VALENZUELA MEDICAL CENTER

INTERNAL MEDICINE

MORBIDITY
AND
MORTALITY
Presentor: Dr. Charmaine Ballano YL1
Moderator: Dr. Ron Michael Castillo (IM JCON)

Reactor:
Dr. John Arnel Pangilinan MD FPCP FPSG FPSDE
 ● To review the pathophysiology of
Hepatocellular Carcinoma

● To briefly discuss guideline-based screening

OBJECTIVES and management of Hepatocellular
Carcinoma
 GENERAL DATA

❏ MP
❏ 63 y/o, Male
❏ Filipino, Catholic
❏ Farmer at Cebu city
❏ Northville 2, Bignay Valenzuela City (Cebu City)
❏ First admission at our institution
 CHIEF Abdominal
COMPLAINT
Pain
 HISTORY OF PRESENT ILLNESS

3 months PTA

Patient was known case of diabetes

mellitus, noncompliant with his
medications, apparently well with no
subjective complaints but mentioned
having “yellowish eyes” as described
by his relatives during a family
gathering, Patient was advised to go
to Manila by his relatives for medical
assessment but he did not seek any
further work up or consultation and
no medications were taken.
 HISTORY OF PRESENT ILLNESS
3 months PTA
Patient was known case of diabetes
mellitus, noncompliant with his
medications, apparently well with no
subjective complaints but mentioned
having “yellowish eyes” as described
by his relatives during a family
gathering, Patient did not seek any
further work up or consultation and
no medications were taken.
During interim
(+) progression of symptoms was noted, apparently
having jaundice described by his relatives as having
slightly yellow skin than usual, there were no
abdominal pain, fever, change in bowel habits and
consistency, no change in urine color, marked
pruritus or bleeding episodes. No consult done, no
meds/supplement taken. Patient moved from Cebu
to Valenzuela, contemplating to seek medical
consult regarding his condition.
 HISTORY OF PRESENT ILLNESS

1 week PTA

Still with icteric sclerae and

jaundice,

(+) on-off epigastric pain, non-

radiating, PS 3/10, no
aggravating/palliating factors
elicited

No other associated symptoms noted

such as nausea/vomiting, fever, dob,
chest pain

No consult done
No meds taken
 HISTORY OF PRESENT ILLNESS

1 week PTA During interim

Still with icteric sclerae and (+) persistence of symptoms

jaundice,
PS 5-7/10 (from 3/10), on and off
(+) on-off epigastric pain, non- colicky in character, radiating to the
radiating, PS 3/10, no back
aggravating/palliating factors
(+) 3 episodes of vomiting of
elicited
previously ingested food, around half
No other associated symptoms noted cup per bout
such as nausea/vomiting, fever, dob,
(+) loss of appetite
chest pain
NO change in bowel habits, no fever
No consult done noted. No other family members were
No meds taken experiencing the same symptoms. Still
no consult done and no meds taken.
 HISTORY OF PRESENT ILLNESS

1 week PTA During interim Few hours PTA

Still with icteric sclerae and
jaundice,
(+) on-off epigastric pain, non-
radiating, PS 3/10, no
aggravating/palliating factors
elicited
No other associated symptoms noted
such as nausea/vomiting, fever, dob,
chest pain
No consult done
No meds taken
(+) persistence of symptoms + progression of epigastric pain, now
with PS 10/10
PS 5-7/10 (from 3/10), on and off
+ radiating to the back
colicky in character, radiating to the
+ episodes of vomiting of previously
back
ingested food (2x)
(+) 3 episodes of vomiting of
no fever, no cough, no loose bowel
previously ingested food, around half
cup per bout movement noted.
(+) loss of appetite
NO change in bowel habits, no fever Persistence of symptoms prompted
noted. No other family members were consult at our institution hence
experiencing the same symptoms. Still subsequently admitted
no consult done and no meds taken.
PAST MEDICAL HISTORY

❏ Type 2 DM for >5 years (Metformin 500 mg BID)

❏ noncompliant and was lost to follow-up
❏ NO Hypertension
❏ NO Bronchial Asthma
❏ NO PTB
❏ NO previous hospitalization
❏ NO history Blood transfusion
❏ NO allergy to food and medications
❏ Unrecalled immunization history
FAMILY HISTORY

❏ NO DM
❏ NO Hypertension
❏ NO Bronchial Asthma
❏ NO PTB
❏ NO Cancer
❏ NO known heredofamilial diseases
 PERSONAL AND SOCIAL HISTORY

❏ OFW (unrecalled years), currently a farmer

❏ 10 pack-year smoker
❏ Occasional Alcoholic drinker:
❏ (-) illicit drug use
❏ Fond of eating raw fish with vinegar
 REVIEW OF SYSTEM

❏ General: (-) anorexia, (-) weight gain (-) fever

❏ HEENT: (-) headache, (+) icteric sclera, (-) nasoaural discharge
❏ Mouth/Throat: (-) sore throat, (-) gum bleeding
❏ Chest/Lungs: (-) cough, (-) hemoptysis,
❏ CVS: (-) chest pain, (-) palpitations, (-) orthopnea
❏ GI: (-) dysphagia, (-) reflux symptoms, (+) jaundice, (-)
hematochezia/melena
❏ GU: (-) dysuria, (-) hematuria (+) tea-colored urine
❏ Neurologic: (-) seizures, (-) changes in sensorium
 PHYSICAL EXAMINATION

