystitis Pathogenesis Clinical Manifestations Diagnostic Evaluation and Imaging Treatment Complications of Cholecystitis Gangrenous Cholecystitis Empyema Emphysematous Cholecystitis Mirizzi Syndrome Cholecystoenteric Fistula References 34 Percutaneous treatment of gallbladder disease Overview Indications and Contraindications for Percutaneous Cholecystectomy Acute Calculous Cholecystitis in High-Risk Patients Acute Calculous Cholecystitis With Delayed Presentation Acute Acalculous Cholecystitis in High-Risk Patients Special Populations Pregnancy Sepsis of Unknown Origin in the Intensive Care Conclusion Technical Aspects and Complications Insertion Technique Complications Management of the Percutaneous Cholecystectomy Catheter and the Gallbladder Percutaneous Treatment of Gallstones: Techniques of Historic Interest References 35 Technique of cholecystectomy Overview Indications Laparoscopic Versus Open Techniques Laparoscopic Technique Operating Room Setup Pneumoperitoneum Port Placement and Exposure Dissection and Critical View of Safety Completion of Cholecystectomy Three-Port and Two-Port Techniques Single-Incision Laparoscopic Surgery Robotic Cholecystectomy Contraindications Cirrhosis Conversion to Open Open Technique Incision Exposure and Placement of Retractors Dissection Retrograde Cholecystectomy Anterograde, or Fundus-Down, Cholecystectomy Partial or Subtotal Cholecystectomy Intraoperative Problems Anatomic Variations Gallbladder Perforation Biliary Injury Bleeding Bowel Injury Postoperative Management Conclusion References 36A Stones in the bile duct: clinical features and open surgical approaches and techniques Overview Origin of Choledocholithiasis Preoperative Diagnosis Timing and Sequence of Interventions Suspected Choledocholithiasis Prior to Cholecystectomy Common Bile Duct Exploration at Time of Open Cholecystectomy Postcholecystectomy Choledocholithiasis See Chapter 38 Incidence Treatment Retained Stones in the Presence of A T-Tube. Retained or Recurrent Stones in the Absence of A T-Tube. Clinical Experience With Reoperation Surgical Techniques for Exploration of the Common Bile Duct Supraduodenal Choledochotomy and Exploration of the Common Bile Duct Exposure Choledochotomy Exploration of the Duct Postexploratory Investigations Choledochoscopy T-Tube Cholangiography T-Tube Drainage. T-Tube Placement. Avoiding Problems in the Closure of the Choledochotomy. Postoperative Management. Transduodenal Sphincteroplasty Indications Stones Impacted in the Distal Ampullary Region. Multiple and Recurrent Common Bile Duct Stones. Papillary Stenosis. Pyogenic Cholangitis See Chapter 43. Chronic Pancreatitis and Acute Gallstone Pancreatitis See Chapters 55 to 58. Technique Preparation, Position of the Patient, and Incision Preparation of the Operative Field and Exposure Duodenotomy Identification of the Papilla Sphincteroplasty Instrumental Exploration of the Common Bile Duct Duodenal Closure Comment Review of Reported Results References 36B Stones in the bile duct Overview Indications Clinical Scenarios Preoperative Choledocholithiasis Intraoperative Choledocholithiasis See Chapters 31 and 36A Postoperative Choledocholithiasis Techniques Laparoscopic Transcystic Common Bile Duct Exploration Laparoscopic Transcholedochal Common Bile Duct Exploration Laparoscopic Transduodenal Sphincterotomy and Common Bile Duct Exploration Laparoscopic Biliary-Enteric Bypass Laparoscopic-Assisted Endoscopic Retrograde Cholangiopancreatography Conclusion References 36C Stones in the bile duct: endoscopic and percutaneous approaches Historical Overview Indications for Endoscopic Therapy Endoscopic Techniques Difficult Stones Endoscopic Papillary Large Balloon Dilation Mechanical Lithotripsy Other Lithotripsy Modalities Electrohydraulic Lithotripsy Laser Lithotripsy Extracorporeal Shock-Wave Lithotripsy Endoprosthesis Placement Dissolution Therapy Results of Endoscopic Therapy Complications of Endoscopic Therapy Long-Term Morbidity Laparoscopic and Percutaneous Approaches to Bile Duct Stones Laparoscopic Common Bile Duct Exploration Percutaneous Approach Specific Clinical Scenarios Pregnancy Patients With Gallbladder in Situ Suspected Choledocholithiasis Acute Cholangitis Gallstone Pancreatitis Conclusions References 37 Cholecystolithiasis and stones in the common bile duct: which approach and when? Cholecystolithiasis Indications for Cholecystectomy Asymptomatic Gallstones Symptomatic Gallstones Biliary Colic. Cholecystitis. Grade I Acute Cholecystitis. Grade II Acute Cholecystitis. Grade III Acute Cholecystitis. Uncommon Presentations of Acute Cholecystitis. Cholecystectomy Technique Choosing Laparoscopic Versus Open Techniques Percutaneous Cholecystostomy Timing of Subsequent Operation for Cholecystitis Choledocholithiasis Silent Common Bile Duct Stones Diagnostic Considerations Imaging Modalities: Why and When Transabdominal Ultrasound Endoscopic Retrograde Cholangiopancreatography Endoscopic Ultrasound Intraoperative Cholangiography Symptomatic Common Bile Duct Stones Definitive Treatment Approaches: Biliary Obstruction Catheter-Based Approaches ERCP See Chapters 20, 29, 36B, and 36C. Percutaneous Transhepatic Cholangiography. Surgical Approaches: Open and Laparoscopic Techniques Approach to Recurrent Common Bile Duct Stones Cholecystectomy With Intraoperative Cholangiography. Common Bile Duct Exploration: Transcystic Versus Choledochotomy Access. Gallstone Pancreatitis Cholangitis Need for Cholecystectomy After Endoscopic Retrograde Cholangiopancreatography/Sphincterotomy Conclusion References 38 Postcholecystectomy problems Overview Indications for Cholecystectomy Overall Morbidity of Cholecystectomy Postcholecystectomy Problems: Overview Immediate Technical Problems Bile Leak and Bile Duct Injury Hemorrhage Infection Retained Common Bile Duct Stones Delayed Technical Problems Spilled Gallstones Gallbladder Remnant and Remnant Cystic Duct Lithiasis Biliary Strictures Functional Problems Sphincter of Oddi Dysfunction Postcholecystectomy Diarrhea Diagnostic Studies in the Evaluation of Postcholecystectomy Problems Ultrasound Cholangiopancreatography Hepatobiliary Scintography Axial Imaging Algorithm for the Evaluation of Postcholecystectomy Pain Conclusions References 39 Intrahepatic stones Overview Epidemiology Etiology Secondary Hepatolithiasis Cholangiocarcinoma Symptoms Diagnosis Imaging Diagnosis Abdominal Ultrasound Abdominal Computed Tomography Magnetic Resonance Imaging Percutaneous Transhepatic Cholangiography and Endoscopic Retrograde Cholangiography Treatment for Hepatolithiasis Pharmacologic Therapy Percutaneous Transhepatic Cholangioscopic Lithotomy Peroral Cholangioscopic Lithotripsy POCSL Surgical Treatment Prognosis References 40 Extrahepatic biliary atresia Overview Etiology Epidemiology Clinical Features Workup Surgical Management Preoperative Care Surgical Technique Postoperative Outcomes Postoperative Complications Cholangitis Portal Hypertension Hepatopulmonary Syndrome Malignancy Controversies in the Management of Biliary Atresia Postoperative Steroids Liver Transplantation References 41 Primary sclerosing cholangitis Overview Epidemiology Clinical Presentation Diagnosis Other Serologic Abnormalities Imaging Modalities Histopathology Etiopathogenesis Natural History Associated Diseases Inflammatory Bowel Disease and Colorectal Cancer Autoimmune Hepatitis Complications Gallbladder Disorders and Choledocholithiasis Dominant Strictures Cholangiocarcinoma Cirrhosis and Portal Hypertension Pruritus Fatigue Fat-Soluble Vitamin Deficiency and Steatorrhea Hepatic Osteodystrophy Peristomal Varices and Pouchitis After Proctocolectomy Treatment of Primary Sclerosing Cholangitis Pharmacotherapy Surgical Therapy Resection of Cholangiocarcinoma Orthotopic Liver Transplantation Conclusion References 42 Biliary fistulae and strictures Overview Internal Biliary Fistulae Incidence and Etiology Fistulae Involving the Gallbladder Fistulae Involving the Common Bile Duct, Cystic Duct Remnant, and Other Extrahepatic Ducts Fistulae Involving the Intrahepatic Ducts, Liver, and Lung Diagnostic Tests Laboratory Testing Plain and Contrast Radiographs Direct Cholangiography Radionuclide Imaging Sonography Computed Tomography and Magnetic Resonance Imaging Cholangiopancreatography Specific Clinical Presentations and Treatment Gallstone Ileus Cholecystoduodenal Fistulae Cholecystocolic Fistulae and Choleric Enteropathy Cholecystocholedochal Fistula, Including Mirizzi Syndrome Proximal Choledochoduodenal Fistulae and Chronic Peptic Ulcer Disease Distal Parapapillary Choledochoduodenal Fistula Fistula to the Hepatic Veins or Portal Veins External Biliary Fistulae and Strictures Etiology and Prevention Fistulae After Cholecystostomy Biliary Fistulae After Other Invasive Radiologic Procedures Injury, Stricture and Fistulae After Abdominal Operations Clinical Presentation Pathologic Consequences of External Biliary Fistulae Diagnostic Procedures and Initial Management Treatment Bile Duct Injury at Cholecystectomy Incidence Pathogenesis Anatomic Variations Biliary Ischemia Pathologic Factors Technical Factors General Laparoscopic-Specific Factors Location and Classification Biliary Injury: Clinical Presentation Pathologic Consequences Fibrosis Atrophy Portal Hypertension Management Radiologic Investigations Preoperative Preparation Surgical Treatment Injury Recognized at Initial Operation. Injury Recognized in the Immediate Postoperative Period. Injury Presenting at an Interval After Initial Operation. Technical Approaches to Biliary Repair See Chapter 31 End-to-End Duct Repair. Biliary-Enteric Repair. Liver Split and Liver Resection. Isolated Sectoral Hepatic Duct Injuries. Combined Modality Approaches. Hepatic Resection See Chapter 103. Liver Transplantation See Chapter 112. Portal Hypertension and Biliary Stricture See Chapter 76. Results of Biliary Reconstruction. Operative Morbidity and Mortality. Long-Term Results and Follow-Up. Nonoperative Approaches. Bile Duct Injury After Other Operations Nontraditional Cholecystectomy Biliary Reconstructive Operations Open Cholecystectomy Common Duct Exploration Liver Resection Other Procedures Nonsurgical Conditions Causing Fistulae and Strictures After Liver Truama Recurrent Pyogenic Cholangitis Chronic Pancreatitis Hydatid Disease References 