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Book Details
Abstract
Comprehensive and complete, Blumgart’s Surgery of the Liver, Pancreas and Biliary Tract – edited by Dr. William R. Jarnagin and a team of experts- delivers the comprehensive, cutting-edge guidance you need to achieve optimal outcomes in surgery of the liver, biliary tract, and pancreas. Edited by a panel of experts and featuring contributions by many leading authorities, this 2-volume reference brings you the latest information on pathology, diagnostics, surgery, and non-operative intervention all in one source. At www.expertconsult.com you can not only access the complete contents online, but also an abundance of detailed illustrations and step-by-step procedural video clips from the Memorial Sloan Kettering video library that show you how to perform key procedures step by step.
- Glean all essential, up-to-date, need-to-know information in one comprehensive reference that provides extensive coverage of pathology, diagnostics, surgery, and non-operative intervention as well as hepatobiliary and pancreatic surgery.
- Deepen your understanding of surgical anatomy to help with diagnosis, surgical operation, interventional radiology, and endoscopy.
- See how to perform key procedures by watching operative videos from the Memorial Sloan Kettering video library.
- Apply the most advanced diagnostic and management options for each disease, including interventional techniques.  
- Stay current with the latest knowledge and advancements including minimally invasive techniques in hepatic resection; surgical considerations for congenital disorders of the pancreas; non-surgical therapies for pancreatic cancer; microwave ablation and other emerging technologies; the most recent developments in the rapidly changing area of transplantation; and the newest best practices in pre- and post-operative care and blood transfusion.
- Get in-depth coverage of the pancreas from the only fully comprehensive text on both hepatobiliary and pancreatic surgery.
- Learn from the very best. Rely on the trusted guidance of experts, with a fresh perspective from senior editor, Dr. William Jarnigan, who has earned a national and international reputation in the surgical management of diseases of the biliary tract.
- Access the full text online at www.expertconsult.com, along with image and video libraries, tables, figures, and more!
A single, comprehensive reference that covers pathology, diagnostics, surgery, and non-operative intervention all in one text!
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| e9781437714548v1.pdf | 1 | ||
| Front cover | 1 | ||
| Expert Consult page | 2 | ||
| Half title page | 3 | ||
| Frontispiece | 4 | ||
| Blumgart's Surgery of the Liver, Pancreas and Biliary Tract | 5 | ||
| Copyright page | 6 | ||
| Dedication | 7 | ||
| Editors | 8 | ||
| Contributors | 9 | ||
| Preface | 25 | ||
| Acknowledgments | 26 | ||
| Table of Contents | 27 | ||
| Video Contents | 33 | ||
| Introduction Hepatobiliary and pancreatic surgery: | 35 | ||
| Ancient History until the Eighteenth Century | 35 | ||
| Eighteenth Century to Modern Times | 37 | ||
| Imaging in Hepatobiliary and Pancreatic Surgery | 38 | ||
| Surgery of the Biliary Tract and Pancreas | 38 | ||
| Biliary Tract | 38 | ||
| Pancreas | 41 | ||
| Liver Surgery | 43 | ||
| Major Hepatic Resection | 44 | ||
| Liver Tumors | 46 | ||
| Liver Transplantation | 48 | ||
| References | 50 | ||
| 1 Liver, Biliary, and Pancreatic Anatomy and Physiology | 55 | ||
| 1A Embryologic development of the liver, biliary tract, and pancreas | 56 | ||
| Overview of Liver and Biliary Tract Development | 56 | ||
| Endodermal Patterning | 56 | ||
| Hepatic Competence | 58 | ||
| Hepatic Induction | 58 | ||
| Morphogenesis of the Hepatic Bud | 58 | ||
| Liver Bud Growth | 59 | ||
| Overview of Hepatoblast Differentiation | 60 | ||
| Biliary Epithelial Cell Differentiation and Formation of the Ductal Plate | 60 | ||
| Remodeling of the Ductal Plate | 61 | ||
| Developmental Relationship Between the Ducts, Vessels, and Mesenchyme of the Portal Tract | 62 | ||
| Hepatocyte Differentiation | 62 | ||
| Overview of Pancreatic Development | 63 | ||
| Basic Pancreatic Embryology | 63 | ||
| Endodermal Patterning of the Pancreas | 63 | ||
| Dorsal and Ventral Pancreatic Bud Development | 64 | ||
| Pancreatic Mesenchyme | 64 | ||
| TGF-β Signaling | 64 | ||
| Notch Signaling | 65 | ||
| Hedgehog Signaling | 65 | ||
| WNT | 65 | ||
| Endothelial Cells | 65 | ||
| Glucagon | 65 | ||
