Metabolic Changes Following Major Hepatic Resection

Aronsen, K. F.; Ericsson, B.; Phil, B.

doi:10.1097/00000658-196901000-00010

Cited by 50 publications

(13 citation statements)

References 6 publications

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“…This confirms the findings of others.18 21 Though it has been estimated that replacement of liver mass may take as long as four to six months after partial hepatectomy18 I' recent reports suggest that the process may be much more rapid, and especially so in the first 7 to 14 days after operation.14 a9 Exact measurements of the rate of regeneration of the liver in man are difficult to obtain. Pack et al 22 suggested that growth may be as rapid as 50 g or more a day.…”

Section: Discussionsupporting

confidence: 66%

Injuries to the Liver: Analysis of 20 Cases

Blumgart¹,

Vajrabukka²

1972

BMJ

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Twenty cases of liver injury among 55 consecutive cases of abdominal injury submitted to laparotomy over a four-year period are reported. Forty-four of the cases were blunt injuries, and the cases of liver injury were in this group. Road traffic accidents accounted for 37 of the 44 cases and 17 of the 20 liver injuries. Except in two cases injury to the liver was associated with injury to other organs. Severe chest injury was found in 40% of the cases and serious skeletal injury in 45%. The overall mortality in blunt injury to the liver was 20% (4 cases) and was directly attributable to the liver injury in only one case.Liver injuries are classified as minor or major according to the depth of the wound and the associated destruction of liver tissue. Liver resection is advocated for major injuries. Right hepatic lobectomy was performed on five occasions and three of the patients survived. Death in the other two was due to associated injuries. The remarkable regenerative capacity of the liver is emphasized.

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Section: Discussionsupporting

confidence: 66%

Injuries to the Liver: Analysis of 20 Cases

Blumgart¹,

Vajrabukka²

1972

BMJ

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“…The cyclic changes in basic liver function were similar to those described by others after major hepatic resection [8,9,[11][12][13][14]. Prompt resumption of a healthful diet was probably the most important factor in our patient's recovery.…”

Section: Commentssupporting

confidence: 84%

Alopecia, ascites, and incomplete regeneration after 85 to 90 per cent liver resection

Starzl¹,

Putnam²,

Groth³

et al. 1975

The American Journal of Surgery

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The purpose of this report is to describe some unusual manifestations that followed a very extensive hepatectomy (85 to 90 per cent) and to comment about the less than complete degree of regeneration that occurred postoperatively. Case ReportA nineteen year old girl had undergone exploration one week prior to admission because of a huge mass that occupied all of the upper abdomen and which, as indicated by liver scan ( Figure 1, left), replaced much of the liver. Tissue diagnosis of a well differentiated hepatoma was made from the previous exploration. Measurement of alpha fetoprotein was negative. For some months she had had severe abdominal pain that was eventually demonstrated to be due to hemorrhage into the tumor. A selective celiac arteriogram demonstrated a single hepatic artery. (Figure 1, right.) Although the entire arterial blood supply appeared to be involved in tumor, an attempt at resection was decided on.The procedure was carried out May 10, 1972, through a bilateral subcostal incision. The right hepatic artery, portal vein, and hepatic duct were ligated and divided. Branches of the left main hilar structures passing to the medial segment of the left lobe were cut, leaving only the lateral segment connected. The right and middle hepatic veins and all the small hepatic veins entering the inferior vena cava from the caudate lobe were sacrificed so that only the left hepatic vein remained. The lateral segment of the left lobe was smaller than usual, constituting approximately 15 per cent of the normal liver mass. Part of this segment had to be excised to remove the tumor, which extended to the left of the falciform ligament. The remaining hepatic fragment was thought to represent between 10 and 15 per cent of a normal liver. The excised specimen weighed 2,100 gm and had areas of hemorrhage within the tumor. It was examined histologically in five university departments of pathology noted for their special interest in liver disease. All consultants described the well-differentiated features of the neoplasm. Two diagnoses of hepatocellular adenoma were made, but three of the consultants classified the lesion as a hepatoma (hepatocarcinoma).After resection was completed, the residual fragment felt tense, a condition that was aggravated by efforts to cover the raw liver edge with the falciform ligament or omentum. Consequently, the raw surface was left open. The large right subphrenic cavity was extensively drained. The operation required nine hours and 5,500 ml of blood. Postoperative ventilatory support was provided for the first five hours. The patient was completely disoriented for three days but then suddenly became lucid.Requests for reprints should be addressed to Thomas E. Starzl, MD. Department of Surgery, University of Colorado Medical Center, 4200 East Ninth Avenue, Denver, Colorado 80220. NIH Public Access Author ManuscriptAm J Surg. Author manuscript; available in PMC 2010 October 25. Serious abnormalities in liver function, including jaundice, did not clear until the third week. (Figure 2) A...

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“…Studies in both cirrhotic and noncirrhotic adults have shown that biochemical liver function tests (LFTs) return to normal within weeks of major liver resection [1][2][3][4] and that liver size approaches 80% to 90% of its original volume within 6 months [3][4][5]. Liver regeneration is faster and more complete in noncirrhotics compared with those with cirrhosis.…”

mentioning

confidence: 99%