43 Cholangitis Overview Cholangitis Pharmacologic Treatment for Cholangitis Duration of Antibiotic Therapy for Cholangitis Diagnostic Imaging Studies Transabdominal Ultrasound Endoscopic Ultrasound Intraductal Ultrasonography Computed Tomography Magnetic Resonance Cholangiopancreatography Direct Cholangiography Percutaneous Transhepatic Cholangiography Management of Cholangitis Extrahepatic Biliary Stone Obstruction: Procedures for Biliary Decompression Endoscopic Biliary Decompression See Chapters 29 and 36C Contraindications Percutaneous Transhepatic Cholangiography and Drainage See Chapters 30 and 52 Standard Procedure Contraindications Open Common Bile Duct Exploration See Chapters 31 and 36 Intrahepatic Biliary Stone Obstruction See Chapters 39 and 44 Recurrent Pyogenic Cholangitis See Chapter 44 Nonlithiatic Biliary Obstruction AIDS Cholangiopathy Biliary-Enteric Strictures Primary Sclerosing Cholangitis Immunoglobulin G4?Associated Cholangitis Cholangitis and Intraabdominal Hepatic Abscess Summary References 44 Recurrent pyogenic cholangitis Etiology and Pathogenesis Pathology Clinical Features Investigations Management Acute Attack Surgical Treatment During an Acute Attack Nonsurgical Treatment of an Acute Attack Definitive Surgery Approach to the Biliary Tract Removal of Stones During Laparotomy Cholecystectomy Biliary Drainage Procedures Hepaticocutaneous Jejunostomy Postoperative Choledochoscopy and Extraction of Stones Hepatic Resection Treatment for Intrahepatic Duct Strictures Liver Transplantation Results of Treatment Short-Term Results Long-Term Results Conclusion References 45 Biliary parasitic disease Fascioliasis Epidemiology Life Cycle Risk Factors Clinical Manifestations Acute Infection Chronic Infection Fasciola and Liver Fibrosis Imaging Studies Abdominal Ultrasound Computed Tomography Magnetic Resonance Imaging Diagnosis Acute Phase Chronic Phase Diagnosis of Fascioliasis by Surgery Treatment Future Directions and Vaccines Clonorchiasis and Opisthorchiasis Life Cycle Clinical Manifestations Clonorchis sinensis Opisthorchis viverrini Opisthorchis felineus Consequences of Chronic Infection Treatment Other Parasitoses of the Biliary Tract References 46 Bile duct cysts in adults Diagnosis Classification Etiology Demographics Clinical Features Imaging Associated Hepatobiliary Pathology Malignancy and Bile Duct Cysts See Chapters 49, 51B, and 59 Treatment General Principles Type I Cyst Type II Cyst Type III Cyst Choledochocele Type IV Cyst Caroli Disease Laparoscopic Advances in Surgical Management References 47 Tumors of the biliary tree Invasive Carcinomas of the Biliary Tract Growth Patterns and Macroscopic Features Microscopic Features Anatomic Variants Pathologic Differential Diagnosis Immunohistochemical and Molecular Characteristics Other Types of Carcinomas in the Biliary Tract Clinically Relevant Pathologic Parameters in Biliary Carcinomas Tumor Type. Invasive Versus Noninvasive Components. Pathologic Stage. Grading. Perineural and Vascular Invasion. Assessment of Surgical Margins. Noninvasive Epithelial Neoplasia Dysplasia Biliary Intraepithelial Neoplasia Mass-Forming Intraepithelial Neoplasms Neuroendocrine Neoplasms Other Tumors Mesenchymal Tumors Secondary Tumors Hematopoietic Malignancies Tumorlike Lesions References 48 Benign tumors and pseudotumors of the biliary tract Embryologic and Anatomic Factors See Chapters 1 and 2 Clinical Presentations and Diagnosis Papilloma and Adenoma Treatment Multiple Biliary Papillomatosis Granular Cell Tumors Neuroendocrine Tumors See Chapter 93 Neural Tumors Leiomyomas Pseudotumors Heterotopic Tissue References 49 Tumors of the gallbladder Epidemiology Etiology Anatomic Considerations Pathology see Chapter 47 Preneoplastic Lesions Gross Morphology Histology see Chapter 47 Molecular Biology see Chapter 9C Pattern of Spread Clinical Presentation Radiologic Investigation Preoperative Pathologic Diagnosis Staging Surgical Management Benign Polyps Gallbladder Carcinoma Incidentally Discovered During or After Routine Cholecystectomy Staging Laparoscopy Extent of Resection by Stage Liver Resection Lymph Node Dissection Port Site Recurrences Results T1 Tumors Confined to Muscular Coat T2 Tumors Invading Subserosal Layer T3/T4 Tumors Locally Advanced Regional Lymph Node Positivity Gallbladder Cancer Discovered Incidentally After Laparoscopic Cholecystectomy Significance of Jaundice on Presentation Adjuvant Therapy Palliative Management Summary References 50 Intrahepatic cholangiocarcinoma Epidemiology and Demographics Etiology and Risk Factors Primary Sclerosing Cholangitis see Chapter 43 Parasitic Infections see Chapter 45 Hepatolithiasis see Chapters 39 and 44 Congenital Biliary Cystic Disease see Chapter 46 Hepatic Cirrhosis and Viral Infections see Chapters 70 and 76 Benign Biliary Tumors see Chapters 48 and 90B Chemical Agents General Risk Factors Pathogenesis see Chapter 9C Pathologic Subtypes and Mode of Spread see Chapter 47 Clinical Presentation Diagnosis and Evaluation Serum Markers for Cholangiocarcinoma Bile Markers for Cholangiocarcinoma Imaging Transabdominal Ultrasound see Chapter 15 Computed Tomography see Chapter 18 Magnetic Resonance Imaging see Chapter 19 Positron Emission Tomography see Chapter 17 Staging Treatment Surgical Hepatic Resection see Chapter 103B Status of Lymphadenectomy Transplantation see Chapter 115B Tumor Ablation Transarterial Chemoembolization see Chapter 96A Transarterial Radioembolization see Chapter 96B Chemotherapy Systemic Neoadjuvant Adjuvant Advanced Disease Biologic Therapy Regional Chemotherapy see Chapter 99 Radiation Therapy Palliation Summary References 51A Extrahepatic bile duct tumors Epidemiology Tumor Location and Histology Clinical Presentation Diagnostic Studies Preoperative Evaluation and Management Preoperative Biliary Drainage See Chapters 51B and 52 Portal Vein Embolization See Chapter 108C Preoperative Staging Systems Diagnostic Laparoscopy see Chapter 23 Surgical Treatment of Hilar Cholangiocarcinoma See Chapters 51B, 103B, and 103C Orthotopic Liver Transplantation see Chapter 115B Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy see Chapter 108D Outcomes After Resection Adjuvant Therapy After Resection Palliative Therapy Summary References 51B Perihilar cholangiocarcinoma with emphasis on presurgical management Anatomic Pathology for Surgeons Choice of Hepatectomy Type Radiologic Staging Multidetector Row Computed Tomography Cholangiography Preoperative Biliary Drainage Portal Vein Embolization see Chapter 108C Other Specific Management Strategies Internal Drainage and Bile Replacement Inchinkoto and Ursodeoxycholic Acid Synbiotic Administration References 52 Interventional techniques in hilar and intrahepatic biliary strictures Indications for Biliary Drainage Endoscopic Versus Percutaneous Drainage See Chapters 13, 29, and 30 Preprocedure Preparation Imaging Laboratory Studies Antibiotics Psychological Preparation Intraprocedural Issues Approach Image Guidance Sedation Technical Aids Drainage Catheter Versus Primary Stent Placement Postprocedure Care Summary References 53 Congenital disorders of the pancreas Overview Embryologic Development of the Pancreas Pancreas Divisum Possible Association Between Pancreas Divisum and Pancreatitis Imaging in Pancreas Divisum Therapy to the Minor Papilla in Those With Pancreas Divisum and Pancreatitis Resection in Those With Pancreas Divisum and Pancreatitis The Case Against an Association Between Pancreas Divisum and Pancreatitis Cystic Fibrosis and Recurrent Pancreatitis Summary Annular Pancreas Pathogenesis Clinical Presentation and Diagnosis in Adults Clinical Presentation and Diagnosis in Children Therapy for Annular Pancreas Summary Pancreatobiliary Maljunction Pathogenesis Diagnosis and Investigation Carcinogenesis in Pancreatobiliary Maljunction Therapy for Pancreatobiliary Maljunction Without Bile Duct Dilation Congenital Cysts of the Pancreas Heterotopic Pancreas References 54 Definition and classification of pancreatitis Overview History of the Definition and Classification of Pancreatitis Definition and Classification of Pancreatitis in the Modern Era The Future of Pancreatitis Definition and Classification References 55 Etiology, pathogenesis, and diagnostic assessment of acute pancreatitis Etiology and Pathogenesis of Acute Pancreatitis Acute Biliary Pancreatitis Acute Alcoholic Pancreatitis Nonbiliary and Nonalcoholic Acute Pancreatitis Metabolic Causes Hypertriglyceridemia. Hypercalcemia. Inborn Errors of Metabolism. Chronic Renal Failure and Dialysis-Related Causes Drug-Induced and Toxin-Induced Pancreatitis Infectious Causes Bacterial Causes. Viral Causes. Fungal and Parasitic Causes. Iatrogenic or Traumatic Pancreatitis Autoimmune Pancreatitis Anatomic or Congenital Causes Tumors Genetic Causes Idiopathic Acute Pancreatitis Assessment of Acute Pancreatitis Diagnostic Assessment Definition and Classification of Severity of Acute Pancreatitis Clinical Assessment Scoring Systems for Assessing Severity of Pancreatitis Laboratory Assessment Single-Parameter Biochemical Markers C-Reactive Protein. Hematocrit. Procalcitonin. Other Biomarkers Imaging Assessment Computed Tomography Magnetic Resonance Imaging Summary References 56 Management of acute pancreatitis and complications Acute Pancreatitis General Description Presentation, Diagnosis, and Initial Management Assessment of Severity Initial Management Pain Control Fluid Therapy and Resuscitation Critical Care and the Management of Systemic Complications See Chapter 25 Organ Failure Intraabdominal Hypertension Referral to a Specialist Unit Nutrition See Chapter 26 Antibiotics Endoscopic Retrograde Cholangiopancreatography Imaging Management of Necrosis Acute Fluid Collections Intervention for Infected Pancreatic Necrosis Retroperitoneal Step-Up Management Techniques Minimally Invasive Pancreatic Necrosectomy Video-Assisted Retroperitoneal Debridement Transmural Drainage Management of Late Walled-Off Pancreatic Necrosis Endoscopic Ultrasound-Guided Cystgastrostomy/Necrosectomy Laparoscopic Cystgastrostomy Open Surgical Necrosectomy Open Necrosectomy With Open Packing Open Necrosectomy With Closed Packing Open Necrosectomy With Continuous Closed Postoperative Lavage Programmed Open Necrosectomy Early Procedure-Related Complications