| Extracellular Matrix | 65 | ||
| Transcription Factors | 66 | ||
| Ptf1α | 66 | ||
| NEUROG3 | 66 | ||
| PAX6 | 66 | ||
| PAX4/ARX | 66 | ||
| NKX2-2 | 66 | ||
| NKX6-1 and NKX6-2 | 67 | ||
| MAFA and MAFB | 67 | ||
| HNF Cascade | 68 | ||
| SOX9 | 68 | ||
| References | 69 | ||
| 1B Surgical and radiologic anatomy of the liver, biliary tract, and pancreas | 72 | ||
| Anatomy Overview | 72 | ||
| Liver | 72 | ||
| Retrohepatic Inferior Vena Cava | 72 | ||
| Hepatic Veins | 72 | ||
| Functional Surgical Anatomy | 72 | ||
| Surgical Implications and Exposure | 78 | ||
| Biliary Tract | 78 | ||
| Intrahepatic Bile Duct Anatomy | 78 | ||
| Extrahepatic Biliary Anatomy and Vascular Anatomy of the Liver and Pancreas | 79 | ||
| Main Bile Duct and Sphincter of Oddi | 80 | ||
| Gallbladder and Cystic Duct | 84 | ||
| Biliary Ductal Anomalies | 84 | ||
| Anomalies of the Accessory Biliary Apparatus | 86 | ||
| Bile Duct Blood Supply | 86 | ||
| Anatomy of Biliary Exposure | 88 | ||
| Biliary-Vascular Sheaths and Exposure of the Hepatic Bile Duct Confluence | 88 | ||
| Umbilical Fissure and Segment III (Ligamentum Teres) Approach | 88 | ||
| Surgical Approaches to the Right Hepatic Biliary Ductal System | 88 | ||
| Exposure of the Bile Ducts by Liver Resection | 89 | ||
| Extrahepatic Vasculature | 90 | ||
| Celiac Axis and Blood Supply of Liver, Biliary Tract, and Pancreas | 90 | ||
| Variations in the Hepatic Artery | 90 | ||
| Portal Vein | 90 | ||
| Pancreas | 93 | ||
| Pancreatic Duct | 94 | ||
| Annular Pancreas | 97 | ||
| Lymphatic Drainage | 98 | ||
| Liver and Pancreas | 98 | ||
| Lymph Node Metastasis and Carcinoma of the Head of the Pancreas | 98 | ||
| Nerve Supply to the Liver and Pancreas | 98 | ||
| References | 99 | ||
| 2 Assessment of hepatic function: | 100 | ||
| Preoperative Considerations | 100 | ||
| Clinical Scoring Systems | 100 | ||
| Dynamic Liver Tests | 102 | ||
| Measurement of Hepatic Uptake and Elimination | 102 | ||
| Hepatobiliary Scintigraphy and Single-Photon Emission Computed Tomography | 103 | ||
| Measurements of Hepatic Metabolism and Elimination | 104 | ||
| Lidocaine Metabolism | 104 | ||
| Galactose Elimination Capacity | 104 | ||
| Measurement of Predicted Postoperative Liver Volume | 104 | ||
| Volumetric Assessment of the Liver | 104 | ||
| Computed Tomography | 104 | ||
| Other Measures of Liver Function | 105 | ||
| Conclusion | 105 | ||
| References | 107 | ||
| 3 Pancreatic physiology and functional assessment | 109 | ||
| The Pancreas | 109 | ||
| Endocrine Pancreas | 109 | ||
| Structure and Innervation | 109 | ||
| Synthesis and Storage of Insulin | 109 | ||
| Stimulus–Secretion Coupling for Insulin Secretion | 109 | ||
| Incretins and the Regulation of Insulin Secretion | 111 | ||
| Glucagon and Other Islet Hormones | 111 | ||
| Endocrine Pancreas in Diabetes | 111 | ||
| Endocrine Pancreas in Chronic Pancreatitis | 111 | ||
| Exocrine Pancreas | 111 | ||
| Structure | 112 | ||
| Neurohormonal Regulation of Exocrine Pancreatic Function | 112 | ||
| Electrolyte Secretion | 113 | ||
| Stimulus-Secretion Coupling in Duct Cells | 114 | ||
| Acinar Cell Biology | 114 | ||
| Digestive Enzyme Activation | 114 | ||
| Stimulus–Secretion Coupling in Acinar Cells | 114 | ||
| Assessment of Pancreatic Function | 114 | ||
| Endocrine Function | 114 | ||
| Assessment of Exocrine Function | 115 | ||
| Indirect Pancreatic Function Tests | 116 | ||
| Direct Pancreatic Function Tests | 116 | ||
| General Approach to Exocrine Pancreatic Function Testing | 117 | ||
| References | 118 | ||
| 4 Liver blood flow: | 120 | ||
| Liver Blood Flow Overview | 120 | ||
| Physiology | 120 | ||
| Liver Blood Supply | 120 | ||
| Hepatic Artery | 120 | ||
| Portal Vein | 120 | ||
| Hepatic Veins | 120 | ||
| Control of Liver Blood Flow | 121 | ||
| Intrahepatic Vascular Resistance in Health | 121 | ||
| Relationship between Hepatic Artery and Portal Vein Blood Flow | 121 | ||
| Metabolism | 121 | ||
| Blood Gas Tensions | 122 | ||
| Sympathetic Nervous System | 122 | ||
| Other Endogenous Vasoactive Agents | 122 | ||
| Anesthetic Agents | 123 | ||
| Measurement of Liver Blood Flow | 123 | ||
| Flow in Single Vessels | 123 | ||
| Electromagnetic Flowmeter | 123 | ||
| Doppler Ultrasound | 123 | ||
| Invasive. | 124 | ||
| Noninvasive. | 124 | ||
| Total Liver Blood Flow | 124 | ||
| Clearance Techniques | 124 | ||
| Indicator Dilution | 124 | ||
| Indicator Fractionation | 124 | ||
| Hepatic Tissue Perfusion | 125 | ||
| Inert Gas Clearance | 125 | ||
