![\"human-liver\"](\"http:\/\/liverandpancreasclinic.com\/blog\/wp-content\/uploads\/2018\/02\/human-liver.jpg\")
<\/p>\nThis is a patient information booklet providing specific practical information about hepatic hemangioma in brief. Its aim is to provide the patient & his or her family with useful information on this particular liver problem, the procedures and tests you may need to undergo, treatment approaches, risks involved, duration, expenses and helpful advice on coping successfully with the problem. If you require more information, Dr. D.R.Kulkarni or your doctor will be able to provide more information.<\/p>\n
<\/p>\n
The human liver is a reddish brown organ <\/strong>normally weighing approximately 1.5% of body weight. It is the largest internal organ. It is located in the right upper part of the abdominal cavity, resting just below the diaphragm under the protection of rib cage. Liver is broadly divided into a large right and a relatively small left lobe. Additionally there is a small lobe called caudate lobe. The right and left lobes are further subdivided into segments. These subdivisions help in planning liver surgery when a patient\u00a0needs removal of a portion of liver.<\/p>\n <\/p>\n <\/p>\n Apart from a patch where it connects to the diaphragm the liver is covered entirely by peritoneum, a thin, double-layered me\u00a0mbrane that reduces friction against other organs. The peritoneum folds back on itself to form the falciform ligament and the right and left triangula\u00a0r ligaments. These “ligaments” are in no way related to the true anatomic ligaments in joints, and have essentially no functional importance. An exception to this is the falciform ligament, which attaches the liver to the anterior body wall from within.<\/p>\n Liver is supplied by two large blood vessels, one\u00a0called the hepatic artery and one called the portal\u00a0vein. The hepatic artery carries blood from the\u00a0aorta, whereas the portal vein carries blood containing digested nutrients from the entire\u00a0gastrointestinal tract and also from the spleen and\u00a0pancreas. The hepatic portal vein supplies\u00a0approximately 75% of the liver’s blood supply,\u00a0the hepatic artery accounting for the remainder of\u00a0its blood flow. Oxygen is provided from both\u00a0sources.<\/p>\n Before entering the liver the portal vein and\u00a0hepatic artery divide into right and left branch for\u00a0each of the lobes. They further subdivide within the liver tissue to supply each segment in total 9\u00a0in number. Blood flows through channels called\u00a0sinusoids and empties into the central vein of\u00a0each lobule. (Each lobule is made up of\u00a0millions of hepatic cells, which are the basic metabolic\u00a0cells.). The central veins coalesce into hepatic veins,\u00a0which leave the liver. There are 3 main hepatic veins that\u00a0drain blood from liver into a large vein (inferior vena\u00a0cava), which carries blood from lower portion of body to\u00a0heart. Apart from the 3 main Hepatic Veins there are\u00a0many smaller draining veins, which enlarge if any or all\u00a0of the 3 veins are blocked due to diseases like cirrhosis\u00a0or hepatic vein thrombosis or veno-occlusive disorders.<\/p>\n The caudate lobe is a separate structure, which receives\u00a0blood flow from both the right- and left-sided vascular\u00a0branches and then drains through small veins directly\u00a0into the vena cava.<\/p>\n The bile produced in the liver is collected in bile\u00a0canaliculi, which merge to form bile ducts. Bile ducts are\u00a0tube like structures carrying bile produced\u00a0 within liver to\u00a0the intestine. Within the liver, these ducts are called\u00a0intrahepatic (within the liver) bile ducts, and once they\u00a0exit the liver they are\u00a0 considered extrahepatic (outside\u00a0the liver). The intrahepatic ducts eventually drain into\u00a0the right and left hepatic ducts, which merge to form the\u00a0common hepatic duct. The term biliary tree is derived\u00a0from the arboreal branches of the bile ducts. The cystic\u00a0duct draining the gallbladder joins with the common\u00a0hepatic duct to form the common bile duct. Bile can either drain directly into the duodenum via the common\u00a0bile duct, or be temporarily stored in the gallbladder via\u00a0the cystic duct. The common bile duct and the pancreatic\u00a0duct enter the second part of the duodenum\u00a0 together at\u00a0the ampulla of Vater.