Systemic Inflammatory Response Syndrome/Bacteremia Requiring Critical Care Support Acute or Delayed Hemorrhage See Chapter 124 Enteric Fistulation Late Complications Pancreatic Fistulation Disconnected Pancreatic Tail Discussion References 57 Etiology, pathogenesis, and diagnosis of chronic pancreatitis Etiology of Chronic Pancreatitis See Chapter 54 Toxic and Metabolic A, N = Alcohol and Nicotine in MANNHEIM Idiopathic I = Idiopathic in MANNHEIM Genetic H = Hereditary in MANNHEIM Autoimmune I = Immunologic in MANNHEIM Recurrent and Severe Acute Pancreatitis Obstructive E = Efferent Duct Factors in MANNHEIM Miscellaneous M = Miscellaneous in MANNHEIM Pathogenesis of Chronic Pancreatitis Necrosis-Fibrosis Hypothesis Protein-Plug Stone/Ductal Obstruction Hypothesis Oxidative Stress Theory Toxic-Metabolic Theory Primary Duct Hypothesis Sentinel Acute Pancreatitis Event Hypothesis Sustained Intraacinar Nuclear Factor-κB Activation Diagnosis of Chronic Pancreatitis Imaging Methods Plain Abdominal Radiography Transabdominal Ultrasonography See Chapter 15 Computed Tomography See Chapter 18 Endoscopic Retrograde Pancreatography See Chapter 20 Endoscopic Ultrasonography See Chapter 16 Magnetic Resonance Imaging and Cholangiopancreatography See Chapter 19 Tests of Exocrine Pancreatic Function See Chapter 4 Invasive Direct Pancreatic Function Tests Noninvasive Indirect Pancreatic Function Tests Summary References 58 Management of chronic pancreatitis Introduction Conservative Treatment Pancreatic Exocrine Dysfunction See Chapter 4 Pancreatic Exocrine Enzyme Supplementation Substitution Therapy in Chronic Pancreatitis Conservative Treatment of Pain Interventional Procedures to Treat Pancreatic Pain See Chapter 16 Autoimmune Pancreatitis Endoscopic Treatment Decompression of Pancreatic Pseudocysts Common Bile Duct Stenting Surgical Treatment Drainage Procedures Resective Procedures Partial Pancreatoduodenectomy: Kausch-Whipple Procedure Duodenum-Preserving Pancreatic Head Resection: Beger Procedure Duodenum-Preserving Pancreatic Head Resection: Frey Procedure Duodenum-Preserving Pancreatic Head Resection: Bern Modification Pancreatic Left Resection in Chronic Pancreatitis Total Pancreatectomy and Islet Cell Autotransplantation Evidence-Based Surgery in Chronic Pancreatitis: Pancreatoduodenectomy and Duodenum-Preserving Pancreatic Head Resection Conclusions References 59 Pancreatic and periampullary tumors: classification and pathologic features Tumors of the Pancreas Invasive Ductal Adenocarcinoma Pancreatic Intraepithelial Neoplasia PanIN Other Invasive Carcinomas Related to Ductal Adenocarcinoma Intraductal Neoplasms Intraductal Papillary Mucinous Neoplasms See Chapter 60 Intraductal Tubulopapillary Neoplasms Mucinous Cystic Neoplasms See Chapter 60 Serous Cystic Tumors See Chapter 60 Pancreatic Neuroendocrine Neoplasms See Chapter 65 Acinar Neoplasms Acinar Cell Cystadenoma Pancreatoblastoma Solid Pseudopapillary Neoplasm Miscellaneous Cystic Pancreatic Lesions Pseudotumors Mesenchymal Tumors Secondary Tumors See Chapter 64 Tumors of the Ampulla of Vater See Chapters 51A and 63 Adenoma and Noninvasive Papillary Carcinoma Intestinal-Type Adenomas Noninvasive Pancreatobiliary-Type Papillary Neoplasms Flat-Type Intraepithelial Neoplasia Dysplasia and Carcinoma in Situ Adenocarcinoma See Chapter 63 Poorly Differentiated Neuroendocrine Carcinoma Well-Differentiated Neuroendocrine Tumors Gangliocytic Paraganglioma References 60 Cystic neoplasms of the pancreas Introduction Clinicopathologic Variables Serous Cystadenomas Mucinous Cystic Neoplasms Intraductal Papillary Mucinous Neoplasms Intraductal Papillary Mucinous Neoplasm?Associated Malignancy Genetics of Intraductal Papillary Mucinous Neoplasm Diagnostic Evaluation of Pancreatic Cystic Neoplasms Treatment of Pancreatic Cystic Neoplasms Serous Cystadenoma Mucinous Cystic Neoplasms Main-Duct IPMN and Combined-Type IPMN: Indication and Extent of Resection Branch-Duct Intraductal Papillary Mucinous Neoplasm: Indication for Resection Solid Pseudopapillary Tumor and Other Cystic Pancreatic Neoplasms See Chapter 59 The Indeterminate Cystic Neoplasm Conclusions References 61 Pancreatic cancer Overview Race and Ethnicity African Americans Ashkenazi Jews Asians Risk Factors for Pancreatic Ductal Adenocarcinoma and Pancreatic Cancers See Chapter 9C Familial Pancreatic Cancer and Inherited Genetic Disorders Six Genetic Syndromes Associated With Pancreatic Ductal Adenocarcinoma Hereditary Pancreatitis Hereditary Nonpolyposis Colorectal Cancer Hereditary Breast and Ovarian Cancer Familial Atypical Multiple Mole and Melanoma Syndrome Peutz-Jeghers Syndrome Ataxia-Telangiectasia Tobacco Exposure Environmental Tobacco Smoke and Second-Hand Smoke Smokeless Tobacco High-Risk Occupations Occupational Exposures Diabetes Pancreatitis Cholecystectomy Hormonal Factors Lifestyle Factors and Height and Weight Diet Coffee and Alcohol Consumption Infectious Agents Summary References 62 Pancreatic cancer Clinical Presentation Diagnosis Diagnostic Biopsy Staging Laparoscopy Treatment Surgical Treatment Resectable Disease Results Adjuvant Therapy Neoadjuvant Therapy, Borderline Resectable, and Locally Advanced Disease Palliative Therapy Unresectable Disease Palliative Chemotherapy References 63 Duodenal adenocarcinoma Overview Presentation Risk Factors Diagnostic Evaluation Treatment Surgical Resection Neoadjuvant and Adjuvant Therapy Patterns of Recurrence References 64 Pancreas as a site of metastatic cancer Overview Clinical Presentation, Diagnosis, Staging, and Surgical Treatment Long-Term Outcome and Follow-Up References 65 Pancreatic neuroendocrine tumors Introduction Epidemiology Molecular Biology Pathology and Staging Prognosis Familial Syndromes Functional Tumors: Clinical Features Insulinoma Gastrinoma Glucagonoma Vasoactive Intestinal Peptide-Secreting Neuroendocrine Tumor Somatostatinoma Pancreatic Polypeptide-Secreting Neuroendocrine Tumors Nonfunctional Tumors: Clinical Features Imaging Surgical Management Resection of the Primary Tumor: Surgical Considerations Surgical Considerations With Familial Syndromes Management of Metastatic Disease Nonsurgical Management Somatostatin Analogue?Based Treatments Systemic Chemotherapy Biologic Therapies Surveillance and Follow-Up References 66 Techniques of pancreatic resection Overview Preoperative Workup and Management Diagnosis and Staging of Disease Imaging General Preoperative Patient Assessment Perioperative Management See Chapters 24 and 25 Perioperative Anticoagulation Antibacterial Prophylaxis Octreotide Analogues Preoperative Biliary Drainage See Chapters 29 and 30 Enhanced Recovery Pathway Staging Laparoscopy Resectional Techniques Pancreaticooduodenectomy Whipple Procedure Technique Vascular Resection Multivisceral Resections Lymphadenectomy Reconstruction After Pancreaticoduodenectomy Pancreaticojejunostomy Bilioenteric Anastomosis Reconstitution of Gastrointestinal Continuity Abdominal Drains and Nasogastric Tubes Distal Pancreatectomy Technique Management of the Pancreatic Remnant Splenic Preservation Segmental Central Pancreatectomy Technique Total Pancreatectomy Technique Transduodenal Resection of the Papilla of Vater Technique Conclusion References 67 Minimally invasive pancreatic resectional techniques Diagnostic Laparoscopy Historic Overview Minimally Invasive Totally Laparoscopic and Robotic Pancreatic Resections Left Pancreatic Resection Distal and Subtotal Pancreatectomy Surgical Technique Outcomes Pancreaticoduodenectomy and Total Pancreatectomy Surgical Technique Outcomes Tumor Enucleation and Central Pancreatectomy Minimally Invasive Treatment of Pancreatic Cancer References 68 Chemotherapy and radiotherapy for pancreatic cancer Adjuvant Chemoradiotherapy Ongoing Trials Adjuvant Chemotherapy Neoadjuvant Treatment Ongoing Trials Treatment for Unresectable Pancreatic Cancer Summary References 69 Palliative treatment of pancreatic and periampullary tumors Obstructive Jaundice Bypass Surgery Surgical or Endoscopic or Percutaneous Drainage Gastric Outlet Obstruction Bypass Surgery or Stent Laparoscopic Palliation Pancreatoduodenectomy for Palliation Local Ablative Therapies Radiofrequency Ablation Irreversible Electroporation Pain Management Percutaneous Celiac Plexus Block Endoscopic Ultrasound?Guided Celiac Plexus Block Celiac Plexus Block During Surgery Thoracoscopic Splanchnicectomy Summary References 70 Chronic hepatitis: Chronic Hepatitis Chronic Hepatitis C Epidemiology Presentation Diagnosis Natural History Treatment Surgery in the Patient With Hepatitis C Hepatitis B Epidemiology Transmission Presentation Diagnosis Natural History Treatment Surgery in the Patient With Chronic Hepatitis B Nonalcoholic Steatohepatitis Epidemiology Presentation Diagnosis Natural History Treatment Surgery in the Patient With NASH Autoimmune Hepatitis Epidemiology Presentation Diagnosis Natural History Treatment Surgery in the Patient With Autoimmune Hepatitis Summary: Approach to Surgery in Patients With Liver Disease References 71 Hepatic steatosis, steatohepatitis, and chemotherapy-related liver injury Overview Histopathology of Fatty Liver Disease and Sinusoidal Injury Fatty Liver Disease Sinusoidal Injury Epidemiology of Fatty Liver Disease Diagnosis Nonalcoholic Steatohepatitis and Hepatocellular Carcinoma Chemotherapy-Mediated Hepatotoxicity Influence of Fatty Liver Disease and Sinusoidal Injury on the Safety of Liver Resection References 72 Pyogenic liver abscess Overview Etiology Incidence Clinical Presentation Diagnosis Microbiology Treatment Percutaneous Treatment Surgical Treatment Treatment Summary Outcome and Prognosis References 73 Amebiasis and other parasitic infections Amebic Liver Abscess History Epidemiology Organism Community Screening Procedures Host Factors Pathogenesis Molecular Genetics Host Defense and Potential for Vaccine Development Pathology Clinical Presentation Ultrasonography Other Imaging Modalities Amebic Serology Role of Aspiration Complications Peritoneal and Visceral Involvement Thoracic and Pleuropulmonary Involvement Vascular and Pericardial Involvement Chemotherapy Metronidazole Other Medications Therapeutic Strategy Prevention Liver Fluke Disease Fascioliasis Morphology and Life Cycle Pathology Clinical Features Consequences of Chronicity of