| Laser Doppler Flowmetry | 125 | ||
| In Vivo Fluorescent Microscopy | 125 | ||
| Near-Infrared Spectroscopy | 125 | ||
| New and Future Developments | 126 | ||
| Clinical Relevance | 127 | ||
| Hemorrhagic Shock, Hypoperfusion, and Ischemia-Reperfusion Injury | 127 | ||
| Liver Atrophy | 127 | ||
| Liver Resection and Regeneration | 128 | ||
| Blood Flow in Hepatic Tumors | 128 | ||
| Bile Duct Obstruction | 128 | ||
| Portal Hypertension (See Chapters 70 and 74) | 129 | ||
| Hemodynamics | 129 | ||
| Intrahepatic Vascular Resistance in Liver Cirrhosis | 129 | ||
| Treatment (See Chapters 70 and 74) | 130 | ||
| Hemodynamic Studies and Human Liver Transplantation | 131 | ||
| Effect of Liver Transplantation on Liver Blood Flow | 131 | ||
| Effect of Laparoscopy on Liver Blood Flow | 132 | ||
| Acknowledgement | 132 | ||
| References | 133 | ||
| 5 Liver regeneration: | 138 | ||
| Liver Regeneration | 138 | ||
| Clinical Relevance of Liver Regeneration | 138 | ||
| Basic Characteristics of Liver Regeneration | 138 | ||
| Models of Liver Regeneration | 138 | ||
| General Features of Liver Regeneration | 139 | ||
| Liver Stem Cells | 140 | ||
| Endogenous Hepatic Progenitor Cells | 140 | ||
| Exogenous Mobilized Progenitor Cells | 140 | ||
| Induction of Proliferation: Priming and Cell-Cycle Progression | 140 | ||
| Intracellular Pathways and New Profiling Techniques | 142 | ||
| Remodeling of the Liver | 143 | ||
| Maintaining Liver Function During Regeneration | 143 | ||
| Termination of Proliferation | 144 | ||
| Liver Atrophy | 144 | ||
| Mechanisms of Liver Atrophy | 145 | ||
| Portal Vein–Induced Hepatic Atrophy | 145 | ||
| Biliary-Induced Hepatic Atrophy | 146 | ||
| Clinical Causes of Atrophy | 146 | ||
| Compensatory Regeneration Triggered by Atrophy | 146 | ||
| Factors Influencing Liver Regeneration | 146 | ||
| Patient-Related Factors | 146 | ||
| Age | 146 | ||
| Biliary Obstruction | 146 | ||
| Diabetes Mellitus | 146 | ||
| Nutritional Status | 147 | ||
| Gender | 147 | ||
| Intrinsic Liver Disease | 147 | ||
| Pharmacologic Therapy | 147 | ||
| Liver Transplantation | 148 | ||
| Effect of Immunosuppression | 148 | ||
| Donor Age | 149 | ||
| Viral Hepatitis and Bacterial Infections | 149 | ||
| Other Factors | 149 | ||
| Experimental Strategies to Promote Liver Regeneration | 149 | ||
| Clinical Implications | 150 | ||
| Stimulating Liver Regeneration Preoperatively | 150 | ||
| Portal Vein Embolization to Promote Liver Regeneration | 150 | ||
| Ischemic Preconditioning to Stimulate Regeneration | 150 | ||
| Regenerative Potential of the Liver After Chemotherapy | 151 | ||
| Supporting Liver Regeneration Under Difficult Clinical Conditions | 151 | ||
| New Horizons and Future Perspectives | 151 | ||
| Therapeutic Use of Stem Cells | 151 | ||
| Use of Antisense MicroRNAs | 152 | ||
| Summary | 152 | ||
| References | 153 | ||
| 6 Liver fibrogenesis: | 159 | ||
| Liver Fibrogenesis | 159 | ||
| Molecular and Cellular Mechanisms of Fibrosis | 159 | ||
| Common Triggers of Hepatic Fibrogenesis | 160 | ||
| Hepatic Stellate Cell Activation and Hepatic Myofibroblasts (MFBs) | 161 | ||
| Functions of Hepatic MFBs | 161 | ||
| Fibrogenesis | 161 | ||
| Proliferation | 161 | ||
| Immunoregulation | 162 | ||
| Vasoregulation | 163 | ||
| Structural Features of Hepatic Fibrogenesis | 164 | ||
| Regulation of Collagen Deposition and Degradation | 164 | ||
| Diagnosis and Clinical Monitoring of Hepatic Fibrosis | 164 | ||
| Biochemical Tests | 165 | ||
| Serum Assays of Extracellular Matrix Molecules | 166 | ||
| Cytokines and Chemokines Associated with Hepatic Fibrosis | 166 | ||
| Proteomics and Glycomics | 166 | ||
| FibroScan | 166 | ||
| Therapeutic Strategies | 167 | ||
| Reversibility of Fibrosis: The Point of No Return | 167 | ||
| Prevention of Hepatocyte Apoptosis in Liver Injury | 167 | ||
| Caspase Inhibitors | 167 | ||
| Inhibition of HSC Activation or Inactivation of MFBs | 167 | ||
| Induction of MFB Apoptosis | 168 | ||
| Blocking MFB–ECM Interactions | 168 | ||
| Antagonizing Compounds That Mediate Inflammation | 168 | ||
| Selectively Antagonizing Pathways of HSC Activation | 169 | ||
| Enhancing ECM Degradation | 169 | ||
| References | 170 | ||
| 7 Bile secretion and pathophysiology of biliary tract obstruction | 174 | ||
| Overview | 174 | ||
| Bile Secretion | 174 | ||
| Bile Formation | 174 | ||
| Bile Composition | 174 | ||
| Bile Salt Secretion | 174 | ||
| Biliary Lipid Secretion | 176 | ||
| Bilirubin Secretion | 176 | ||
| Bile Flow | 177 | ||