<\/p>\n The liver has a “capsule” around it, which contains nerve\u00a0endings, accounting for pain when the liver enlarges\u00a0 and\u00a0stretches its capsule. The damaged liver has an amazing\u00a0ability to regenerate<\/strong> itself. The body needs only\u00a0 about\u00a020% of the liver to live, and if a piece is cut out or\u00a0injured, it can grow back. Sometimes, however, the liver\u00a0gets\u00a0 chronic diseases, which impair its ability to\u00a0regenerate. It can become infiltrated with fat\u00a0(“steatosis”)<\/strong>,\u00a0 shrink from chronic alcohol or viral\u00a0exposure (“cirrhosis”)<\/strong> or grow large from infection or a\u00a0blocked blood\u00a0 drainage (“hepatomegly”)<\/strong>. Any\u00a0inflammation of the liver, whether caused by germs,\u00a0drugs, or radiation, is called\u00a0\u00a0hepatitis<\/strong>. A damaged liver\u00a0may heal, or may slowly fail and require liver transplant\u00a0to save the patient’s life.<\/p>\n The liver is an astounding laboratory sustaining\u00a0metabolism. Liver’s main job is to filter the blood\u00a0coming from the digestive tract, before passing it to the\u00a0rest of the body. The liver detoxifies chemicals and\u00a0metabolizes drugs. As it does so, the liver also secretes\u00a0bile that ends up back in the intestines. Bile contains bile\u00a0salts, which are responsible for digestion and absorption\u00a0of food material. The liver is responsible for\u00a0carbohydrate, fats & protein\u00a0 metabolism and also makes\u00a0albumin, proteins important for blood clotting and other\u00a0functions. It also produces various clotting factors, stores\u00a0 glucose, fats, vitamins like A, D3, B12 & minerals like iron & copper. This myriad of functions makes clear why\u00a0the liver is essential to life.<\/p>\n The diagnosis of liver function is made by blood tests.\u00a0Liver function tests can readily pinpoint the extent of\u00a0liver\u00a0 damage. Usually in liver diseases\u00a0 patient can have a\u00a0combination of raised bilirubin, increase in liver\u00a0enzymes, drop\u00a0 in blood albumin levels, alteration in\u00a0clotting test results,\u00a0 depending on the type of liver\u00a0disease.<\/p>\n If liver function is altered then other tests are asked\u00a0depending on clinical picture and lab results. If hepatitis\u00a0is\u00a0 suspected, then tests to detect cause of hepatitis are\u00a0done. Sometimes, one may require an ultrasound or a CT\u00a0scan or MRI to produce images of the liver and diagnose\u00a0liver tumors, abscess,\u00a0 and other pathologies.<\/p>\n Physical examination of the liver is not accurate in\u00a0determining the extent of liver damage. It can only\u00a0 reveal\u00a0presence of tenderness or the size of\u00a0 liver, but in most\u00a0cases, some type of radiological study is required\u00a0 to\u00a0examine it. In patients with chronic liver disease\u00a0noninvasive tests like Phytate\u00a0 liver scan (nuclear scan)\u00a0and\u00a0 Ultrasound elastography of liver (Fibroscan) are\u00a0 done to assess the liver status.<\/p>\n However, the ideal way to determine damage to the liver\u00a0is with a biopsy. A biopsy is not required in all cases,\u00a0 but\u00a0may be necessary when the cause or\u00a0 extent of damage is\u00a0unknown. A needle is inserted into the skin just\u00a0 below\u00a0the rib cage and a biopsy is obtained. The tissue is sent to\u00a0the laboratory,\u00a0 where it is analyzed under a\u00a0 microscope.\u00a0Sometimes, a radiologist may assist the physician\u00a0performing a liver biopsy by providing\u00a0 ultrasound\u00a0guidance.<\/p>\n A hemangioma is a noncancerous tumor made of\u00a0widened (dilated) blood vessels that are atypical\u00a0or irregular in\u00a0 arrangement and size. These\u00a0vascular spaces may contain thrombin,\u00a0calcifications, or prominent scarring (sclerosed Hemangioma is the most common benign tumor\u00a0affecting the liver. The widespread use of\u00a0noninvasive abdominal imaging modalities has\u00a0led to increased detection of it even when it is\u00a0asymptomatic.<\/p>\n Giant hemangiomas are large hemangiomas and\u00a0the size definition actually varies in the books but\u00a0commonly\u00a0 anything more than 5cms is\u00a0considered giant hemngioma.