Infection in Fascioliasis Treatment Clonorchiasis Epidemiology Morphology and Life Cycle Pathology Relationship to Recurrent Pyogenic Cholangitis Clinical Features Treatment Biliary Ascariasis Epidemiology Pathology Clinical Features Acute Suppurative Cholangitis Hepatic Ascariasis Acute Pancreatitis Late Complications Diagnosis Laboratory Studies Diagnostic Imaging Management Biliary Opisthorchiasis Clinical Features Opisthorchis viverrini Opisthorchis felineus Consequences of Chronicity of Infection in Opisthorchiasis Diagnosis of Opisthorchiasis Treatment of Opisthorchiasis Blood Flukes Schistosomiasis Life Cycle Pathogenesis Clinical Picture Diagnosis Treatment Acknowledgment References 74 Hydatid disease of the liver Pathogenesis and Etiology Epidemiology Development of A Hydatid Cyst Complications of Hydatid Cysts Compression Cyst Infection Rupture Into the Biliary Tract Rupture Into the Bronchial Tree Rupture Into the Peritoneum Rupture Into Other Cavities or Organs Diagnosis Symptoms Laboratory Tests Liver Function Tests Other Laboratory Tests Serology Immunoelectrophoresis Enzyme-Linked Immunosorbent Assay Blotting Radiology Computed Tomography See Chapter 18 Magnetic Resonance Imaging See Chapter 19 Treatment Indications and Methods Background Indications General Indications for Treatment: A Stage-Specific Approach Surgical Treatment Indications Contraindications Common Principles of Surgery Preoperative Evaluation Prevention of Intraoperative Spillage Perioperative Benzimidazoles Approach Open Approach Laparoscopy See Chapter 105 Conservative Surgery Intraoperative Management of Biliary-Cyst Communication Management of the Residual Cavity Postoperative Complications Biliary Fistula Biliary Stricture Recurrence Radical Surgery Pericystectomy Liver Resection Percutaneous Treatments PAIR Puncture, Aspiration of Cyst Content, Injection of Protoscolicidal Solution, and Reaspiration of the Fluid PAIR Catheterization Percutaneous Evacuation of Cyst Content Morbidity, Mortality, and Recurrence of Surgical Procedures and Percutaneous Treatment: Review of the Literature Medical Treatment Watch and Wait Approach Alveolar Echinococcosis Disease Epidemiology Course of Infection Clinical Presentation Diagnosis Biology Radiology Alveolar Echinococcosis Diagnostic Criteria Treatment Adjuvant Medical Treatment Acknowledgment References 75 Simple cysts and polycystic liver disease Simple Cysts of the Liver Pathology and Pathogenesis Prevalence and Etiology Manifestations and Diagnosis Course and Complications Differential Diagnosis Ciliated Hepatic Foregut Cysts Prevalence and Etiology Manifestation and Diagnosis Course, Complications, and Treatment Management Sclerotherapy Method Limitations Complications Long-Term Outcome Fenestration Method Limitations Complications Long-Term Outcome Sclerotherapy Versus Fenestration Polycystic Liver Disease Genetics PCLD Associated With ADPKD Isolated PCLD Without ADPKD The Two-Hit Theory Pathology and Pathogenesis Epidemiology PCLD Associated With ADPKD Isolated PCLD Manifestations and Diagnosis Symptoms Biology Imaging Natural History Complications Within Cysts From Cyst Compression From Associated Conditions Staging Differentiation Among Simple Cysts, Isolated PCLD, and PCLD Associated With ADPKD Differential Diagnosis for Multiple Cysts Cystic Metastases Management Nonsurgical Treatments Medical Treatment Avoidance of Estrogen Replacement Therapy. Somatostatin Analogues. Mammalian Target of Rapamycin Inhibitors. Arterial Embolization. Cyst-Targeted Treatments Percutaneous Sclerotherapy. Fenestration Technique and Indication Complications Outcome Treatment of Intracystic Complications Hepatectomy Technique Morbidity and Mortality Long-Term Outcome Transplantation Technique Perioperative Risk Long-Term Outcome Conclusion References 76 Cirrhosis and portal hypertension Overview Cirrhosis: Histopathologic Features Pathogenesis and Reversibility of Cirrhosis Role of Liver Biopsy in Advanced Liver Disease Morphologic Findings in Cirrhosis Assessment of Underlying Etiology in Cirrhosis Alcoholic Liver Disease Nonalcoholic Fatty Liver Disease Chronic Hepatitis C Chronic Hepatitis B Autoimmune Hepatitis Primary Biliary Cirrhosis Primary Sclerosing Cholangitis Hereditary Hemochromatosis Wilson Disease α1-Antitrypsin Deficiency Cryptogenic Cirrhosis Noncirrhotic Portal Hypertension Nodular Regenerative Hyperplasia Venous Outflow Obstruction Schistosomiasis Congenital Hepatic Fibrosis Drugs and Toxins Idiopathic Portal Hypertension Conclusion References 77 Nonhepatic surgery in the cirrhotic patient Overview Evaluation and Stratification of Liver Disease Perioperative Management and Optimization Specific Procedures Cholecystectomy Herniorrhaphy Colectomy Bariatric Surgery Cardiac Procedures Thoracic Procedures Trauma Summary References 78 Portal hypertension in children Special Features of Portal Hypertension in Children Causes of Portal Hypertension in Children Extrahepatic Causes Intrahepatic Causes Effects of Portal Hypertension in Children Clinical Features Diagnosis Management Emergency Therapy Endoscopic Treatment of Acute Variceal Bleeding Sengstaken-Blakemore Tube Emergency Surgical Approaches and Emergency Portosystemic Shunts Prophylaxis Against the First Gastrointestinal Hemorrhage Prevention of Recurrent Gastrointestinal Bleeding Intrahepatic Causes of Portal Hypertension Direct Obliteration of Varices. Surgery. Extrahepatic Portal Venous Obstruction Direct Variceal Ablation. Surgery. Summary References 79 Management of liver failure Etiology of Acute Liver Failure Viral Drugs Other Etiologies Diagnosis Prognosis Management Overall Strategy General Measures Management of Specific Complications Neurologic Encephalopathy Infection Hemodynamic Instability Renal Failure Metabolic Abnormalities Coagulopathy Nutrition References 80 Support of the failing liver Failing Liver Standard Medical Therapy SMT Nonbiologic Liver Support Plasma Exchange and Hemodiafiltration Historic Blood Purification Options Albumin Dialysis MARS Prometheus Biologic Liver Support Ex Vivo Liver Perfusion Hepatocyte Transplantation Extracorporeal Hepatocyte Systems Clinical Trials of Bioartificial Liver Devices Latvian Hybrid Bioreactor Trial HepatAssist System Extracorporeal Liver-Assist Device TECA-Hybrid Artificial Liver Support System Bioartificial Liver Support System Radial Flow Bioreactor Modular Extracorporeal Liver Support System Amsterdam Medical Center Bioartificial Liver Hybrid Bioartificial Liver Extracorporeal Liver Support and Study End Points Posthepatectomy Liver Failure Future Directions References 81 Management of ascites in cirrhosis and portal hypertension Historic Overview Portal Hypertension and Mechanisms of Ascites Formation Characteristics and Evaluation of Ascites Management of Cirrhotic Ascites Dietary Sodium Restriction Medical Management Diuretics Aldosterone Antagonists Loop Diuretics Albumin Arginine Vasopression Receptor Antagonists Refractory Ascites Paracentesis Transjugular Intrahepatic Portosystemic Shunts Peritoneovenous Shunt Liver Transplantation Complications Hepatic Hydrothorax. Spontaneous Bacterial Peritonitis References 82 Medical management of bleeding varices Natural History of Varices Role of Endoscopy and Screening Strategies Noninvasive Modalities Laboratory-Based Markers Cross-Sectional Imaging Transient Elastography Alternative Imaging Techniques Prevention of Variceal Hemorrhage Primary Prophylaxis Secondary Prophylaxis Role of Transjugular Intrahepatic Portosystemic Shunt Novel Therapies for Portal Hypertension Portal Hypertensive Gastropathy Gastric Varices Summary References 83 Portal hypertensive bleeding Overview Emergency Management Controlling Acute Hemorrhage: Pharmacologic Agents Controlling Acute Esophageal Variceal Hemorrhage: Endoscopic Therapy Tamponade Techniques Technique. Gastric Varices Ectopic Varices Portal Gastropathy and Gastric Antral Vascular Ectasia Recurrent Bleeding No Therapy: Observation Only References 84 Portal hypertensive bleeding Treatment of Esophagogastric Varices Indications Surgical Anatomy, Pathophysiology of Varices, and Effects of Devascularization Anatomy and Pathophysiology Evolution of Devascularization Procedures Hassab Devascularization Procedure Sugiura and Futagawa Devascularization Procedure Sugiura-Futagawa Operation: Thoracic Procedure Sugiura-Futagawa Operation: Abdominal Procedure Modified Sugiura Devascularization Procedure Author’s Approach Combined Shunt With Devascularization and Other Procedures Laparoscopic Devascularization Laparoscopic Devascularization: Procedure Results/Outcome Operative Mortality Operative Morbidity Efficacy: Control of Variceal Hemorrhage Devasularization Versus Shunt Laparoscopic Devascularization Conclusion References 85 Portal hypertensive bleeding: Overview Natural History of Esophageal Varices Pharmacologic Management of Portal Hypertension Prophylaxis Acute Variceal Hemorrhage Prevention of Rebleeding After Initial Control Endoscopic Therapy of Variceal Hemorrhage Prophylaxis Acute Variceal Hemorrhage Prevention of Rebleeding Transjugular Intrahepatic Portosystemic Shunt Prophylaxis of Bleeding With Transjugular Intrahepatic Portosystemic Shunting Acute Variceal Bleeding and Transjugular Intrahepatic Portosystemic Shunting Prevention of Rebleeding by Transjugular Intrahepatic Portosystemic Shunting Treatment of Budd-Chiari Syndrome With Transjugular Intrahepatic Portosystemic Shunting Treatment of Ascites With Transjugular Intrahepatic Portosystemic Shunting Surgical Shunts for Bleeding Esophageal Varices Prophylactic Surgery Acute Variceal Hemorrhage Prevention of Rebleeding After Initial Control General Aspects of Nonselective Shunts General Aspects of Distal Splenorenal Shunt Partial Shunt Types of Shunts: Technical Aspects Portacaval Shunt Mesocaval Shunt See Chapter 86 Meso-Rex Shunt Distal Splenorenal Shunt Devascularization Procedures for Bleeding Esophageal Varices Liver Transplantation for Bleeding Esophageal Varices Meso-Rex Shunt for Portal Vein Occlusion After Liver Transplantation Extrahepatic Portal Vein Thrombosis Present Role of Surgical Shunts Summary References 86 Technique of portosystemic shunting Overview Preoperative Assessment Portocaval Shunts Access Exposure and Dissection Anastomoses Mesocaval Shunts