| Enterohepatic Circulation | 177 | ||
| Biliary Obstruction | 177 | ||
| Causes of Jaundice | 177 | ||
| Pathophysiology | 178 | ||
| Hepatobiliary | 178 | ||
| Cardiovascular | 179 | ||
| Renal | 179 | ||
| Coagulation | 180 | ||
| Immune System | 180 | ||
| Wound Healing | 181 | ||
| Other Factors | 181 | ||
| Management | 181 | ||
| Cardiopulmonary | 181 | ||
| Renal | 181 | ||
| Nutrition | 182 | ||
| Coagulation | 182 | ||
| Pruritus | 182 | ||
| Cholangitis | 182 | ||
| Preoperative Drainage | 182 | ||
| Summary | 183 | ||
| References | 184 | ||
| 8A Pancreatic cancer and premalignant tumors: | 185 | ||
| Pancreatic Cancer Overview | 185 | ||
| Progression Model of Pancreatic Ductal Adenocarcinoma | 185 | ||
| Intraductal Papillary Mucinous Neoplasm | 185 | ||
| Future Perspective of Precursor Lesions | 188 | ||
| Genetics of Pancreatic Ductal Adenocarcinoma | 188 | ||
| Genomic (DNA) Alterations in Pancreatic Cancer | 188 | ||
| Copy-Number Aberrations | 189 | ||
| Specific Gene Mutations | 189 | ||
| Oncogenes | 190 | ||
| Tumor Suppressor Genes | 190 | ||
| Other Caretaker Genes | 192 | ||
| Telomere Length Abnormalities | 192 | ||
| Alternative Genetic Silencing: Epigenetic Abnormalities | 192 | ||
| Second ERA of Molecular Biology | 193 | ||
| Core Signaling Pathways Disrupted in Pancreatic Cancer | 193 | ||
| Future Perspective of the Genetics and the Epigenetics of Pancreatic Ductal Adenocarcinoma | 193 | ||
| Familial Pancreatic Cancer | 193 | ||
| Finding Familial Patients | 194 | ||
| Transcriptomic (RNA) Abnormalities in Pancreatic Cancer | 194 | ||
| Posttranscriptional Regulation | 195 | ||
| MicroRNAs | 195 | ||
| Future Perspectives on the Transcriptome | 195 | ||
| Stromal Content in Pancreatic Cancer | 195 | ||
| Molecular Genetics of Other Pancreatic Neoplasms | 196 | ||
| Final Thoughts and Perspectives | 196 | ||
| References | 197 | ||
| 8B Molecular pathogenesis of biliary tract cancer | 200 | ||
| Cholangiocarcinoma | 200 | ||
| Classification | 200 | ||
| Epidemiology | 200 | ||
| Clinical Risk Factors for Cholangiocarcinoma | 201 | ||
| Primary Sclerosing Cholangitis | 201 | ||
| Parasitic Infection | 201 | ||
| Fibrotic and Cystic Liver Hepatobiliary Diseases | 201 | ||
| Bile Salt Transporter Protein Polymorphisms | 201 | ||
| Intrahepatic Biliary Stones | 202 | ||
| Chemical Carcinogen Exposure | 202 | ||
| Viral Hepatitis | 202 | ||
| Molecular Pathogenesis | 202 | ||
| Genome-wide Analysis | 202 | ||
| Oncogenes and Tumor Suppressor Genes | 202 | ||
| Genetic Polymorphism at P450 | 203 | ||
| MRP2/ABCC2, MUTYH, NEIL1, and AID | 203 | ||
| Human CYP1A2 and Arylamine N-Acteyltransferases (NAT1 and NAT2) | 205 | ||
| Trefoil Factor Family (TFF1) | 205 | ||
| References | 207 | ||
| 8C Molecular biology of liver carcinogenesis and hepatitis | 208 | ||
| Overview of Molecular Etiology | 208 | ||
| Epidemiology | 208 | ||
| Risk Factors | 209 | ||
| Genetic and Epigenetic Alterations | 209 | ||
| Signal Transduction Pathways | 212 | ||
| Hepatitis B Virus | 214 | ||
| Hepatitis C Virus | 216 | ||
| Future Directions | 218 | ||
| References | 219 | ||
| 9 Liver immunology | 222 | ||
| Fundamentals of Immunology | 222 | ||
| Anatomic Considerations | 222 | ||
| Tolerance Versus Immunity | 222 | ||
| Liver Immune Cells | 225 | ||
| Antigen-Presenting Cells | 225 | ||
| Dendritic Cells | 225 | ||
| Kupffer Cells | 226 | ||
| Liver Sinusoidal Endothelial Cells | 227 | ||
| Effector Cells | 227 | ||
| T Cells | 227 | ||
| γδ T cells | 227 | ||
| Natural Killer T Cells | 228 | ||
| Natural Killer Cells | 228 | ||
| Cytokines | 228 | ||
| Tumor Necrosis Factor-α | 228 | ||
| Interleukin-6 | 228 | ||
| Type I Interferons (Interferon-α and Interferon-β) | 228 | ||
| Interferon-γ | 229 | ||
| Immune System in Liver Diseases | 229 | ||
| Transplantation | 230 | ||
| Hepatitis | 230 | ||
| Cancer | 231 | ||
| Autoimmune Hepatitis | 231 | ||
| Primary Biliary Cirrhosis | 232 | ||
| Primary Sclerosing Cholangitis | 232 | ||
| Ischemia/Reperfusion Injury | 232 | ||
| Partial Hepatectomy | 232 | ||
| Drug-Induced Liver Disease | 234 | ||
| Bacterial and Parasitic Liver Disease | 234 | ||
| Summary | 234 | ||
| References | 235 | ||
| 10 Cytokines in liver, biliary, and pancreatic disease | 237 | ||
| Overview | 237 | ||
| Microbiologic Recognition and Toll-Like Receptors | 237 | ||
| Endotoxin Structure and Biologic Activity | 237 | ||
| Immune Regulation and Response to Endotoxin (SEE CHAPTER 9) | 238 | ||
| Tumor Necrosis Factor Superfamily | 241 | ||
| Interleukin-1 Family | 242 | ||