<\/p>\n It’s not clear what causes a liver hemangioma to\u00a0form. It is probably congenital \u2014 meaning that\u00a0you’re born with it. It\u00a0 is certainly not familial or\u00a0genetically inherited. Some associations are\u00a0observed regarding occurrence and growth\u00a0 of a\u00a0hemangioma like age, sex, hormonal influence,\u00a0drugs etcetera.<\/p>\n Women, especially with a history of multiparity,\u00a0are affected more often than men. Women who\u00a0have been pregnant\u00a0 are more likely to be\u00a0diagnosed with a liver hemangioma than women\u00a0who have never been pregnant. Women who\u00a0 used\u00a0hormone replacement therapy for menopausal\u00a0symptoms may be more likely to be diagnosed\u00a0with liver\u00a0 hemangioma than women who did not.<\/p>\n Several pharmacologic agents have been\u00a0postulated to promote its growth. Steroid therapy\u00a0, estrogen therapy, and\u00a0 pregnancy can increase\u00a0the size of an already existing hemangioma.<\/p>\n Hepatic hemangiomas can occur at all ages. Most\u00a0hepatic hemangiomas are diagnosed in\u00a0individuals aged 30-50\u00a0 years. Female patients\u00a0often present at a younger age and with larger\u00a0tumors. Hepatic hemangiomas may be seen in Hemangiomas can be mistaken for hypervascular\u00a0malignancies of the liver or vice versa and can\u00a0coexist with (and occasionally mimic) other\u00a0benign and malignant hepatic lesions, including\u00a0focal nodular hyperplasia, hepatic adenoma,\u00a0hepatic cysts, hemangioendothelioma, hepatic\u00a0metastasis, and primary hepatocellular\u00a0carcinoma.<\/p>\n Additionally liver hemangioma could be one\u00a0feature of a larger disease complex or a welldefined\u00a0clinical syndrome. In Klippel-TrenaunayWeber\u00a0syndrome, hepatic hemangiomas occur in\u00a0association with congenital hemiatrophy and Multiple hepatic hemangiomas have been\u00a0reported in patients with systemic lupus\u00a0erythematosus.<\/p>\n Hemangiomas of the liver are usually small and\u00a0hence asymptomatic. However, even large\u00a0hemangiomas remain asymptomatic most often.\u00a0Most cases of liver hemangioma are discovered\u00a0during a test or procedure for some other But in a small number of people, liver\u00a0hemangioma will grow, may cause symptoms or\u00a0complications and require\u00a0 treatment. It’s not clear\u00a0why this happens. Larger, especially more than\u00a010cms and multiple lesions may produce Dull pain, vague discomfort, which cannot be\u00a0explained in words or fullness in the right upper\u00a0abdomen, is the most common complaint\u00a0especially when it is located in the right lobe of\u00a0liver. Hepatic hemangiomas are more common in Early satiety (feeling full after eating even small\u00a0amount of food), nausea, and vomiting may occur\u00a0when large lesions compress the stomach,\u00a0producing obstruction. This is more common\u00a0with lesions located in the left side or those Rarely, hemangiomas may present as a large\u00a0abdominal mass. Other atypical presentations\u00a0include jaundice from compression of the bile\u00a0ducts, gastrointestinal bleeding, fever of\u00a0unknown origin or cardiac failure.<\/p>\n In some cases, acute abdominal pain occurs due\u00a0to various complications like clot formation\u00a0inside the hemangioma (called thrombosis),\u00a0hemorrhage into the lesion or free intraabdominal\u00a0cavity, twisting or torsion if there is a stalk\u00a0 for\u00a0hanging hemangioma or compression of adjacent\u00a0tissues or organs.<\/p>\n Consumption of coagulation factors causes an\u00a0illness that resembles a systematic inflammatory\u00a0process with findings of fever, weight loss,\u00a0anemia, thrombocytosis, increased fibrinogen\u00a0level, and elevated erythrocyte sedimentation Babies with benign infantile hemangioendothelioma\u00a0may have a growth in the abdomen,\u00a0failure to survive or grow, anemia, and heart\u00a0failure\u00a0The only findings upon physical examination are,\u00a0infrequently, an enlarged liver, a\u00a0 palpable\u00a0abdominal mass or the presence of an arterial\u00a0bruit over the right upper quadrant.<\/p>\n It may be unsettling to know you have a mass in\u00a0your liver, even if it’s a benign mass. However,\u00a0there’s no evidence\u00a0 that an untreated liver\u00a0hemangioma can lead to liver cancer.