Access Exposure and Dissection Anastomosis Distal Splenorenal Shunt Access Exposure and Dissection Anastomosis Portal Azygos Disconnection Common Themes in Perioperative and Postoperative Management See Chapters 24 and 25 Outcomes References 87 Transjugular intrahepatic portosystemic shunting Overview Indications Variceal Bleeding Gastric Varices and Gastropathy Ectopic Varices Ascites Hepatic Hydrothorax Budd-Chiari Syndrome Portal Vein Occlusion Preoperative Decompression Contraindications Technique Special Technical Considerations Budd-Chiari Syndrome Portal Thrombus Polycystic Liver References 88 Budd-Chiari syndrome and veno-occlusive disease Budd-Chiari Syndrome Predisposing Conditions Hematologic Disorders Oral Contraceptives Pregnancy and Postpartum Malignant Neoplasms Infections Trauma Connective Tissue Disorders Membranous Obstruction of the Vena Cava Miscellaneous Rare Conditions Pathology Clinical Manifestations Symptoms Chronic Liver Disease. Physical Examination Findings Diagnostic Studies Ultrasonography Computed Tomography Magnetic Resonance Imaging Hepatic Venography and Pressure Measurements Liver Biopsy Abnormal Liver Function Tests Nonsurgical Therapy Interventional Radiologic Therapy Percutaneous Transluminal Angioplasty Transjugular Intrahepatic Portosystemic Shunt Surgical Therapy Findings at Operation Side-to-Side Portacaval Shunt Mesoatrial Shunt Combined SSPCS and Cavoatrial Shunt Surgical Outcomes Membranous Obstruction of Vena Cava: Surgical Options Surgical Removal of Venous Obstruction Liver Transplantation Indications Outcomes Venoocclusive Disease Symptoms and Signs Diagnostic Studies Treatment Summary Budd-Chiari Syndrome Venoocclusive Disease References 89 Tumors of the liver Overview Hepatocellular Tumors Hepatocellular Carcinoma Clinical and Epidemiologic Background Gross Pathology Histopathology Growth Patterns Histologic Variants Fibrolamellar Hepatocellular Carcinoma. Clear-Cell Carcinoma. Sarcomatoid Hepatocellular Carcinoma. Sclerosing Hepatocellular Carcinoma. Other Morphologic Patterns of Hepatocellular Carcinoma. Hepatocellular Carcinoma in Noncirrhotic Liver Grading and Other Pathologic Prognostic Factors Molecular Genetics Premalignant Hepatocellular Lesions and Small Hepatocellular Carcinoma Macroregenerative Nodule. Dysplastic Nodule. Small Hepatocellular Carcinoma. Natural History of Premalignant Lesions and Diagnostic Challenge. Hepatoblastoma Benign Liver Cell Tumors Focal Nodular Hyperplasia Hepatocellular Adenomas Molecular Classification of Hepatocellular Adenomas Biliary Cell Tumors Cholangiocarcinoma Epidemiology and Clinical Background Pathology. Biliary Papillomatosis Intrahepatic Papillary Neoplasia and Biliary Intraepithelial Neoplasia BilIN Hepatocholangiocarcinoma HCC-CC Mucinous Cystic Neoplasm Mucinous Cystic Neoplasm, Low Grade Biliary Cystadenoma. Mucinous Cystic Neoplasm With an Associated Invasive Carcinoma Biliary Cystadenocarcinoma. Other Benign Cystic and Bile Duct Lesions Ciliated Hepatic Foregut Cysts. Bile Duct Adenoma. Mesenchymal Tumors Benign Mesenchymal Tumors Hemangioma Infantile Hemangioendothelioma Mesenchymal Hamartoma Angiomyolipoma Lipoma Fibrous Tumors Other Benign Mesenchymal Tumors Malignant Mesenchymal Tumors Epithelioid Hemangioendothelioma Angiosarcoma Undifferentiated Embryonal Sarcoma Other Sarcomas Miscellaneous Tumors Inflammatory Pseudotumor Neuroendocrine Tumor Others Hematopoietic Neoplasms Primary Hepatic Lymphoma Secondary Involvement Metastasis References 90A Benign liver lesions Cavernous Hemangioma Pathogenesis and Pathology Clinical and Biologic Data Imaging Management Focal Nodular Hyperplasia Pathogenesis and Pathology Clinical and Biologic Data Imaging Management Hepatocellular Adenoma Diagnostic Pathway Complications Management Other Lesions Fatty Lesions of the Liver Angiomyolipoma Lipoma Biliary Hamartoma Bile Duct Adenoma Inflammatory Pseudotumors Rare Tumor or Pseudotumor Solitary Fibrotic Tumor Lymphangioma Leiomyoma Heterotopic Tissue Hepatic Pseudolesions Perfusion Disorders Parenchymal Compression Confluent Fibrosis Postradiation Pseudolesion Peliosis Focal Fatty Changes Regenerative Processes Nodular Regenerative Hyperplasia Focal Nodular Hyperplasia-Like Lesions References 90B Cystic hepatobiliary neoplasia Overview Definition Mcn-L Hepatobiliary Cystadenoma With Ovarian Stroma Incidence Pathology See Chapter 89 Risk Factors and Origin Presentation Diagnosis Differential Diagnosis Imaging Cytology and Tumor Markers Cytology. Tumor Markers. Complications Management Hepatobiliary Cystadenoma Without Ovarian Stroma Incidence Pathology Presentation and Diagnosis Natural History and Management Cystadenocarcinoma Definition and Incidence Epidemiology and Presentation Origin and the Cystadenoma- Cystadenocarcinoma Sequence Diagnosis Gross Morphology and Imaging Biology Cyst Content Treatment Cystic Variants of Intraductal Papillary Mucinous Neoplasm of the Bile Duct Definition and Etiology Pathology Diagnosis Complications Management and Prognosis Conclusion References 91 Hepatocellular carcinoma Overview Molecular Profile of Liver Tumors See Chapter 9D Prevention of the Risk Factors of Hepatocellular Carcinoma Screening and Recall of High-Risk Individuals Staging and Prognostic Evaluation Treatment Strategy Future Prospects Summary References 92 Hepatic metastasis from colorectal cancer Natural History of Metastases From Colorectal Cancer Principles of Medical Treatment of Metastatic Colorectal Cancer Preoperative Evaluation of Patients With Colorectal Liver Metastases Role of Preoperative Imaging Ultrasonography Computed Tomography Magnetic Resonance Imaging Positron Emission Tomography Prognostic Variables and Preoperative Scoring Systems Characteristics of the Patient and Primary Tumor Characteristics of Liver Metastases Extrahepatic Disease Predictive Models and Clinical Risk Scores Prognostic Value of Response to Preoperative Chemotherapy Molecular/Genetic Determinants of Outcome Preoperative Systemic Chemotherapy Chemotherapy for Downstaging of Unresectable Disease Resectable Colorectal Cancer Liver Metastases Chemotherapy-Induced Hepatotoxicity Management of Disappeared Liver Metastases Preoperative Treatment Algorithm Perioperative Management Specific Operative Techniques Role of Laparoscopic Staging See Chapter 23 Intraoperative Staging and Role of Ultrasound See Chapter 23 Transection Techniques Surgical Strategies for Patients With Extensive Disease Synchronous Metastases and Timing of Resection Multifocal Bilateral Liver Metastases Postoperative Management of Patients With Resected Colorectal Liver Metastases Immediate Postoperative Care See Chapter 24 Perioperative Morbidity and Mortality Mortality Morbidity Outcome and Surgical Volume Postoperative Follow-Up Postrecovery Management Postoperative Prognostic Factors Pathologic Characteristics of Liver Metastases Impact of Postoperative Complications Adjuvant Systemic Chemotherapy Adjuvant Hepatic Arterial Infusion Chemotherapy Long-Term Outcomes After Resection of Colorectal Liver Metastases Patterns of Recurrence Re-Resection for Recurrence After Resection Overall Survival Conclusion References 93 Hepatic metastasis from neuroendocrine cancers Overview Classification of Gastroenteropancreatic Neuroendocrine Tumors Small Intestinal Carcinoids Pancreatic Neuroendocrine Tumors See Chapter 65 Natural History Liver-Directed Therapy for Neuroendocrine Liver Metastases Hepatic Resection for Neuroendocrine Metastases Hepatic Transplantation for Neuroendocrine Metastases See Chapter 112 Radiofrequency Ablation of Neuroendocrine Hepatic Metastases See Chapter 98B Ethanol Ablation of Hepatic Neuroendocrine Metastases See Chapter 98D Cryoablation of Hepatic Neuroendocrine Metastases See Chapter 98D Guidelines for Ablation Bland Embolization, Chemoembolization, and Radioembolization of Hepatic Neuroendocrine Metastases See Chapter 96 Resection versus Intraarterial Therapy Systemic Treatment of Hepatic Neuroendocrine Metastases See Chapter 65 Somatostatin Analogues Chemotherapy New Drugs and Targets See Chapter 65 Peptide Receptor Radionuclide Therapy References 94 Noncolorectal nonneuroendocrine metastases Overview Series Summarizing Multiple Primary Tumor Types Series Focused on One Primary Tumor Type Sarcoma Breast Cancer Melanoma Cutaneous Melanoma Uveal Melanoma Gastric and Pancreatic Cancer Renal Carcinoma Reproductive Tract Tumors Other Primary Tumors Critical Evaluation of Liver Resection for Metastatic Noncolorectal Nonneuroendocrine Tumors Conclusion References 95 Hepatic tumors in childhood Overview History Malignant Tumors Hepatoblastoma Incidence Pathology Basic Biology See Chapter 9D Clinical Findings Imaging Staging Treatment Outcome Future Directions Hepatocellular Carcinoma Hepatoma Epidemiology Pathology See Chapter 89 Biology and Molecular Biology Clinical Findings Staging Treatment Outcome Fibrolamellar Variant Future Directions Rhabdomyosarcoma of the Extrahepatic Bile Ducts Incidence Pathology Presentation Imaging Treatment Future Directions Embryonal Sarcoma Incidence Pathology Clinical Presentation Imaging Treatment and Outcome Leiomyosarcoma Primary Hepatic Rhabdoid Tumor Incidence Pathology Imaging Clinical Presentation Treatment Outcome Angiosarcoma Malignant Germ Cell Tumors Primary Hepatic Non-Hodgkin’s Lymphoma Hepatic Metastases Neuroblastoma Wilms Tumor Osteogenic Sarcoma Desmoplastic Small Round-Cell Tumor Rhabdomyosarcoma Colon Cancer Malignant Peripheral Nerve Cell Tumor Adrenocortical Carcinoma Rhabdoid Tumor Hepatic Evaluation and Resection Surgical Anatomy Hepatic Regeneration Evaluation of a Child With a Hepatic Mass Benign Hepatic Tumors See Chapters 89 and 90 Hemangiomata and Vascular Malformations Incidence Presentation and Diagnosis Treatment Outcome Hemangioendothelioma Hemangioblastoma Mesenchymal Hamartoma Epidemiology Presentation and Diagnosis Treatment Outcome Focal Nodular Hyperplasia and Hepatocellular Adenoma Epidemiology Presentation and Diagnosis Treatment Outcome Cysts and Cystic Disease See Chapters 75 and 90B References 96A Hepatic artery embolization and chemoembolization of liver tumors Basic Principles of Hepatic Arterial Embolotherapy Blood Supply of Liver Tumors Transarterial Chemoembolization Indications Procedure Therapeutic Efficacy of