In the following you will find information on liver diseases that are treated surgically.
Synonyms in a broader sense
Medical: hepar liver flap, liver cell, liver cancer, liver cirrhosis, fatty liver
Surgical diseases of the liver
Below you can see the list of all topics that have already been published on liver diseases that belong to the medical field of surgery:
Definition Liver
The liver is the central metabolic organ of humans. Its tasks include the food-dependent storage, conversion and release of sugars and fats, the breakdown and excretion of endogenous and medicinal toxins, the formation of most blood proteins and bile, and numerous other tasks.
- Thyroid cartilage larynx
- Trachea (windpipe)
- Heart (Cor)
- Stomach (Gaster)
- Large intestine (colon)
- Rectum (rectum)
- Small intestine (ilium, jejunum)
- Liver (Hepar)
- Lung, or lung wing
Function and anatomy of the liver
In humans, the liver lies in the right upper abdomen directly below the diaphragm and protrudes with its left liver lobes to the middle of the upper abdomen. In adults the liver weighs about 1400 – 1800 g and is divided into four large lobes: Lobus hepatis dexter – Lobus hepatis sinister – Lobus quadratus – Lobus caudatus. The liver can also be divided into segments.
There are 8 liver segments, which are of great importance during surgical removal. Segment 1 corresponds to the caudate lobus. Segments 2-4 correspond to the left liver lobe. Segments 5-8 correspond to the right lobe. You can learn more about the function and anatomy of the liver in our topic:
- Anatomy Liver
Disease of the liver
The following diseases, which often require surgical intervention, are explained below: 1. liver tumors2. Liver abscess3. Echinococcosis4.
Gallstones5. Acute liver failure All liver diseases treated by the Department of Internal Medicine can be found under the following link: Liver – Internal Medicine. As with tumors in other organs, there are both benign and malignant tumors in the liver.
The following tumors are among the benign tumors of the liver: They do not necessarily have to be removed surgically. Only if the symptoms are clear and the tumor has increased in size should it be removed surgically. Liver cysts (fluid-filled cavities) occur in approximately one in 10 people.
They are harmless and develop already in the womb, during the organ development of the foetus. If they do not cause any discomfort, they do not require any treatment. If there are upper abdominal complaints, a feeling of fullness or other symptoms, the liver cysts can be removed by surgical intervention.
In malignant liver tumors, a distinction is made between hepatocellular carcinoma (HCC) and cholangiocellular carcinoma (CCC). The former (HCC) develops in the liver itself. The other (CCC) is a malignant cancer of the bile ducts.
The number of people affected by hepatocellular carcinoma or cholangiocellular carcinoma has increased significantly in recent years. This is due to viral liver inflammation and the increasing life expectancy of the population. In addition, metastases from other malignant tumors can implant themselves in the liver.
These are often metastases from colon or rectal cancer. Liver tumors are particularly treacherous because they develop symptoms very late and are therefore discovered very late. These include jaundice, nausea, weight loss, water belly, pain in the upper abdomen.
Early detection as well as surgical removal are of great importance for the probability of survival. In addition, chemotherapy can increase the chances of recovery. The right lobe of the liver is far more frequently affected by a liver abscess than the left.
In 40% of cases, several small accumulations of pus are found in the liver. Typical signs of liver abscesses are chills, fever, pressure pain in the right upper abdomen, nausea, vomiting. The diagnosis is confirmed by patient interview, physical examination, blood count and imaging.
The liver may be enlarged and palpable in liver abscesses. In addition, the affected person expresses pain when pressing on the abdomen. In the blood test, elevated inflammation values can give an indication of a liver abscess.
Imaging procedures such as sonography (Sono), X-ray, computer tomography (CT) ultimately confirm the suspicion of a liver abscess. Liver abscesses are first treated with antibiotics.If the drug is not effective, a CT/sono controlled fine needle puncture and an outwardly draining wound drainage can lead to healing. If the conservative therapy fails, a surgical intervention is performed.
In this procedure, the abscess alone or a complete liver segment is removed, a wound irrigation is performed and a wound drainage (a tube that drains the secretion to the outside) is inserted.
- Hemangioma(blood sponge in the liver)
- Liver adenoma (benign new formation/accumulation of liver cells)
- Focal Nodular Hyperplasia (benign new formation of liver, bile duct and connective tissue cells).
- Liver tumors
Two types of echinococcosis are still known today: The alveolar echinococcosis and the cystic echinococcosis. In alveolar echinococcosis the liver is infested by fox tapeworms (Echinococcus multilocularis).
The carriers of the parasite are foxes, dogs and cats. The infection must be treated early, otherwise it destroys the entire liver structure. The carrier of cystic echinococcosis is the dog tapeworm (Echinococcus granulosus).
After oral uptake, the parasites penetrate the intestinal wall and enter the liver via the portal vein. If possible, the echinococcosis should be surgically removed. If necessary, healthy liver tissue is also removed (partial resection of the liver) to be on the safe side.
At the same time, echinococcosis can be treated with an antiparasitic drug (“albendazole”). Gallstones are precipitated salts of the bile fluid that form lumps. They can occur either in the gallbladder, in which case the disease is referred to as cholecystolithiasis, or in the bile ducts (choleangiolithiasis).
There are two forms of gallstones: stones containing cholesterol (about 90%) and stones containing bilirubin (about 10%). Risk factors that favor gallstones are: the female sex, age: > 40 years, overweight, childbearing age, fair skin type. Typical symptoms caused by gallstones are colicky abdominal pain, nausea, discolored bowel movements, pain in the right and middle upper abdomen radiating to the back and right shoulder, yellowing of the skin and mucous membranes, in the case of massively congested bile ducts.
Diagnosis is based on the one hand on questioning the patient, who often confirms the above-mentioned symptoms. An elevated inflammation laboratory can provide indications of gallstones. Ultimately, the imaging ensures the suspected diagnosis.
Another method of diagnosis is endoscopic retrograde cholangio-pancreaticography (ERCP). Here, a tube with a camera at its tip is advanced through the stomach and duodenum into the bile duct. From there, it is possible to examine whether there is a gallstone in it.
Gallstones that do not cause any symptoms do not need to be treated. Small stones (<3 cm) can also come off by themselves. Large stones, or small stones that remain in the bile ducts, must be removed surgically.
Nowadays, the gallbladder is removed by means of a laparoscopy, a minimally invasive method. Chronic gallstone disease leads to recurrent inflammation of the gall bladder. A so-called porcelain gallbladder can develop from this.
The name is correct, since the gallbladder looks like porcelain due to its calcification in the ultrasound image. In the case of a porcelain gallbladder, the risk of malignant degeneration is increased, which is why those affected are advised to undergo early surgical removal of the gallbladder.
- Echinococcosis
- Gallstones
