Hepatic abscesses, like abscesses elsewhere, are localised collections of necrotic inflammatory tissue caused by bacterial, parasitic or fungal agents. Introducción: el absceso hepático amebiano es la manifestación . El diagnóstico diferencial se relaciona con absceso piógeno, subfrénico, piocolecisto. Absceso Hepático Amibiano Ha disminuído la frecuencia 25% tienen antecedente de diarrea Más frecuente en hombres Más frecuente en LHD Absceso único.
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Los botones se encuentran debajo. Metronidazol Drenaje en algunos casos. Imagen por Resonancia T1 T2.
ABSCESOS HEPÁTICOS Amibiano y piógeno.
This slide illustrates the multistep transformation that results in the development piogeho HCC. The next phase is dysplasia, which in turn evolves through genetic or epigenetic alterations into HCC. This sequence has been studied in detail and more is being discovered about the exact pathways that underlie malignant transformation as time goes by. Tornillo L, et al.
Verslype C, et al. This slide shows patients for whom HCC surveillance is recommended. Bruix J, et al. Simonetti RS, et al. How does one choose between radiofrequency ablation and resection, given that there are data from a randomized trial showing no difference in overall survival between the 2 strategies? In tumors of this size, the decision of whether to apply radiofrequency ablation rather than resection may depend on local availability of a hepatobiliary team with experience in resecting tumors or, conversely, access to an interventional radiologist able to perform local ablation with high accuracy.
This does not compete well with resection. Design and endpoints of clinical trials in hepatocellular carcinoma. Journal of the National Cancer Institute. For patients with intermediate-stage B disease who have multinodular tumors without symptoms, no portal invasion, extrahepatic spread, or lymph node involvement, the recommended treatment is transarterial chemoembolization.
Surgery is not indicated in patients who have satellite lesions or portal hypertension. Early data are encouraging, but there is insufficient evidence on which to base a recommendation at this point. For more information, go online to: N Engl J Med.
For patients with liver dysfunction, such as portal hypertension or abnormal bilirubin or those with Child-Pugh class B disease, the first-line treatment option is liver transplantation.
However, there is a shortage of donors in almost every country worldwide. A third option is percutaneous local ablation. This procedure is suitable for patients who are hepaticoo candidates for surgery or liver transplantation.
Radiofrequency ablation is considered the first-line treatment option for these patients based on data from 4 randomized, controlled trials that found this approach to be significantly more effective than percutaneous ethanol injection regarding local control of disease. In addition, meta-analyses suggest there may be an overall survival benefit in favor of radiofrequency ablation. Several randomized, controlled trials have been conducted in this patient population.
Based on these data, both the European Association for the Study of the Liver and AASLD guidelines recommend chemoembolization as the first-line treatment option for this patient group. Trials emerging in this area are exciting.
In first-line therapy, several studies zbsceso evaluating the combination of sorafenib with another agent, for example, erlotinib. This tyrosine kinase inhibitor blocks epidermal growth factor receptor 1. In HCC, epidermal growth factor signaling is activated and is a factor in the pathogenesis of the disease.
Sorafenib does not target epidermal growth factor signaling, and so the combination of these 2 agents may provide dual activity. Another phase III trial is comparing sorafenib vs brivanib in the first-line setting. Brivanib is another novel tyrosine kinase inhibitor, which blocks several pathways, including vascular endothelial growth factor VEGF and Abscesl receptor.
A trial comparing sorafenib with sunitinib was halted in for futility and toxicity, and sunitinib is no longer under investigation in the abscewo of advanced HCC. Sunitinib is hepatio potent multikinase inhibitor that blocks several signaling cascades, some of which are also blocked by sorafenib. Gefitinib, another multikinase inhibitor is also under evaluation as first-line therapy, and there are additional trials involving other types of therapies.
Another study is investigating first-line use of sorafenib plus or minus doxorubicin.
Absceso hepático piógeno versus amebiano: Estudio clínico comparativo de una serie de 58 casos