Chemoembolization Hepatocellular Carcinoma See Chapter 91 Neuroendocrine Tumors See Chapter 93 Sarcoma and Gastrointestinal Tumors See Chapter 94 Colorectal Metastases See Chapter 92 Uveal Melanoma See Chapter 94 Complications Postembolization Syndrome Liver Failure Liver Abscess Bile Duct Injury Extrahepatic Nontargeted Embolization Iatrogenic Vascular Injury Embolotherapy Combined With Other Treatment Emerging Techniques of Hepatic Arterial Embolotherapy Bland Embolization With Microspheres TACE With Drug-Eluting Beads Conclusion References 96B Radioembolization for liver tumors Overview Vascular Anatomy of the Liver and Its Tumors See Chapter 2 Portal Vein Hepatic Artery History of Radioembolization External Radiation See Chapter 97 Radioembolization Yttrium-90 Microspheres Overview Pretreatment Evaluation Clinical Evaluation Laboratory Workup Pretreatment Angiography and Coil Embolization Technetium-99m Macroaggregated Albumin Scan See Chapter 17 Available Devices TheraSphere Dose Calculation for Therasphere. SIR-Spheres Dose Calculation for SIR-Spheres. New Concepts Radiation Segmentectomy Extended?Shelf-Life Microspheres Radiation Lobectomy New Concepts Blood Flow Patterns for Dose Calculation Transcatheter Yttrium-90 Radioembolization Other Radionuclides Iodine-131?Labeled Iodized Oil and Iodized Oil Lipiodol Overview Administration Conclusion Rhenium-188 HDD?Labeled Iodized Oil Overview Administration Conclusion Other Rhenium-188 Carrier Combinations. Phosphorus-32 Glass Microspheres Overview Administration Conclusion Milican/Holmium-166 Microspheres Primary Liver Tumors Role of Radioembolization in Management of Hepatocellular Carcinoma See Chapter 91 Patient Selection Indications and Efficacy Patients Within Transplant Criteria. Patients Beyond Transplant Criteria. Patients With Advanced Disease. Conclusion Role of Radioembolization in Management of Intrahepatic Cholangiocarcinoma See Chapter 50 Secondary Liver Tumors Patient Selection for Radioembolization in the Management of Metastatic Liver Disease: General Considerations Role of Radioembolization in the Management of Metastatic Colorectal Carcinoma See Chapter 92 Overview Patient Selection Efficacy of Radioembolization Role of Radioembolization in the Management of Metastatic Neuroendocrine Tumors See Chapter 93 Overview Evidence Role of Radioembolization in the Management of Metastatic Mixed Neoplasia See Chapter 94 Overview Internal Radiation to Metastatic Breast Cancer to Liver Other Role of Radioembolization in the Management of Metastatic Melanoma Overview Evidence Posttreatment Assessment Clinical and Laboratory Parameters Radiologic Parameters Complications of Radioembolization Postradioembolization Syndrome Hepatobiliary Toxicity Hepatic Injury Biliary Injury Portal Hypertension Radiation Pneumonitis Gastrointestinal Complications Vascular Injury Conclusion Summary References 97 External beam radiotherapy for liver tumors Technical Innovations Intensity-Modulated Radiotherapy Image-Guided Radiotherapy and Motion Management Stereotactic Body Radiotherapy Hepatocellular Carcinoma See Chapter 91 Biliary Tumors Intrahepatic Cholangiocarcinoma See Chapter 50 Extrahepatic Cholangiocarcinomas See Chapters 51 and 59 Conclusion References 98A Ablative treatment of liver tumors Ablative Technologies Radiofrequency Ablation See Chapter 98B Microwave Ablation See Chapter 98C Cryoablation See Chapter 98D Irreversible Electroporation See Chapter 98C Other Techniques Imaging Guidance Treatment Planning Periprocedural and Postprocedural Assessment Tumor Manipulation Clinical Application References 98B Radiofrequency ablation of liver tumors Radiofrequency Ablation Technology Radiofrequency Ablation Procedure Percutaneous Radiofrequency Ablation Open or Laparoscopic Radiofrequency Ablation Monitoring and Follow-Up Current Practice Radiofrequency Ablation of Colorectal Hepatic Metastases Radiofrequency Ablation of Hepatocellular Carcinoma Radiofrequency Ablation versus Resection for Hepatocellular Carcinoma Radiofrequency Ablation for Recurrent Hepatocellular Carcinoma Radiofrequency Ablation as a Bridge to Transplantation Radiofrequency Ablation and Intrahepatic Cholangiocarcinoma Tumor Response and Recurrence Complete and Incomplete Response Rates to Radiofrequency Ablation Rates of Recurrence at Radiofrequency Ablation Site Complications of Radiofrequency Ablation Conclusion References 98C Microwave ablation and irreversible electroporation Microwave Ablation Physics of Microwave Energy Local Tissue Factors That Affect Thermoablation Technical Considerations Clinical Results Hepatocellular Carcinoma see Chapter 91 Colorectal Liver Metastases see Chapter 92 Neuroendocrine Tumors and Metastasis From Other Primary Tumors See Chapters 93 and 94 Specific Complications and Future Applications Irreversible Electroporation Physics of Irreversible Electroporation Local Tissue Factors Technique in Liver for Tumors With Vascular Proximity Clinical Results for Hepatic Malignancies References 98D Cryotherapy and ethanol injection Patient Population Hepatocellular Carcinoma See Chapter 91 Metastatic Disease General Indications for Nonresectional Therapy of Liver Tumors Pathophysiology of Cryoablation Cooling Rate Slow Cooling Rates Intermediate Cooling Rates Rapid Cooling Rates Depth of Hypothermia Joule-Thompson Effect and Thawing Thawing Process Repeated Freeze-Thaw Cycles Microvascular Effects Morphologic and Histologic Changes After Cryotherapy Immunology and Cryoablation See Chapter 10 Operative Technique Preoperative Preparation Cryotherapy at Laparotomy: Open Cryotherapy Postoperative Care Laparoscopic Cryotherapy Percutaneous Cryotherapy Approaches Follow-Up of Patients Treated by Cryotherapy Technical Considerations Inflow Occlusion Monitoring the Ice Ball Bile Duct Warming Complications of Cryotherapy Cracking the Ice Ball and Liver Surface Fracture Myoglobinuria Generalized Hypothermia Hemorrhage Bile Fistula and Bile Collections Cryoshock Mortality Long-Term Results of Cryoablation Hepatocellular Carcinoma Liver Metastases Comparison With Radiofrequency and Microwave Ablation Ethanol Injection Conclusion References 99 Regional chemotherapy for liver tumors Overview Systemic Chemotherapy Rationale for Hepatic Arterial Chemotherapy Surgical Technique and Operative Considerations Hepatic Artery Pump Placement Conventional Hepatic Arterial Anatomy Aberrant Hepatic Arterial Anatomy See Chapter 2 Aberrant Origin of the Gastroduodenal Artery Accessory Left Hepatic Artery Accessory Right Hepatic Artery Replaced Left Hepatic Artery Replaced Right Hepatic Artery Pump Placement After Major Hepatectomy Postoperative Assessment Technical Complications of Hepatic Artery Infusion Pump Placement Extrahepatic Perfusion Incomplete Hepatic Perfusion Gastroduodenal Ulcers Arterial or Catheter Thrombosis Infectious Complications Hemorrhagic Complications Biliary Sclerosis Minimally Invasive Techniques for Placement of Hepatic Arterial Infusion Pumps Placement of Hepatic Arterial Infusion Pumps Using Percutaneous Interventional Techniques Toxicity and Response Rates of Hepatic Arterial Infusion Therapy Toxicity of Intrahepatic Therapy Approaches to Decrease Hepatic Toxicity Methods to Increase Response Rate First-Line Hepatic Arterial Chemotherapy in Unresectable Liver Metastases see Chapter 92 Combined Hepatic Arterial Infusion and Systemic Chemotherapy Conversion of Unresectable to Resectable Disease See Chapter 92 Adjuvant Hepatic Arterial Chemotherapy After Liver Resection of Colorectal Metastases See Chapter 92 Hepatic Arterial Infusion for NonColorectal Liver Metastases and Primary Liver Cancer see Chapters 50, 91, and 94 Concluding Remarks References 100 Systemic chemotherapy for hepatic colorectal cancer Systemic Therapy Traditional Cytotoxic Chemotherapy Fluoropyrimidines Oxaliplatin Irinotecan Molecular Targeted Therapy Bevacizumab Other Antiangiogenic Agents Epidermal Growth Factor Receptor Inhibitors Combining Systemic Therapy With Surgery Initially Resectable CRCLM Preoperative Therapy Adjuvant Therapy Initially Unresectable CRCLM: Conversion Chemotherapy Response to Therapy Imaging Pathologic Response Progression on Chemotherapy Carcinoembryonic Antigen Disappearing Liver Metastases Management of Synchronous Disease Extrahepatic Disease Impact of Systemic Chemotherapy on Additional Treatment Modalities Portal Vein Embolization See Chapter 108C Two-Stage Hepatectomy See Chapters 92, 103B, and 108A Liver-Directed Therapy Conclusion References 101 Advances in systemic therapy for hepatocellular carcinoma Overview Hepatocellular Carcinoma and Cirrhosis: Two Diseases in One Role of Chemotherapy in Hepatocellular Carcinoma Novel Biologic Therapies in HCC Epidermal Growth Factor Receptor, c-MET, and Insulin Growth Factor Receptor Combination Therapy Studies With Antiangiogenics Second-Line Therapies Immunotherapy Arginine Metabolism Etiology and Systemic Therapy Outcome Assessment of Radiologic Response in Hepatocellular Carcinoma Neoadjuvant and Conversion Therapy Adjuvant Therapy Combining Local and Systemic Therapies Conclusion References 102 Isolated hepatic perfusion for extensive liver cancer Isolated Hepatic Perfusion for Unresectable Hepatic Metastases Surgical Technique Results Colorectal Cancer See Chapter 92 Ocular Melanoma See Chapter 94 Other Histologies Percutaneous Hepatic Perfusion Conclusion References 103A Hepatic resection Overview Conclusion References 103B Hepatic resection for benign disease and for liver and biliary tumors General Principles Benign Disease Malignant Disease Principal Hazards Future Liver Remnant Portal Hypertension and Ascites See Chapter 76 Infection Selection of Patients for Liver Resection Anatomy and Classification Preoperative Considerations Preoperative Investigations Other Investigations Staging Laparoscopy Assessment of Resectability Preoperative Preparation Anesthetic Considerations See Chapter 24 Operative Procedures Patient Positioning Incisions Exposure, Mobilization, and Assessment Intraoperative Ultrasound Major Anatomic Hepatic Resections Inflow Control and Preservation of Biliary Tree Integrity Outflow Control Parenchymal Transection Drainage of Abdominal Cavity Right Hepatectomy Inflow and Biliary Control Pedicle Ligation Exposure and Control of Right Hepatic Vein