| Interleukin-6 | 243 | ||
| Fas Ligand | 243 | ||
| Transforming Growth Factor-β | 244 | ||
| Cytokines in the Liver and Pancreas | 244 | ||
| Regulation of Cytokine Expression in the Liver | 244 | ||
| Cytokines and the Hepatic Acute-Phase Response | 244 | ||
| Cytokines and the Pancreas | 246 | ||
| Cytokines and Apoptosis | 246 | ||
| Nitric Oxide | 247 | ||
| Liver Regeneration | 247 | ||
| Pathogenesis of Endotoxin and Cytokines in Liver, Biliary, and Pancreatic Disease | 248 | ||
| Endotoxemia and Bacterial Translocation | 248 | ||
| Pathogenesis of Proinflammatory Cytokines | 249 | ||
| Cytokines in Ischemia-Reperfusion Injury | 249 | ||
| Cytokines in Ablation of Hepatic Tumors (See Chapters 83 and 85) | 250 | ||
| Future Directions | 250 | ||
| References | 252 | ||
| 11 Infections in liver, biliary, and pancreatic surgery | 255 | ||
| Infection | 255 | ||
| Host Defenses | 255 | ||
| Host Defenses Challenged by Underlying Hepatopancreatobiliary Conditions in Surgical Patients | 258 | ||
| Liver | 258 | ||
| Biliary System | 258 | ||
| Pancreas | 259 | ||
| Host Defenses Challenged by Hepatopancreatobiliary Surgery | 260 | ||
| Liver | 260 | ||
| Surgery. | 260 | ||
| Host Defense. | 260 | ||
| Infections. | 261 | ||
| Pathophysiology of Infection. | 261 | ||
| Risk Factors. | 261 | ||
| Causative Organisms. | 261 | ||
| Prevention and Treatment. | 261 | ||
| Biliary System | 262 | ||
| Surgery. | 262 | ||
| Host Defense. | 262 | ||
| Infections. | 262 | ||
| Pathophysiology of Infection. | 262 | ||
| Risk Factors. | 262 | ||
| Causative Organisms. | 262 | ||
| Prevention and Treatment. | 262 | ||
| Pancreas | 263 | ||
| Surgery. | 263 | ||
| Host Defense. | 263 | ||
| Infections. | 263 | ||
| Pathophysiology of Infection. | 263 | ||
| Risk Factors. | 263 | ||
| Causative Organisms. | 263 | ||
| Prevention and Treatment. | 263 | ||
| Conclusion | 263 | ||
| References | 265 | ||
| 2 Diagnostic Techniques | 268 | ||
| 12 Clinical investigation of hepatopancreaticobiliary disease | 269 | ||
| Clinical History and Physical Examination | 269 | ||
| Examination of the Liver | 269 | ||
| Examination of the Spleen | 271 | ||
| Signs of Portal Hypertension | 272 | ||
| Clinical Features of Alcoholic Liver Disease | 272 | ||
| Clinical Features of Other Types of Liver Disease | 272 | ||
| Primary Biliary Cirrhosis | 272 | ||
| Ulcerative Colitis and Crohn Disease | 272 | ||
| Budd-Chiari Syndrome | 272 | ||
| Hemochromatosis | 272 | ||
| Polycystic Disease | 272 | ||
| Acute Liver Failure | 273 | ||
| Liver Masses | 273 | ||
| Gallbladder and Biliary Tract Disease | 273 | ||
| Gallbladder | 273 | ||
| Acute Cholecystitis | 273 | ||
| Cholelithiasis | 274 | ||
| Biliary Obstruction | 274 | ||
| Bile Duct Stones | 274 | ||
| Acalculous Biliary Pain | 274 | ||
| Sphincter of Oddi Dysfunction | 276 | ||
| Iatrogenic Biliary Injury | 277 | ||
| Pancreas | 277 | ||
| Acute Pancreatitis | 277 | ||
| Chronic Pancreatitis | 277 | ||
| Pancreatic Cancer | 278 | ||
| Investigation of Hepatobiliary Disease | 278 | ||
| Colorectal Liver Metastases | 279 | ||
| Investigation of Patients With Pancreatic Disease | 279 | ||
| References | 281 | ||
| 13 Ultrasound of the liver, biliary tract, and pancreas | 282 | ||
| Ultrasound Technology | 282 | ||
| Principles of Ultrasound Interpretation | 282 | ||
| Gray-Scale Ultrasound Terminology and Artifacts | 282 | ||
| Doppler Ultrasound | 282 | ||
| Recent Technologic Advances | 284 | ||
| Liver Ultrasound | 285 | ||
| Normal Liver Anatomy | 285 | ||
| Detection and Characterization of Focal Liver Masses | 285 | ||
| Gray-Scale Ultrasound of Focal Liver Masses | 285 | ||
| Ultrasound Microbubble Contrast Agents for Evaluation of Liver Masses | 285 | ||
| Benign Liver Lesions | 288 | ||
| Cystic Masses | 288 | ||
| Cavernous Hemangioma | 289 | ||
| Focal Nodular Hyperplasia | 290 | ||
| Hepatic Adenoma | 290 | ||
| Malignant Liver Neoplasms | 290 | ||
| Hepatocellular Carcinoma | 290 | ||
| Fibrolamellar Carcinoma | 292 | ||
| Liver Metastases | 292 | ||
| Sonography of Diffuse Liver Disease | 292 | ||
| Steatohepatitis | 292 | ||
| Acute Hepatitis | 293 | ||
| Cirrhosis | 294 | ||
| Liver Transplantation (see Chapter 100) | 296 | ||
| Vascular Disorders of the Liver | 297 | ||
| Portal Vein Thrombosis and Cavernous Transformation | 297 | ||
| Transjugular Intrahepatic Portosystemic Shunt Evaluation | 298 | ||
| Budd-Chiari Syndrome and Venoocclusive Disease (See Chapter 77) | 300 | ||
| Ultrasound of the Gallbladder and Bile Ducts | 301 | ||