<\/p>\n Problem comes when one cannot differentiate\u00a0between a hemangioma from a cancer.<\/p>\n It is usually solitary, but 10% patients can have\u00a0multiple hemangiomas in their liver.<\/p>\n Complications are rare with hemangiomas even\u00a0when they are large in size. They include rupture\u00a0with resultant\u00a0 hemoperitoneum, intratumoral\u00a0bleeding, compression of bile ducts and nearby\u00a0arteries and veins, gastric\u00a0 compression, bleeding\u00a0inside the bile ducts & heart failure.<\/p>\n Complications depend on the size and location of\u00a0the tumor.<\/p>\n Women who have been diagnosed with liver\u00a0hemangioma face a risk of complications if they\u00a0become pregnant. The female hormone estrogen,\u00a0which increases during pregnancy, is believed to\u00a0cause some liver hemangiomas to grow larger. A\u00a0growing hemangioma can cause signs and\u00a0symptoms and may require treatment. Having a\u00a0liver hemangioma doesn’t mean you can’t become\u00a0pregnant. However, discussing the possible\u00a0complications with your\u00a0 doctor can help you\u00a0make a more informed choice.<\/p>\n Medications that affect hormone levels in your\u00a0body, such as birth control pills, could cause\u00a0complications if you have been diagnosed with\u00a0liver hemangioma. But this is controversial. If\u00a0you’re considering this type of medication, Most patients with liver hemangioma come with\u00a0the diagnosis on a routine ultrasonography as said\u00a0before & rarely other form of imaging like CT or\u00a0MRI. Rarely a diagnosis is made before\u00a0investiagations because the tumor is large.<\/p>\n The modalities used to aid in the diagnosis of\u00a0hepatic hemangiomas include ultrasonography,\u00a0dynamic contrast-enhanced computed\u00a0tomography (CT) scanning, nuclear medicine\u00a0studies using technetium-99m (99m Tc) \u2013 labeled Ultrasonography is the most commonly used\u00a0initial diagnostic tool. Serial ultrasonographic\u00a0examinations are done to monitor any increase in\u00a0size of the hemangioma over time. Microbubble\u00a0contrast -enhanced ultrasonography helps\u00a0 in\u00a0differentiating from a hepatocellular cancer.\u00a0However, difficulty occurs in large lesions where\u00a0central thrombosis or scarring may be present.\u00a0Unfortunately, contrast-enhanced\u00a0ultrasonography is available at relatively few\u00a0medical centers.<\/p>\n The finding on ultrasonography of a suspected\u00a0hemangioma should be diagnostically correlated\u00a0with CT scan or MRI to ensure a correct\u00a0diagnosis.<\/p>\n Dynamic contrast-enhanced CT scanning is\u00a0preferred to routine CT scanning. When\u00a0requesting a CT scan to investigate a liver mass,\u00a0the hepatobiliary specialist insists on\u00a0nonenhanced, arterial, portal venous, and delayed First, the liver is imaged by CT before the\u00a0administration of intravenous contrast. The next\u00a0series of images is\u00a0 obtained about 30 seconds\u00a0after the injection of contrast, at the time that\u00a0contrast is entering the liver via the hepatic\u00a0artery. Portal venous imaging occurs 60 seconds\u00a0later, as contrast is returning to the liver from the MRI is highly sensitive and specific in the\u00a0diagnosis of & differentiating liver tumors\u00a0especially hepatic hemangioma.\u00a0 When\u00a0gadolinium is used as an intravenous contrast\u00a0agent, hemangiomas enhance in a fashion similar\u00a0to that seen\u00a0 on dynamic CT. The sensitivity for\u00a0detection of hepatic hemangioma is upwards of\u00a090%. Therefore often patient has\u00a0 to go through\u00a0these 3 forms of imaging sequentially. In spite of\u00a0all this diagnosis may still be unsure especially Scintigraphic studies using Tc-99m\u00a0pertechnetate-labeled red blood cells were used\u00a0for many years to help in\u00a0 diagnosing hepatic\u00a0hemangiomas. Single-photon emission\u00a0computerized tomography (SPECT) using Tc99m The diagnostic accuracy of noninvasive tests has\u00a0obviated the need for hepatic arteriography also\u00a0in most cases.\u00a0 However, this invasive modality\u00a0still may be useful in helping to diagnose some\u00a0hepatic hemangiomas.<\/p>\n Diagnostic accuracy diminishes for all imaging\u00a0modalities when assessing a liver lesion that is\u00a0less than 2 cm in diameter. MRI is the most\u00a0accurate radiologic study to establish the\u00a0diagnosis of a small hepatic tumor.