Parenchymal Transection Wound Closure and Drainage Anterior Approach to Right Hepatectomy With Hanging Maneuver Extended Right Hepatectomy Left Hepatectomy Inflow Control Outflow Control Parenchymal Transection Extended Left Hepatectomy Preoperative Evaluation Operative Technique Experience: Extended Left Hepatectomy Left Lateral Sectionectomy Hepatic Segmentectomy Segment I Caudate Lobe Resection Anatomy Resection Resection of Segments II, III, IV, V, VI, VII, and VIII Resection of Segment IV Resection of Segments IV and V Resection of Segments V and VIII Right Anterior Sectionectomy Central Hepatic Resection Resections of Segments VI and VII Right Posterior Sectionectomy Resection of Segment II or III Hepatic Resection for Hilar Cholangiocarcinoma Cryoablation-Assisted Hepatic Resection Technique Enucleation of Giant Hemangiomata and Other Benign Liver Tumors See Chapter 90A Technique References 103C Standard and extended resections for perihilar cholangiocarcinoma Standard Procedure Hepatic Trisectionectomy Combined Vascular Resection Hepatopancreatoduodenectomy References 103D Liver resection in cirrhosis Preoperative Evaluation General Status Tumor-Related Factors Assessment of Liver Functional Reserve Child-Pugh Classification Portal Hypertension Indocyanine Green Retention Rate Other Tools to Assess Liver Function Preoperative Simulation and Volume Estimation Surgical Techniques Inflow and Outflow Occlusion Intraoperative Ultrasound Anatomic Resection Surgical Margin Laparoscopic Liver Resection Surgical Devices for Liver Parenchyma Division Clamp Crushing Ultrasonic Dissector Vessel-Sealing System Ultrasonic Scalpel and Multiprobe Bipolar Radiofrequency Device Automatic Suture Device Vascular Stapler Comparison of Surgical Devices Anterior Approach Hepatic Vein Reconstruction Postoperative Management Fluid Infusion and Transfusion Diuretics Drainage Nutritional Support Complications Liver Failure Bile Leakage Postoperative Bleeding Refractory Ascites Infection Peptic Ulcer Conclusion References 104 Resection technique for live-donor transplantation Donor Workup Step 1 Step 2a Step 2b Step 3 Step 4 Side and Size of Graft Donor Right Hepatectomy See Chapter 117 Exposure Isolation of Major Vessels and Parenchymal Transection Graft Delivery Inclusion of Middle Hepatic Vein Donor Left Hepatectomy Segment II and III Donor Hepatectomy Anatomic Anomalies of the Donor See Chapter 2 Liver Graft Back-Table Procedure: Perfusion and Trimming Donor Postoperative Care Donor Mortality and Morbidity Conclusion References 105 Minimally invasive techniques in hepatic resection Terminology and Definitions Indications Tumor Size and Location Tumor Pathology Safety and Benefits Oncologic Outcomes Surgical Technique General Principles Imaging Equipment Positioning Incisions, Exploration, and Exposure Transection Techniques See Chapter 103B Extraction, Drainage, and Closure Conversion to Laparotomy Specific Hepatectomy Procedures See Chapter 103B Left Lateral Sectionectomy Peripheral Partial Hepatectomy: Wedge Resection, Metastasectomy, or Tumorectomy Left Hemihepatectomy Right Hemihepatectomy Anatomic Segmentectomy and Sectionectomy Robotic-Assisted Laparoscopic Hepatectomy Conclusion References 106 Vascular isolation techniques in hepatic resection Anatomic Basis for Vascular Control Hemodynamic Response to Different Types of Clamping Hemodynamic Response to Pedicle Clamping Hemodynamic Consequences and Limitations of Hepatic Vascular Exclusion Anesthetic Considerations See Chapter 24 Low Central Venous Pressure Anesthesia or Limited Filling Maintaining Low Venous Backflow See Chapter 24 Special Considerations During Hepatic Vascular Exclusion Surgical Aspects of Vascular Clamping See Chapter 103B Inflow Vascular Clamping Total Inflow Control Continuous Clamping Intermittent Clamping Preconditioning Postconditioning Topical Hypothermia Selective Inflow Control Selective Inflow Clamping of One Hemiliver Segmental Selective Clamping Inflow and Outflow Vascular Control Hepatic Vascular Exclusion Hepatic Vascular Exclusion With Caval Flow Preservation Hepatic Vascular Exclusion With Hypothermia Isolated Caval Clamping Infrahepatic Caval Clamping Isolated Total Caval Clamping No Clamping Technique Conclusion References 107 Vascular reconstruction techniques Inferior Vena Cava Resection and Reconstruction Complete Obstruction of Inferior Vena Cava Partial Obstruction of Inferior Vena Cava Resection and Reconstruction of Inferior Vena Cava Control of Suprahepatic Inferior Vena Cava Vascular Clamping Procedures and IVC Resection Reconstruction of Inferior Vena Cava Hepatic Vein Resection and Reconstruction Portal Vein Resection and Reconstruction Hepatic Artery Resection and Reconstruction Conclusion References 108A Parenchymal preservation in hepatic resectional surgery Rationale for Parenchymal-Preserving Techniques for Hepatectomy for Cancer Surgical Techniques for Parenchymal Preservation Mini-Mesohepatectomy Right Posterior Sectionectomy Defining “Anatomic Resection? Conclusion References 108B Segment-oriented anatomic liver resections Anatomy and Terminology See Chapter 2 Patient Selection Preoperative Planning General Operative Principles Preoperative Assessment and Anesthesia Exposure and Mobilization Intraoperative Assessment Transection Techniques Procedures Monosegment and Bisegment Resections Segment I Resection Direct Approach. Anterior Approach. Segment III or III Resection Combined Resection of Segments II and III: Left Lateral Sectionectomy Segment IV Resection Segment V or VIII Resection Segment V Resection Segment VIII Resection Combined Resection of Segments V and VIII Segment VI or VII Resection Segment VI Resection Segment VII Resection Combined Resection of Segments VI and VII Combined Resection of Segments V and VI Three or More Segmental Resections Resection of Segments V to VIII: Right Hepatectomy Resection of Segments II to IV: Left Hepatectomy Resection of Segments IV, V, and VIII: Mesohepatectomy References 108C Preoperative portal vein embolization Evaluation of Future Liver Remnant Volume to Predict Safety of Major Hepatectomy Systematic Volumetry Minimal FLR Volume Required for Safe Liver Resection Indications and Contraindications for Portal Vein Embolization Technical Aspects of Portal Vein Embolization Access Routes to Portal Venous System Transileocolic Venous Approach Percutaneous Transhepatic Contralateral Approach Percutaneous Transhepatic Ipsilateral Approach Optimal Extent of Embolization Sequential Arterial Embolization and Portal Vein Embolization Degree and Speed of Hypertrophy and Risk of Postoperative Hepatic Insufficiency Complications of Percutaneous Portal Vein Embolization Clinical Outcomes Short-Term Surgical Outcomes Long-Term Surgical Outcomes Hepatocellular Carcinoma See Chapter 91 Biliary Tract Cancer See Chapter 51 Colorectal Liver Metastases See Chapter 92 Outcomes in Patients With Extremely Small Future Liver Remnant Conclusion References 108D Associating liver partition and portal vein ligation for staged hepatectomy ALPPS Indications Assessment of Future Liver Remnant Surgical Technique Anatomic Aspects Surgical Aspects Stage 1 Interval Phase Stage 2 Pathophysiologic Aspects Results Conclusion References 109 Ex vivo and in situ hypothermic hepatic resection History of Hypothermic Perfusion and Ex Vivo Techniques In Situ Hypothermic Perfusion Ante Situm Procedure Ex Vivo Liver Resection Patient Selection and Preoperative Workup Anesthesia Surgical Procedure Assessment of Resectability and Removal of the Liver Ex Situ Liver Resection Hepatic Vein and Inferior Vena Cava Reconstruction Reimplantation Postoperative Course Current Role of Ex Vivo Liver Resection References 110 Adjuncts to hepatic resection Technical Aspects Probe Selection Preparation for Liver Exploration Ultrasound Liver Anatomy Indications Liver Exploration Contrast-Enhanced Intraoperative Ultrasonography Hepatocellular Carcinoma Colorectal Liver Metastases Other Intraoperative Techniques Planning the Surgical Strategy Tumor in Contact With Glissonian Pedicle Tumor in Contact With Hepatic Vein Systematic Extended Right Posterior Sectionectomy Eligibility Criteria Procedure Mini-Mesohepatectomy Eligibility Criteria Procedure Upper Transversal Hepatectomy Eligibility Criteria Procedure Liver Tunnel Eligibility Criteria Procedure Resection Guidance Mobilization of the Liver See Chapter 103B Anatomic Resections See Chapters 2, 103B, 108A, and 108B Segmentectomies See Chapter 108B Puncture of Portal Branch Compression of Portal Branch Hooking of Portal Branch Other Techniques Sectionectomies See Chapter 108B Right Posterior Sectionectomy Right Anterior Sectionectomy Limited Resections Liver Parenchyma Dissection Alternative Methods for Liver Dissection Guidance Postresectional Control Intraoperative Cholangio-Ultrasound Intrahepatic Biliary Tree Integrity Proper Drainage of Bile Duct Stump Conclusions References 111 Liver and pancreas transplantation immunobiology General Considerations: Specificity and Context Physiologic Immunity Innate Immunity Acquired Immunity Cellular Immunity Humoral Immunity Evolving Cellular Composition With Age Mediators of Context: Costimulation and Cytokines Transplant Immunity Clinical Rejection Syndromes Hyperacute Rejection Acute Rejection Chronic Graft Loss Antibody-Mediated Rejection Immunosuppression Corticosteroids Antiproliferative Agents Azathioprine Mycophenolate Mofetil Calcineurin Inhibitors Cyclosporine Tacrolimus mTOR Inhibitors Sirolimus and Everolimus Antilymphocyte Agents Antilymphocyte/Antithymocyte Globulin OKT3 Antiinterleukin-2 Receptor α-Chain Monoclonal Antibodies Costimulation Blockade Minimization of Maintenance Immunosuppression Immunosuppression Withdrawal and Operational Tolerance References 112 Liver transplantation General Indications and Contraindications General Considerations Malnutrition Obesity Psychological Assessment Tobacco Use Illicit Drug Use Age Previous Abdominal Surgery Infection Human Immunodeficiency Virus Hepatitis C Virus Cardiovascular Disease Respiratory Function Hepatopulmonary Syndrome Portopulmonary Hypertension Other Pulmonary Considerations Coexisting Disease Bone Disease Specific Diseases Fulminant Hepatic Failure See Chapter 114 Variants of Acute Liver Failure: Subacute Liver