General Survey Integumentary

awake, coherent, ambulatory, in ➢ (+) Jaundice
mild respiratory distress ➢ Good skin turgor
➢ nail beds are pink
➢ 90/60 ➢ no lesions and rashes
➢ 98 bpm noted
➢ 26
➢ 37.1
➢ 98% room air
 PHYSICAL EXAMINATION

HEENT Chest and Lungs Cardiovascular

➢ Icteric sclerae ➢ (+) spider nevi ➢ Adynamic precordium
➢ Slightly pale ➢ Symmetrical chest ➢ Apex beat at 5th ICS
palpebral expansion MCL
➢ No retraction ➢ normal rate, regular
conjunctivae ➢ Vesicular breath sound rhythm, no murmurs
➢ (-) NAD ➢ No wheezing ➢ no palpable thrills;
➢ (-) CLAD
➢ (-) neck vein
engorgement
 PHYSICAL EXAMINATION

Abdomen Extremities Neurologic

Soft, globular but not tense, Edema grade 1-2 and with GCS15
the flanks were bulging, full equal pulses
+spider nevi, NABS, slightly
tender in palpation
 PERTINENT PERTINENT
FEATURES POSITIVE NEGATIVE
SALIENT

+ 63/male no fever
+ known diabetic no loose bowel movement
+ epigastric pain radiating to the no palpitations
back, on and off in character no diaphoresis
+ jaundice no cough
+ icteric sclerae no dob/desaturation
+ spider nevi
 ABDOMINAL PAIN
PEPTIC ULCER
DIFFERENTIAL
ACUTE GASTRITIS
PANCREATITIS DISEASE
DIAGNOSIS
epigastric pain
radiating to the back
 ABDOMINAL PAIN
DIFFERENTIAL
MYOCARDIAL OTHER DIFFERENTIALS:
DIAGNOSIS INFARCTION

PERICARDITIS
RUPTURED AORTIC ANEURYSM
DIFFERENTIAL
DIAGNOSIS
JAUNDICE
 JAUNDICE
T/C OBSTRUCTIVE
DIFFERENTIAL
VIRAL HEPATITIS Chronic Liver Disease
JAUNDICE FROM
DIAGNOSIS CHOLEDOCHOLITHIASES from ALD
INITIAL IMPRESSION
Acute Pancreatitis BISAP 1
t/c Obstructive Jaundice prob sec to
choledocholithiasis
t/c CLD prob sec to NAFLD
Type 2 DM
Non-covid
 ADMITTING PLAN:

Acute Pancreatitis BISAP 1: MEDICATIONS:

- DIET: NPO 1) Omeprazole 40mg IV ODAC
- IVF: PNSS 1L AT 80cc/hr 2) Tramadol 50mg Iv q8 for pain
- Dx: CBC (Hgb, Hct), BUN, Crea, Na, K, Cl 3) Aminoleban 500cc to run for 8hrs BID
4) Lactulose 30cc ODHS
- Amylase, Lipase, CXR
t/c Obstructive Jaundice prob sec to
choledocholithiasis VSq4

t/c CLD prob sec to ALD I&O qshift

- AST, ALT, ALP, PT-INR, TB, DB, IB,
- WAB ultrasound, Hbsag, AntiHAV, AntiHCV
Type 2 DM
- FBS, LP, BUN, Creatinine, Na, K, Cl
INITIAL WORK UP CBC PT/PTT 01/03 01/03
01/03
WBC 9.85 01/03 AST 281.0 HBSAG:
N 78.7 ALT 150.1 NON-REACTIVE
E 0.3 PT 29.6 ALP 334.9
B 0.2 PTT 38.20
L 12.8 INR 2.56 AMY 968.2
M 8.0
RBC 2.73 TP 75.7
ALB 21.6
HGB 74 GLO 54.1
HCT 0.208
T.Bil 368
MCV 76.2 D.Bil 273 01/03
MCH 27.1 I.Bil 94.6
RDW 21.4 BUN
MCHC 35.6 Na 131.3 Creatinine
PLT 257 K 3.49 EGFR
MPV 10.2 CL 104.6
Na 131.3
K 3.49
CL 104.6
INITIAL WORK UP URINALYSIS

01/03
DARK BROWN, TURBID, PH 6.0, SG 1.030
ALB(+), SUGAR NEG, URO NORM, KETO NEG, BIL(+),
BLOOD NEG, LEUKO NEG, NIT NEG, RBC NEG, WBC
RARE, MT RARE, AMORPHOUS RARE
INITIAL WORK UP CXR 01/02 ECG 01/03
WORKING DIAGNOSIS