<\/p>\n MRI used to confirm the diagnosis when a\u00a0probable hemangioma is detected on\u00a0ultrasonography. Nuclear medicine studies will\u00a0be used when nature of a lesion when the\u00a0diagnosis is equivocal on CT or MRI.<\/p>\n Percutaneous biopsy is frequently used for liver\u00a0tumors whose pathology cannot be established on\u00a0CT scan or MRI.\u00a0 But biopsy of a suspected\u00a0hepatic hemangioma carries an increased risk of\u00a0hemorrhage. Liver biopsy is not done in\u00a0 most\u00a0circumstances where a hemangioma is high in the\u00a0differential diagnosis of a hepatic mass. Liver\u00a0biopsy is only\u00a0 used when radiologic study results\u00a0and alpha-fetoprotein testing are equivocal.<\/p>\n Tumor markers like Alpha-FetoProtein (AFP),\u00a0CA 19-9, and CarcinoEmbryonicAntigen (CEA)\u00a0are done and normal\u00a0 levels bolster clinical\u00a0suspicion of a benign hepatic mass.<\/p>\n Blood investigations like CBC or LFT are not\u00a0done routinely as they do not contribute to\u00a0diagnosis and are required\u00a0 only if a surgery is\u00a0planned.<\/p>\n Most hepatic hemangiomas are small and\u00a0asymptomatic at the time of diagnosis, and they\u00a0are likely to remain that\u00a0 way. In addition,\u00a0malignant transformation has not been reported in\u00a0hepatic hemangiomas. Even large hemangiomas\u00a0have very little risk of complications. For these\u00a0reasons, most asymptomatic hepatic\u00a0hemangiomas are\u00a0 left safely alone.<\/p>\n Once the diagnosis of hepatic hemangioma is\u00a0confirmed by radiologic studies, there will not be\u00a0any further follow up if it is a small hemangioma.\u00a0If there is any doubt about diagnosis you will be\u00a0asked to follow up after I month again to\u00a0 repeat\u00a0the investigations.<\/p>\n For larger hemangioma you will be advised to\u00a0undergo ultrasonography at 6 months and at 12\u00a0months after the\u00a0 initial diagnosis. Providing that\u00a0no change in hemangioma size has occurred,\u00a0long-term follow-up radiologic studies\u00a0 are\u00a0probably not necessary. However if you continue\u00a0to do USG every 6 months and follow up with\u00a0your surgeon it is\u00a0 always better.<\/p>\n Certainly, patients with a new onset of abdominal\u00a0pain deserve a follow-up imaging study. The\u00a0same is true for\u00a0 patients who are undergoing\u00a0treatment with estrogens or have become\u00a0pregnant. Finally, patients with large Until recently, no medical therapy capable of\u00a0convincingly & permanently reducing the size of\u00a0hepatic hemangiomas has been described.\u00a0Modalities like radiation or drugs like\u00a0thalidomide are used occasionally with\u00a0unconvincing\u00a0 effect.<\/p>\n Hepatic hemangiomas warrant therapy only if\u00a0they are causing significant symptoms and the\u00a0cause of pain is proved\u00a0 to be hemangioma\u00a0beyond doubt. Therefore all tests must be\u00a0performed to rule out other causes for pain like\u00a0peptic ulcer disease, colitis, gastroduodenitis,\u00a0gallstones & irritable bowel syndrome. Upper GI\u00a0endoscopy, colonoscopy,\u00a0 imaging studies should\u00a0be performed to rule out other causes.\u00a0Unfortunately, in some individuals, determining Surgical treatment may be appropriate in cases of\u00a0rapidly growing tumors. Surgery may also be\u00a0warranted in cases\u00a0 where a hepatic hemangioma\u00a0cannot be differentiated from hepatic malignancy\u00a0on imaging studies. Obviously for\u00a0 patients\u00a0coming with hemangioma complications surgery\u00a0is mandatory.<\/p>\n Size actually does not matter in most cases and as\u00a0said above it is the symptoms that decide the\u00a0requirement of\u00a0 treatment. The management of\u00a0very large (>10 cm) hepatic hemangioma is\u00a0controversial. Resection is advocated for\u00a0 such\u00a0lesions because of the potential risk of\u00a0complications.