| Normal Anatomy of the Gallbladder and Bile Ducts (See Chapter 1B) | 301 | ||
| Gallbladder | 301 | ||
| Cholelithiasis (See Chapter 30) | 301 | ||
| Cholecystitis (See Chapter 31) | 301 | ||
| Gallbladder Polyps and Adenomyomatosis (See Chapter 48) | 301 | ||
| Gallbladder Carcinoma | 301 | ||
| Biliary Ducts | 302 | ||
| Congenital Anomalies | 302 | ||
| Biliary Obstruction | 304 | ||
| Primary Bile Duct Neoplasms | 304 | ||
| Intrahepatic Cholangiocarcinoma. | 304 | ||
| Hilar and Distal Cholangiocarcinoma. | 305 | ||
| Ultrasound of the Pancreas | 305 | ||
| Anatomy and Technique | 305 | ||
| Pancreatitis | 307 | ||
| Pancreatic Neoplasms | 308 | ||
| Solid Neoplasms of the Pancreas | 308 | ||
| Cystic Neoplasms of the Pancreas | 309 | ||
| References | 310 | ||
| 14 Endoscopic ultrasound of the biliary tract and pancreas | 313 | ||
| Imaging and Diagnosis | 313 | ||
| Endoscopic Ultrasound Technique | 313 | ||
| Endoscopic Ultrasound-Guided Fine Needle Aspiration | 313 | ||
| Endoscopic Ultrasound Fine Needle Aspiration Technique | 313 | ||
| Diagnosis of Pancreatic Cancer | 314 | ||
| Endoscopic Ultrasound Fine Needle Aspiration of Solid Pancreatic Lesions | 314 | ||
| Endoscopic Ultrasound Fine Needle Aspiration of Pancreatic Cystic Lesions | 316 | ||
| Complications of Endoscopic Ultrasound Fine Needle Aspiration | 317 | ||
| Staging of Pancreatic Cancer (see Chapter 58B) | 318 | ||
| Endoscopic Ultrasound TNM Staging | 318 | ||
| Endoscopic Ultrasound Determination of Vascular Involvement | 318 | ||
| Preoperative Reassessment after Neoadjuvant Chemoradiotherapy | 319 | ||
| Diagnosis and Staging of Cholangiocarcinoma | 319 | ||
| ENDOSCOPIC ULTRASOUND–Guided Therapy | 319 | ||
| Celiac Plexus Neurolysis | 319 | ||
| Drainage of Pseudocysts and Peripancreatic Collections | 320 | ||
| Tumor Localization | 320 | ||
| Novel Therapeutics | 320 | ||
| Summary | 321 | ||
| References | 322 | ||
| 15 Nuclear medicine techniques in hepatobiliary and pancreatic disease | 324 | ||
| Overview | 324 | ||
| New Developments In Single-Photon Emission Computed Tomography | 324 | ||
| Positron Emission Tomography | 324 | ||
| Physics | 324 | ||
| Camera Issues | 324 | ||
| Dedicated Positron Emission Tomography Systems | 324 | ||
| Computed Tomography/Positron Emission Tomography Hybrid Systems | 325 | ||
| Biochemistry | 326 | ||
| FDG PET Imaging in Patients with Colorectal Cancer Metastatic to Liver (See Chapter 81A) | 326 | ||
| Historical Review | 326 | ||
| Technique | 326 | ||
| Staging | 326 | ||
| Fluorodeoxyglucose Positron Emission Tomography for Detection of Hepatic Metastases | 327 | ||
| Fluorodeoxyglucose Positron Emission Tomography for Detection of Extrahepatic Disease | 327 | ||
| Evaluation of Patients After Treatment | 328 | ||
| Management of Patients with Hepatocellular Carcinoma (See Chapter 80) | 330 | ||
| Diagnosis | 330 | ||
| Treatment Planning and Assessment of Prognosis | 333 | ||
| Cholangiocarcinoma (See Chapter 50) | 333 | ||
| Focal Liver Lesions | 333 | ||
| Diagnosis and Follow-up of Pancreatic Diseases | 333 | ||
| Pancreatic Cancer (See Chapter 58) | 333 | ||
| Assessment of Pancreatic Reserve | 335 | ||
| Exocrine Pancreatic Function. | 335 | ||
| Endocrine Pancreatic Imaging. | 336 | ||
| Gastroenteropancreatic Neuroendocrine Tumors (See Chapter 81b) | 336 | ||
| Hepatobiliary Scintigraphy | 337 | ||
| Normal Scan | 337 | ||
| Augmented Hepatobiliary Scintigraphy | 338 | ||
| Right Upper Quadrant Pain | 340 | ||
| Cholecystitis (See Chapter 30) | 342 | ||
| Chronic Cholecystitis | 343 | ||
| Chronic Acalculous Right Upper Quadrant Pain | 343 | ||
| Acalculous Cholecystitis and the Cystic Duct Syndrome. | 343 | ||
| Postcholecystectomy Syndrome and Sphincter of Oddi Dysfunction (See Chapter 38). | 343 | ||
| Biliary Tract Complications after Surgery (See Chapter 42) | 343 | ||
| Liver Transplantation (See Chapter 97) | 343 | ||
| Hepatocellular Carcinoma | 346 | ||
| Pediatric Imaging | 346 | ||
| Neonatal Jaundice | 346 | ||
| Biliary Atresia (See Chapter 40) | 346 | ||
| Role Of General Nuclear Medicine In Assessment Of Adults With Malignant Involvement Of The Liver And Hepatobiliary Tree | 348 | ||
| Cardiac Preoperative Risk Assessment (See Chapter 22) | 348 | ||
| Sulfur Colloid Imaging | 348 | ||
| Historical Background | 348 | ||
| Diagnosis of Malignancy | 349 | ||
| Dual-Tracer Studies | 349 | ||
| Hemangioma Studies (See Chapter 79A) | 349 | ||
| Neuroendocrine Receptor Imaging (See Chapters 61 and 81B) | 350 | ||