Failure. Fulminant Autoimmune Hepatitis. Metabolic Diseases Budd-Chiari Syndrome Chronic Liver Disease Primary Biliary Cirrhosis Primary Sclerosing Cholangitis Alcoholic Liver Disease Alcoholic Hepatitis Hepatitis A Viral Infection Hepatitis B Viral Infection Hepatitis C Viral Infection Hepatocellular Carcinoma Cholangiocarcinoma Secondary Liver Cancers Pediatric Transplantation Assessment of Patients for Liver Transplantation Consent Management of Patients Awaiting Transplantation References 113 Liver transplantation Preoperative Anesthetic Assessment Cardiovascular System Hyperdynamic Circulation Coronary Artery Disease Nonischemic Cardiomyopathy. Pulmonary System Portopulmonary Hypertension Hepatopulmonary Syndrome Hepatic Hydrothorax Chronic Obstructive Pulmonary Disease and Smoking Hemostasis in End-Stage Liver Disease Renal System Central Nervous System Intraoperative Monitoring Hemodynamic Management Monitoring of Hemostasis Metabolic Monitoring Glucose Control Electrolytes Temperature Monitoring Intraoperative Management Ventilatory Management Hemodynamic, Fluid, and Transfusion Management Critical Intraoperative Events Postreperfusion Syndrome and Refractory Hypotension Pulmonary Embolism Special Situations Acute Liver Failure Combined Liver-Kidney Transplantation Donation After Cardiac Death Living-Related-Donor Liver Transplantation Retransplantation Pediatric Transplantation Age at Transplantation and Survival Recipient Selection Type of Surgical Graft Intraoperative Anesthesia Challenges Vascular Access. Postoperative Intensive Care Early Extubation Medical Complications Surgical Complications References 114 Liver transplantation in patients with fulminant hepatitis Initial Recognition and Management Is Key to Prognosis Etiology of Acute Liver Failure Viral Hepatitis Drug-Induced Liver Injury Management of the Patient With Acute Liver Failure Specific Etiologic Treatment Prevention, Recognition, and Early Treatment of Complications Hepatic Encephalopathy Coagulopathy Infections Hemodynamic Complications Acute Renal Failure Pulmonary Complications Metabolic Disturbances Distinguishing Patients Who May Improve Spontaneously or Who Will Require Liver Transplantation Prognostic Factors Prognostic Scores Preoperative Management Living-Donor Liver Transplantation Auxiliary Liver Transplantation Liver Support Devices Artificial Liver Support Bioartificial Liver Support Hepatocyte Transplantation Conclusion References 115A Liver transplantation for hepatocellular carcinoma Hepatocellular Carcinoma Biology of Hepatocellular Carcinoma Clinically Relevant Aspects of Hepatocellular Carcinoma Pathogenesis Hepatocellular Carcinoma Screening Treatment Options Indications for Transplantation See Chapter 112 Waiting List Screening for Hepatocellular Carcinoma Pretransplant Management of Patients With Hepatocellular Carcinoma Downstaging Technical Aspects of Liver Transplantation in Hepatocellular Carcinoma See Chapter 119 Predicting and Screening for Tumor Recurrence Salvage Transplantation Future Perspectives References 115B Liver transplantation for nonhepatocellular malignant disease Hilar Cholangiocarcinoma See Chapters 50 and 51 Early Experience With Liver Transplantation Neoadjuvant Therapy and Liver Transplantation Mayo Clinic Experience Inclusion and Exclusion Criteria Tumor Diagnosis Neoadjuvant Therapy Staging Operation Liver Transplantation Results Recurrence and Prognostic Factors Pancreatoduodenectomy and Transplantation Vascular Complications Medical and Neoadjuvant Complications Key Questions Diagnostic Accuracy Efficacy Appropriate Use of Donor Organs Deceased-Donor Allocation and Prioritization Resection Versus Transplantation Metastatic Neuroendocrine Cancer See Chapter 93 Metastatic Colorectal Cancer Hepatic Epithelioid Hemangioendothelioma See Chapter 89 Conclusion References 116 Orthotopic liver transplantation Patient Selection Recipient Selection Donor Selection Operative Techniques Donor Hepatectomy Recipient Hepatectomy Recipient Implantation Complications Primary Nonfunction Hepatic Artery Thrombosis Hepatic Artery Stenosis Portal Vein Thrombosis Portal Vein Stenosis Biliary Complications Infection Rejection Metabolic and Systemic Complications Renal Dysfunction Posttransplantation Metabolic Syndrome Diabetes Mellitus Neurologic Complications Outcomes Biliary Atresia Primary Sclerosing Cholangitis and Primary Biliary Cirrhosis Alcoholic Cirrhosis Hepatitis B Virus Hepatitis C Virus Hepatocellular Carcinoma Cholangiocarcinoma Fulminant Hepatic Failure Nonalcoholic Steatohepatitis Retransplantation Conclusion References 117 Living-donor liver transplantation Living-Donor Liver Transplantation: Indications and Results Pediatric Living-Donor Liver Transplantation Adult Living-Donor Liver Transplantation Hepatitis C Virus Primary Hepatic Malignancy Donor Evaluation Anatomic Variations See Chapter 2 Hepatic Artery Portal Vein Biliary Anatomy Hepatic Veins Graft Size and Small-for-Size Syndrome Donor and Recipient Surgical Procedures See Chapters 104 and 119 General Principles Minimally Invasive Approaches in Living-Donor Hepatectomy Left Lateral Section Transplantation Open Donor Procedure Laparoscopic Donor Procedure Recipient Procedure Left Liver Transplantation Open Donor Procedure Laparoscopic Donor Procedure Recipient Procedure Right Liver Transplantation Open Donor Procedure Laparoscopic Donor Procedure Initial Maneuvers. Right-Lobe Mobilization. Hilar Dissection and Liver Resection. Recipient Procedure Donor Complications and Morbidity Recipient Morbidity Biliary Complications Postoperative Care of Living Liver Donors Health-Related Quality of Life Living-Donor Transplantation: Future Directions Acknowledgment References 118 Liver transplantation in children Historic Overview Indications Evaluation of the Potential Transplant Recipient Contraindications Recipient Hepatectomy Graft Procurement and Engraftment Reduced-Size Segmental Liver Transplantation and Split-Liver Transplantation See Chapter 119 Reduced-Size Segmental Liver Transplantation Split-Liver Transplantation Reduced and Hyperreduced Left Lateral Segment Liver Transplantation Living-Donor Transplantation See Chapters 104 and 117 Procedure Adults Donor and Recipient Risk in Living-Donor Liver Transplantation Postoperative Management and Complications After Pediatric Liver Transplantation Immunosuppression Results of Pediatric Liver Transplantation Conclusion References 119 Techniques of liver replacement Historic Overview Donor Operation Standard Liver Procurement Modified Donor Procedures Rapid Procurement Super-Rapid Procurement Back-Table Surgery Liver, Pancreas, and Intestine Procurement From the Same Donor Recipient Operation Abdominal Incision and Exposure Intraoperative Determination of Surgical Strategy Venovenous Bypass Hilar Dissection Host Hepatectomy With or Without Vena Cava Removal Alternative Approaches to Hepatectomy Vascular Anastomoses Biliary Tract Reconstruction Reduced-Size Liver Transplantation References 120 Early and late complications of liver transplantation Procurement Injury to the Graft Intraoperative Hemorrhage and Coagulopathy See Chapters 24 and 113 Primary Graft Dysfunction or Nonfunction Vascular Complications Hepatic Artery Thrombosis Portal Vein Thrombosis Inferior Vena Cava Obstruction Biliary Complications Biliary Leaks Biliary Stricture or Obstruction Renal Dysfunction Fluid and Electrolyte Disturbances Acute Cellular Rejection Infection Posttransplantation Lymphoproliferative Disorder Acute Immunosuppressive Drug Toxicity Recurrent Hepatitis See Chapters 70 and 111 Bone Disease Neuropsychiatric Complications Hypertension and Hyperlipidemia Conclusion References 121 Whole Organ pancreas and pancreatic islet transplantation Whole-Organ Pancreas Transplantation History and Early Results Indications and Patient Selection Donor Operation Back-Table Preparation of the Pancreas Recipient Operation Complications Results Risk/Benefit Considerations Pancreatic Islet Transplantation History and Early Results Islet Autotransplantation The Edmonton Protocol and Beyond Complications and Risk/Benefit Considerations Future Directions in Islet Transplantation References 122 Injuries to the liver and biliary tract Evolution of the Approach to Hepatic Trauma Surgical Anatomy of the Liver: a Trauma Surgeon’s Perspective See Chapter 2 Stable Patient With Blunt Hepatic Injury Practical Aspects of Nonoperative Management Faliure of Nonoperative Management Adjuncts to Nonoperative Management Other Complications of Nonoperative Management Nonoperative Management of Penetrating Hepatic Trauma Unstable Patient With Hepatic Trauma Superficial, Low-Grade Injuries Packing of Deep Liver Lacerations Other Techniques for Hemostasis of Deep Liver Lacerations Bleeding From the Hepatic Veins and Juxtahepatic Vena Cava Urgent Reoperation Planned Reoperation Extrahepatic Biliary Injury Conclusion References 123 Pancreatic and duodenal injuries Evolution of the Approach to Pancreatic Trauma Surgical Anatomy of the Pancreas and Duodenum: a Trauma Surgeon’s Perspective See Chapter 2 Diagnosis of Pancreatic and Duodenal Trauma Operative Management of Injuries to the Body and Tail of the Pancreas See Chapter 66 Distal Pancreatectomy Postoperative Pancreatic Fistula Injuries in the Stable Patient Management of Leaking Duodenal Repair Pancreatoduodenal Injuries in the Unstable Patient Trauma Whipple Conclusion References 124 Aneurysm and arteriovenous fistula of the liver and pancreatic vasculature Hepatic Artery Aneurysms and Pseudoaneurysms Arterioportal Fistula Acquired Arterioportal Fistula Congenital Arterioportal Fistula Management of Arterioportal Fistula Hemangioma Venous Abnormalities Congenital Portal Vein Anomalies Congenital Portosystemic Shunts Pancreatic Arteriovenous Malformations Splenic Artery Aneurysms True Aneurysms False Aneurysms Management References 125 Hemobilia and bilhemia History Etiology Iatrogenic Trauma Accidental Trauma Vascular Disorders Neoplasms Gallstones Infections and Inflammation Clinical Manifestations Diagnosis Treatment Surgical Intervention Arterial Embolization Biliary Tract Management Bilhemia Hemosuccus Pancreaticus References Index A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
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