<\/p>\n Surgical resection and surgical enucleation are\u00a0the treatments of choice. In resection, a\u00a0hemangioma-containing\u00a0 portion of liver with\u00a0surrounding normal liver tissue is removed. In\u00a0enucleation, hemangioma is removed without The size and location of a lesion will influence\u00a0the surgeon’s decision to perform either a formal\u00a0segmental resection of the hemangioma or an\u00a0enucleation of the hemangioma. Typically, these\u00a0procedures are performed using an open In general, both surgical resection and\u00a0enucleation are safe and are well tolerated by\u00a0patients. Typically,\u00a0 postoperative complications\u00a0are less and the average length of hospital stay is\u00a06 days. Surgery is technically more demanding in\u00a0resection.<\/p>\n In the absence of tumor-promoting factors, such\u00a0as estrogen therapy, hemangiomas rarely recur\u00a0after successful resection.<\/p>\n Spontaneously ruptured hemangioma is an\u00a0emergency life-threatening situation. These\u00a0patients are usually admitted\u00a0 with acute\u00a0abdominal pain & shock state. Patients are\u00a0immediately taken to ICU and top priority will be The patient will be then immediately shifted to\u00a0radiology department where interventional\u00a0radiologist does an urgent Arterial embolization.\u00a0Branches of the hepatic artery feeding the\u00a0hemangioma are embolized with polyvinyl\u00a0alcohol,\u00a0 metal coils and other substances.\u00a0Embolization results in stopping the bleeding. It\u00a0also shrinks the tumor, thereby\u00a0 minimizing the\u00a0risk of complications. Patient may get pain &\u00a0fever after this procedure.<\/p>\n If this facility is not available then patient will\u00a0certainly require a surgery with due risk to life.\u00a0During surgery,\u00a0 resection or enucleation is\u00a0usually not attempted unless patient is stable\u00a0since there is risk of more bleeding and\u00a0 usually a\u00a0surgical ligation of the hepatic artery is\u00a0performed. Selective ligation of large feeding\u00a0vessels used to be\u00a0 performed in the days when\u00a0embolization was not available or is not\u00a0available. It has the same effect like\u00a0 embolization\u00a0provided all feeders are ligated, but this is\u00a0difficult and therefore results are not assured.\u00a0Once the\u00a0 patient is stabilized, formal surgical\u00a0resection of the hepatic hemangioma can be\u00a0performed.<\/p>\n Surgical resection may not be possible in certain\u00a0cases because of the massive or diffuse nature of\u00a0the lesion, its\u00a0 proximity to vascular structures, or\u00a0the patient’s comorbidities. Minimally invasive\u00a0therapies for hepatic hemangioma include arterial\u00a0embolization, radiofrequency ablation, and\u00a0hepatic irradiation can be tried in such\u00a0 patients.\u00a0However the long-term success rate of\u00a0embolization (without subsequent surgical\u00a0resection) is not known.\u00a0 Percutaneous\u00a0radiofrequency ablation may be used to improve\u00a0abdominal pain in patient with symptomatic\u00a0hepatic hemangiomas. But this would be useful\u00a0only in small tumor which otherwise also do not\u00a0need therapy. Hepatic irradiation over several\u00a0weeks may cause tumor regression and symptom\u00a0relief with minimal morbidity but no assurance.<\/p>\n Treatment for infantile hemangioendothelioma\u00a0depends on the child’s growth and development.\u00a0The following treatments may be needed:<\/p>\n In infants whose tumor is only in one lobe of the\u00a0liver, surgery is a cure, even if the child has heart\u00a0failure.<\/p>\n No special dietary management is required.\u00a0Also no restriction of physical activity is\u00a0indicated for most patients with hepatic\u00a0hemangiomas. Patients with large hemangiomas\u00a0may need to be instructed to avoid trauma to the\u00a0right upper abdominal quadrant.<\/p>\n No medications are useful to shrink or eradicate\u00a0hepatic hemangiomas.<\/p>\n Overall, a patient with a hepatic hemangioma has\u00a0an excellent prognosis. Malignant transformation has not been described.<\/p>\n Above information will help you to make an\u00a0informed decision but it cannot replace the\u00a0professional advice and\u00a0 expertise of a doctor\u00a0who is familiar with your condition. You may\u00a0have questions that are not covered; you\u00a0should\u00a0 discuss these with your surgeon. You\u00a0must remember every individual is different.<\/strong><\/p>\n Endoscopist:<\/strong> This may be a gastroenterologist or\u00a0a surgeon who is able to undertake endoscopy\u00a0(examination of the stomach or bowel using a\u00a0flexible telescope). A few endoscopists can also\u00a0perform ERCP and EUS, which are special forms\u00a0of endoscopy that examine the biliary and\u00a0pancreatic ducts and the pancreas.