| Hepatic Arterial Perfusion Studies (See Chapter 86) | 350 | ||
| Technetium-99m Macroaggregated Albumin | 350 | ||
| Hepatic Arterial Therapy using Radiopharmaceuticals (See Chapter 84A) | 351 | ||
| Summary | 353 | ||
| References | 355 | ||
| 16 Computed tomography of the liver, biliary tract, and pancreas | 358 | ||
| Imaging Overview | 358 | ||
| Technical Advances | 358 | ||
| Role of Computed Tomography in Liver and Biliary Imaging | 360 | ||
| Technique | 361 | ||
| Non–Contrast-Enhanced Computed Tomography of the Liver | 362 | ||
| Contrast-Enhanced Computed Tomography of the Liver | 363 | ||
| Computed Tomographic Angiographic of the Liver | 363 | ||
| Lesion Evaluation | 364 | ||
| Anatomy | 364 | ||
| Gross Morphology | 364 | ||
| Segmental Anatomy | 364 | ||
| Vascular Anatomy | 364 | ||
| Biliary Anatomy | 366 | ||
| Benign Tumors and Tumorlike Conditions of the Liver | 367 | ||
| Cyst (See Chapters 69 and 79) | 367 | ||
| Hemangioma | 368 | ||
| Focal Nodular Hyperplasia | 368 | ||
| Adenoma | 371 | ||
| Biliary Hamartoma | 371 | ||
| Bile Duct Adenoma | 371 | ||
| Inflammatory Conditions | 371 | ||
| Pyogenic Abscess | 371 | ||
| Fungal Abscesses | 372 | ||
| Echinococcus | 372 | ||
| Amebic Abscess (See Chapter 67) | 372 | ||
| Diffuse Hepatocellular Diseases | 372 | ||
| Fatty Infiltration | 372 | ||
| Cirrhosis (See Chapter 70) | 374 | ||
| Budd-Chiari Syndrome | 374 | ||
| Hepatic Infarction | 374 | ||
| Malignant Lesions of the Liver | 374 | ||
| Hepatocellular Carcinoma | 374 | ||
| Fibrolamellar Hepatocellular Carcinoma | 377 | ||
| Angiosarcoma | 378 | ||
| Hepatic Lymphoma | 378 | ||
| Hepatic Metastases (See Chapter 81) | 378 | ||
| Biliary System | 379 | ||
| Gallstones | 379 | ||
| Cholecystitis (See Chapter 31) | 379 | ||
| Mirizzi Syndrome | 381 | ||
| Choledocholithiasis (See Chapters 35 to 37) | 381 | ||
| Gallbladder Carcinoma | 382 | ||
| Cholangiocarcinoma | 383 | ||
| Hilar Cholangiocarcinoma. | 383 | ||
| Peripheral Cholangiocarcinoma. | 383 | ||
| Extrahepatic Cholangiocarcinoma. | 383 | ||
| Biliary Cystadenoma and Cystadenocarcinoma | 385 | ||
| Computed Tomography of the Pancreas | 386 | ||
| Historical Review | 386 | ||
| Technique | 386 | ||
| Computed Tomography Scan Protocols for the Pancreas | 386 | ||
| Anatomy of the Pancreas | 387 | ||
| Tumors of the Pancreas | 388 | ||
| Pancreatic Adenocarcinoma | 388 | ||
| Neuroendocrine Cancer of the Pancreas | 390 | ||
| Cystic Pancreatic Neoplasms | 391 | ||
| Intraductal Papillary Mucinous Neoplasm. | 391 | ||
| Serous Cystadenomas. | 393 | ||
| Mucinous Cystic Neoplasms. | 393 | ||
| Other Cystic Pancreatic Masses. | 393 | ||
| Metastatic Disease to the Pancreas (See Chapter 60) | 393 | ||
| Solid and Papillary Epithelial Neoplasm of the Pancreas | 394 | ||
| Acinar Cell Carcinoma of the Pancreas | 394 | ||
| Inflammatory Diseases of the Pancreas | 395 | ||
| Pancreatitis (See Chapters 54 and 55) | 395 | ||
| Lymphoplasmacytic Pancreatitis | 395 | ||
| Groove Pancreatitis | 398 | ||
| Other Nonneoplastic Pancreatic Masses: Ectopic Splenic Tissue | 398 | ||
| References | 399 | ||
| 17 Magnetic resonance imaging of the liver, biliary tract, and pancreas | 403 | ||
| Principles of Magnetic Resonance Imaging | 403 | ||
| Magnetic Resonance Imaging Safety | 404 | ||
| Magnetic Resonance Imaging Cholangiography | 405 | ||
| Magnetic Resonance Imaging Contrast Agents | 406 | ||
| Normal Hepatic Appearance on Magnetic Resonance Imaging | 406 | ||
| Diffuse Hepatic Disease | 406 | ||
| Fatty Infiltration of the Liver | 406 | ||
| Iron Deposition Disease | 408 | ||
| Focal Hepatic Lesions | 408 | ||
| Cysts | 408 | ||
| Hemangioma | 408 | ||
| Focal Nodular Hyperplasia | 410 | ||
| Hepatic Adenoma | 410 | ||
| Hepatic Abscesses | 411 | ||
| Hepatic Metastases | 411 | ||
| Hepatocellular Carcinoma | 412 | ||
| Less Common Hepatic Tumors | 413 | ||
| Lymphoma | 413 | ||
| Mesenchymal Tumors | 413 | ||
| Epithelioid Hemangioendothelioma | 413 | ||
| Biliary Cystadenoma and Biliary Cystadenocarcinomas | 413 | ||
| Biliary Tumors | 415 | ||
| Gallbladder Carcinoma | 415 | ||
| Bile Duct Cancer | 415 | ||
| Benign Diseases of the Biliary Tract | 415 | ||
| Cholelithiasis | 415 | ||
| Choledochal Cysts | 416 | ||
| Postoperative Biliary Complications | 416 | ||
| Pancreas | 417 | ||
| Pancreatic Cancer | 417 | ||
| Cystic Lesions of the Pancreas | 417 | ||
| References | 418 | ||
| 18 Direct cholangiography: | 420 | ||
| Direct Cholangiography Overview | 420 | ||
| Percutaneous Transhepatic Cholangiography (See Chapter 28) | 420 | ||
