Background Hepatocellular carcinoma (HCC) is the most common primary liver cancer. Liver cancer is one of the commonest cancers worldwide in terms of incidence and mortality. Viral hepatitis, alcohol abuse, and autoimmune hepatitis are the common causes of HCC. Usually patients present at advanced stages where curative treatment is no longer possible. This study aims to analyze the demographic, clinical, and radiological profiles and treatment patterns of HCC patients. Methods We studied patients with HCC from March 2020 to August 2022 and analyzed their risk factors, clinical characteristics, and treatment modalities. Patients with at least one clinical, radiological, or biochemical evidence of HCC were considered for the study. Data were collected using predetermined proformas. Results Our study included 54 patients with a mean age of 57.17 years, and male: female ratio of 5:1. Of them, 68.52% consumed alcohol and 74.07% smoked cigarettes. At the time of diagnosis, 88.89% of them were symptomatic, weight loss (64.81%) being the most common symptom. The majority of the participants belonged to Barcelona Clinic Liver Cancer (BCLC) terminal stage (38.89%) and had more than three liver lesions (35.19%) involving the right lobe (55.56%). Only four patients underwent curative surgical resection. As most were in the terminal stage (BCLC D), supportive care was provided. Conclusion Alcohol-related liver cirrhosis is the most common cause of HCC in Nepal. Despite the significant progress in diagnostic methods, most of the patients are diagnosed at advanced and terminal stages. These patients are unsuitable for curative treatment and are treated with supportive methods. Keywords Autoimmune hepatitis, hepatitis, hepatocellular carcinoma, treatment.
An 83-year-old-male presented with obstructive jaundice, whose imaging was consistent with the cholangiocarcinoma of the distal common bile duct. The tumor markers were within normal limits. IgG4 level was raised, therefore, IgG4-sclerosing cholangitis was made as the provisional diagnosis. Steroid therapy was started to which he responded well.
Background and Aims: Introduction: Endoscopic Retrograde Cholangiopancreatography(ERCP) has become the first line treatment for patients with common bile duct (CBD) stones. This technique may fail, however, due to presence of a large stone, multiple stones, periampullary diverticula or CBD stricture. The aim of this study was to evaluate the success of CBD cannulation, Endoscopic Sphincterotomy(EST) and CBD clearance in initial attempt, identify the failures of stone extraction and assess the post-ERCP complications. Methods: A prospective study was carried out over the period of January 2019 to January 2020 on 100 consecutive patients with CBD stones. ERCP was done and the stone size and number recorded. EST was performed using a diathermy unit with a cutting current and stones were extracted using a Balloon catheter or a Dormia basket. Results: Of the 100 patients, 44 were male and 56 were female with mean age of 52}17years. Selective CBD cannulation and cholangiogram was achieved in 90%, EST was successful in 90% and complete stone clearance was achieved in first attempt in 46 patients (59%). 52 patients had difficult CBD stone. There were nine complications, most of which rapidly resolved on conservative treatment (four post-ERCP pancreatitis, three bleeding and one retroperitoneal perforation) and one mortality in an old lady due to PSVT that couldn’t be directly attributed to ERCP. Among patients with Stone less than 15 mm in diameter(n=58), stone was removed successfully in 45 patients(78%) whereas in patients with stones over 15 mm (n=20) only one was removed successfully (5%) at initial attempt. Of these 32 patients with residual stones, 13 were referred for surgery and 19 had insertion of biliary stent to be followed by repeat ERCP. Conclusion: Endoscopic therapy is a simple, effective and safe method of treatment in patients with CBD stone.
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