<\/p>\n Gastroenterologist<\/strong>: A physician who is highly\u00a0specialized in \u2018gut\u2019 problems.<\/p>\n General physician:<\/strong> A consultant medical doctor\u00a0who works in a hospital and who is broadly\u00a0specialized including \u2018gut\u2019 problems.<\/p>\n General surgeon:<\/strong> A consultant surgeon who\u00a0works in a hospital and who is broadly\u00a0specialized including \u2018gut\u2019\u00a0 problems.<\/p>\n HepatoPancreatoBiliary surgeon<\/strong>: A surgeon\u00a0who is highly specialized in pancreato-biliary &\u00a0liver operations.<\/p>\n MRI – Magnetic Resonance Imaging<\/strong>\u00a0: CT SCAN – Computerized Tomography: ERCP – Endoscopic Retrograde\u00a0Cholangiography:<\/strong> EUS – Endoscopic UltraSound: MRCP – Magnetic Resonance Cholangio\u00a0Pancreatography<\/strong><\/p>\n <\/p>\n <\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" What\u2019s wrong with my liver? Hemangioma: This is a patient information booklet providing specific practical information about hepatic hemangioma in brief. Its aim is to provide the patient & his or her family with useful information on this particular liver problem, the procedures and tests you may need to undergo,…<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[16,22,24,23,17,26,30,31,19,20,25,18,29,21,27,28],"yst_prominent_words":[],"class_list":["post-63","post","type-post","status-publish","format-standard","hentry","category-liver","tag-hemangioma","tag-hemangioma-of-the-liver","tag-hepatic-hemangioma","tag-hepatic-hemangiomas-treatment","tag-liver-hemangioma","tag-liver-hemangioma-and-alcohol","tag-liver-hemangioma-and-pregnancy","tag-liver-hemangioma-but-it-was-really-cancer","tag-liver-hemangioma-causes","tag-liver-hemangioma-diagnosis","tag-liver-hemangioma-size","tag-liver-hemangioma-symptoms","tag-liver-hemangioma-symptoms-diet","tag-liver-hemangioma-treatment","tag-liver-hemangioma-treatment-natural","tag-liver-hemangioma-ultrasound","loop-entry clr boxed"],"_links":{"self":[{"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/posts\/63","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/comments?post=63"}],"version-history":[{"count":29,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/posts\/63\/revisions"}],"predecessor-version":[{"id":96,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/posts\/63\/revisions\/96"}],"wp:attachment":[{"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/media?parent=63"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/categories?post=63"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/tags?post=63"},{"taxonomy":"yst_prominent_words","embeddable":true,"href":"https:\/\/liverandpancreasclinic.com\/blog\/wp-json\/wp\/v2\/yst_prominent_words?post=63"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"Liver](\"http:\/\/liverandpancreasclinic.com\/blog\/wp-content\/uploads\/2018\/02\/liver-diaphragm.jpg\")
<\/p>\nWhat Is The Function Of Liver?<\/h2>\n
What Are The Tests To Check Liver Function?<\/h2>\n
What Is Hemangioma?<\/h2>\n
\nhemangioma). Phleboliths are rare. Grossly, these\u00a0lesions often appear as having a flat surface or as\u00a0bulging subcapsular lesions. Lesions are reddishblue\u00a0and well demarcated from surrounding\u00a0tissue. Large tumors may become pedunculated.<\/p>\nHow Common Is Liver Hemangioma?<\/h2>\n
What Is A Giant Hemangioma?<\/h2>\n
What Causes A Hemangioma In Liver?<\/h2>\n
\ninfancy. They have also been detected prenatally\u00a0in a growing fetus. Babies may develop a type of\u00a0hepatic hemangioma called benign infantile\u00a0hemangioendothelioma. This rare, noncancerous\u00a0tumor has been linked to high rates of heart\u00a0failure and death in infants. Infants are usually\u00a0diagnosed by the time they are 6 months old.\u00a0Hepatic hemangiomas may be seen in 5-10% of\u00a0children aged 1 year. They typically regress\u00a0during childhood.<\/p>\nWhy Is It Necessary To Investigate a\u00a0Patient with Hemangioma Of Liver?<\/h2>\n
\nnevus flammeus, with or without\u00a0hemimeganencephaly. In Kasabach-Merritt\u00a0syndrome, giant hepatic hemangiomas are\u00a0associated with thrombocytopenia and\u00a0intravascular coagulation. Osler-Rendu-Weber\u00a0disease is characterized by numerous small\u00a0hemangiomas of the face, nares, lips, tongue, oral\u00a0mucosa, gastrointestinal tract, and liver. Von