| History | 420 | ||
| Preprocedural Preparation | 420 | ||
| Procedure | 421 | ||
| Right-Sided Puncture | 421 | ||
| Left-Sided Puncture | 421 | ||
| Success Rate and Accuracy | 422 | ||
| Pitfalls in Interpretation | 422 | ||
| Lack of Opacification | 422 | ||
| Ductal Dilation | 422 | ||
| Complications | 422 | ||
| Endoscopic Retrograde Cholangiopancreatography (See Chapter 27) | 422 | ||
| History | 422 | ||
| Technique | 423 | ||
| Endoscopy and Pancreatography during Endoscopic Retrograde Cholangiopancreatography | 423 | ||
| Complications | 424 | ||
| Direct Cholangiography and Pancreatography by Percutaneous Transhepatic Cholangiography or Endoscopic Retrograde Cholangiopancreatography | 425 | ||
| Biliary Anatomy | 425 | ||
| Interpretations | 426 | ||
| Bile Leaks | 426 | ||
| Filling Defects | 427 | ||
| Air Bubbles, Blood Clots, Calculi, Primary and Secondary Bile Duct Cancers, and Parasitic Diseases | 427 | ||
| Cystic Diseases | 430 | ||
| Strictures | 431 | ||
| Conclusion | 436 | ||
| References | 437 | ||
| 19 Diagnostic angiography in hepatobiliary and pancreatic disease: indications | 439 | ||
| Imaging Overview | 439 | ||
| Arteries | 439 | ||
| Arteriographic Technique | 439 | ||
| Arteriographic Anatomy | 440 | ||
| Preoperative Angiography: Historical Perspective | 441 | ||
| Arteriography in Conjunction with Arterial Interventions | 441 | ||
| Hemorrhage | 442 | ||
| Splenic Bleeding | 442 | ||
| Hepatic Bleeding | 442 | ||
| Pancreas | 443 | ||
| Primary Arterial Disorders | 443 | ||
| Arterial Occlusive Disease | 443 | ||
| Visceral Artery Aneurysms | 444 | ||
| Segmental Arterial Mediolysis | 445 | ||
| Vasculitis | 445 | ||
| Hereditary Hemorrhagic Telangiectasia | 445 | ||
| Peliosis Hepatis | 445 | ||
| Arterial Anastomotic Stenoses | 445 | ||
| Localization of Functioning Pancreatic Neuroendocrine Tumors | 446 | ||
| Insulinomas | 446 | ||
| Gastrinomas | 447 | ||
| Glucagonoma | 447 | ||
| Veins | 448 | ||
| Venographic Technique | 448 | ||
| Visceral Venographic Anatomy | 449 | ||
| Selective Venous Sampling | 449 | ||
| Preoperative Planning for Portal Decompression | 449 | ||
| References | 451 | ||
| 20 Percutaneous biopsy | 452 | ||
| Biopsy Overview | 452 | ||
| Biopsy Technique | 452 | ||
| Fine Needle Aspiration | 452 | ||
| Core Biopsy | 453 | ||
| Imaging Guidance | 453 | ||
| Ultrasound | 453 | ||
| Computed Tomography | 453 | ||
| Computed Tomographic Fluoroscopy | 453 | ||
| Magnetic Resonance Imaging | 453 | ||
| Fluoroscopy | 454 | ||
| New Guidance Equipment | 455 | ||
| Biopsy of Specific Sites | 455 | ||
| Liver Biopsy | 455 | ||
| Focal Liver Lesions | 455 | ||
| Liver Parenchyma Biopsy | 456 | ||
| Transvenous Biopsy | 456 | ||
| Biopsy of Other Organs | 457 | ||
| Adrenal Biopsy | 457 | ||
| Pancreas Biopsy | 457 | ||
| Retroperitoneal and Pelvic Biopsy | 457 | ||
| Lung and Mediastinum Biopsy | 458 | ||
| Bone Biopsy | 458 | ||
| Complications of Percutaneous Biopsy | 458 | ||
| Conclusion | 460 | ||
| References | 461 | ||
| 21 Intraoperative diagnostic techniques | 462 | ||
| Overview | 462 | ||
| Intraoperative Ultrasonography | 462 | ||
| Hepatic Disease | 462 | ||
| Technical Considerations | 462 | ||
| Evaluation of the Liver | 462 | ||
| Biliary Disease | 463 | ||
| Technical Considerations | 463 | ||
| Evaluation of the Biliary Tree | 463 | ||
| Pancreatic Disease | 464 | ||
| e9781437714548v2 | 1234 | ||
| Front cover | 1234 | ||
| Expert Consult page | 1235 | ||
| Half title page | 1236 | ||
| Frontispiece | 1237 | ||
| Blumgart’s Surgery of the Liver, Biliary Tract, and Pancreas | 1238 | ||
| Copyright page | 1239 | ||
| Dedication | 1240 | ||
| Editors | 1241 | ||
| Contributors | 1242 | ||
| Preface | 1258 | ||
| Acknowledgments | 1259 | ||
| Table of Contents | 1260 | ||
| Video Contents | 1266 | ||
| 7 Hepatic Disease | 1268 | ||
| I.A Inflammatory, Infective, and Congenital: Hepatitis | 1271 | ||
| 64 Chronic hepatitis: | 1271 | ||
| Overview | 1271 | ||
| Chronic Hepatitis | 1271 | ||
| Chronic Hepatitis C | 1271 | ||
| Epidemiology | 1271 | ||
| Presentation | 1272 | ||
| Diagnosis | 1272 | ||
| Natural History | 1272 | ||
| Treatment | 1272 | ||
| Surgery in the Patient with Hepatitis C | 1273 | ||
| Hepatitis B | 1273 | ||
| Epidemiology | 1273 | ||
| Transmission | 1274 | ||
| Presentation | 1274 | ||
| Diagnosis | 1274 | ||
| Natural History | 1274 | ||
| Treatment | 1274 | ||
| Surgery in the Patient with Chronic Hepatitis B | 1275 | ||
| Nonalcoholic Steatohepatitis | 1275 |