\nHippel-Lindau disease is marked by cerebellar\u00a0and retinal angiomas, with lesions also in the\u00a0liver and pancreas.<\/p>\nWhat are The Symptoms and Signs?<\/h2>\n
\ncondition. Most people who have a liver\u00a0hemangioma never experience symptoms, never\u00a0show signs and most hemangiomas don\u2019t grow\u00a0even over long periods or have complications and\u00a0hence may never need treatment.<\/p>\n
\nsymptoms.<\/p>\n
\nthe right lobe of the liver than in the left lobe.<\/p>\n
\nhanging form liver like bunch of grapes.<\/p>\n
\nrate.<\/p>\nCan It Cause Cancer?<\/h2>\n
Will There Be Complications If Left\u00a0Untreated?<\/h2>\n
\ndiscuss the benefits and risks with your doctor.<\/p>\nHow Is a Patient With Hemangioma\u00a0of Liver\u00a0 Investigated?<\/h2>\n
\nRBCs, magnetic resonance imaging (MRI),\u00a0hepatic arteriography, and digital subtraction\u00a0angiography.<\/p>\n
\nimaging (the so-called triple phase CT with\u00a0delayed imaging).<\/p>\n
\nmesenteric veins via the portal vein. Finally,\u00a0delayed images are obtained several minutes\u00a0later. If you have already\u00a0 done a CT scan but it is\u00a0suboptimal & improperly done it is advisable to\u00a0repeat it properly or do an MRI with proper
\ntechnique.<\/p>\n
\nsince it is matter of differentiating a benign lesion\u00a0from a malignant tumor.<\/p>\n
\npertechnetate-labeled RBCs is more\u00a0accurate. However, it is not available at all\u00a0medical centers and with availability of CT &\u00a0MRI these are now used very infrequently.<\/p>\nWill I Require an Angiography?<\/h2>\n
Is It Possible To Diagnose a Small\u00a0Hemangioma Convincingly?<\/h2>\n
Will I Require a Biopsy?<\/h2>\n
Will There Be More Tests?<\/h2>\n
Do All Liver Hemangiomas Require\u00a0Treatment?<\/h2>\n
How Is The Patient Followed Up?<\/h2>\n
\nhemangiomas (i.e., >10 cm) may deserve long-term follow-up radiologic studies, perhaps\u00a0annually, because of their probable increased risk\u00a0of complications however it is not mandatory.<\/p>\nIs There Any Nonsurgical Therapy\u00a0Available?<\/h2>\n
When Does A Patient With Liver\u00a0Hemangioma Warrant Surgery?<\/h2>\n
\nif the symptoms are caused by a hemangioma or\u00a0by another process (e.g., irritable bowel\u00a0syndrome) is difficult.<\/p>\nSo Size Of Hemangioma Does Not\u00a0Matter?<\/h2>\n
What Is The Nature Of Surgery?<\/h2>\n
\nremoving any of the surrounding liver tissue.<\/p>\n
\napproach, but laparoscopic surgery can be\u00a0performed in some cases. Hepatic lobectomy may\u00a0be necessary in the case of large lesions. Very\u00a0rarely (large and \/ or multiple lesions) liver may\u00a0have to be replaced (transplantation).<\/p>\nWill It Recur After Surgery?<\/h2>\n
What Is Done If Hemangioma\u00a0Ruptures?<\/h2>\n
\ngiven to hemodynamic stabilization. Patient will\u00a0require various accesses for rapid fluid and blood\u00a0transfusion (called central or jugular or\u00a0subclavian or femoral line). Patient may require\u00a0support for breathing too (ventilator). After\u00a0patient is stabilized investigations are done to\u00a0find the cause of shock including USG & CT\u00a0scan, which confirm that patients critical\u00a0condition is due to a ruptured hemangioma.<\/p>\nAre There Alternative Treatments\u00a0If I Don\u2019t Want Surgery Or I Am Unfit?<\/h2>\n
What Is The Treatment In Infants?<\/h2>\n
\n
Are There Any Dietary & Physical\u00a0Activity Restrictions?<\/h2>\n
Is There Any Medical Management?<\/h2>\n
What Is The Prognosis?<\/h2>\n
\nDoctors Dealing With Liver\u00a0Disease That You May Meet<\/h2>\n
Glossary<\/h2>\n
\nA type of scanning performed to diagnose\u00a0problems not picked up by regular investigations.<\/p>\n
\n<\/strong>A type of scanning performed to diagnose\u00a0problems not picked up by regular investigations.<\/p>\n
\nAn endoscopic procedure performed to visualize\u00a0bile & pancreatic ducts & treat the disease\u00a0endoscopically whenever possible.<\/p>\n
\n<\/strong>An endoscopic procedure performed to visualize\u00a0pancreas & biliary tract from very close, diagnose\u00a0problems, obtain biopsies and at times treat the\u00a0disease too.
\n<\/strong><\/p>\n