Acute Pancreatitis BISAP 1

t/c Obstructive Jaundice prob sec to
choledocholithiasis
t/c CLD prob sec to ALD
Anemia prob sec to
1) occult GI bleed 2) chronic disease
Type 2 DM
Non-covid
COURSE IN THE WARD
 HOSPITAL DAY 1

SUBJECTIVE OBJECTIVE ASSESSMENT PLAN

I&O: 1920 vs 1500 Acute Pancreatitis DIET: NPO

+ epigastric pain
90/70, 87bpm, 20
36.8C, 98% @ RA
CBG: 115-147
+icteric sclerae
+jaundice
+soft, flabby, +epigastric
tenderness
BISAP 1 IVF: PNSS 1L AT
t/c Obstructive 120cc/hr for 2 hrs then
Jaundice prob sec to decreased at 80cc/hr
choledocholithiasis
t/c CLD prob sec to
ALD
Anemia prob sec to
1) occult GI bleed 2)
chronic disease
Type 2 DM
Non-covid
 HOSPITAL DAY 2

SUBJECTIVE OBJECTIVE ASSESSMENT PLAN

Acute Pancreatitis
I&O: 2750 vs 1600 BISAP 1 DIET: NPO
+ epigastric pain
90/70, 70bpm, 20 IVF: PNSS 1L AT 80cc/hr
+ 2 episodes melena, t/c Obstructive Jaundice
36.8C, 98% @ RA prob sec to Dx:
½ cup/bout
CBG: 129-156 choledocholithiasis repeat CBC
t/c CLD prob sec to ALD requested EGD
+icteric sclerae Anemia prob sec to Tx:
+jaundice UGIB from 1) BPUD Omeprazole 80 mg IV
+soft, flabby, +epigastric from Stress induced bolus then drip at
mucosal injury
tenderness 10ccc/hr for 72 hrs
2) r/o BEV
Type 2 DM
continue other meds
 CBC CBC 01/04
01/03 01/04
WBC 9.85 WBC 10.86 FBS 4.96
N 78.7 N 76.9 T.CHOL 1.54
WORK UP

E 0.3 E 0.3 HDL 0.12

B 0.2 B 0.3 TRI 1.21
L 12.8 L 14.4 LDL 0.87 or
M 8.0 M 9.1 VLDL 0.55
RBC 2.73 RBC 2.33 BUN 12.39
CREA 91.05
HGB 74 HGB 64 (for transfusion)
HCT 0.208 HCT 0.179

MCV 76.2 MCV 76.8

MCH 27.1 MCH 27.5
RDW 21.4 RDW 22.3
MCHC 35.6 MCHC 35.6
PLT 257 PLT 256
MPV 10.2 MPV 10.1
 HOSPITAL DAY 3

SUBJECTIVE OBJECTIVE ASSESSMENT PLAN

I&O: 3010 vs 2200 Acute Pancreatitis BISAP 1 NPO

+hunger pangs but still
90/60, 75bpm, 20 t/c Obstructive Jaundice IVF: 120cc/hr
with epigastric pain
36.8C, 98% @ RA prob sec to To consume
no melena
choledocholithiasis
aminoleban then
+icteric sclerae t/c CLD prob sec to ALD
hold
+jaundice Anemia prob sec to

+soft, globular, UGIB from 1) BPUD from Ff up cbc post bt

Stress induced mucosal
+epigastric tenderness of 1u prbc
injury
2) r/o BEV
Type 2 DM
Non-covid
 CBC (after CBC post BT
CBC
melena) 01/06
01/03
01/04

WBC 9.85 WBC 10.86

WBC 10.50
N 78.7 N 76.9
N 77.0
WORK UP

E 0.3 E 0.3
E 0.1
B 0.2 B 0.3
B 0.1
L 12.8 L 14.4
L 12.8
M 8.0 M 9.1
M 10.2
RBC 2.73 RBC 2.33
RBC 3.36
HGB 74 HGB 64
HGB 95
HCT 0.208 HCT 0.179
HCT 0.268
MCV 76.2 MCV 76.8
MCV 79.8
MCH 27.1 MCH 27.5
MCH 28.3
RDW 21.4 RDW 22.3
RDW 21.42
MCHC 35.6 MCHC 35.6
MCHC 35.4
PLT 257 PLT 256
PLT 292
MPV 10.2 MPV 10.1
MPV 10.2
 WHOLE ABDOMINAL ULTRASOUND

01/05
WORK UP

LIVER PARENCHYMAL DISEASE WITH DILATED

INTRAHEPATIC DUCTS
ISOECHOIC SOLID MASS RIGHT LIVER LOBE
CHOLECYSTOLITHIASIS WITH BILE SLUDGE
ENLARGED PROSTATE GLAND GRADE 1
MODERATE ASCITES
THE PANCREAS, SPLEEN AND VISUALIZED BOWELS ARE
UNREMARKABLE
ABDOMINAL CT SCAN IS RECOMMENDED
 HOSPITAL DAY 3

SUBJECTIVE OBJECTIVE ASSESSMENT PLAN

I&O: 3010 vs 2200 Acute Pancreatitis BISAP 1

+hunger pangs but still
90/60, 75 bpm, 20 t/c Obstructive Jaundice
with epigastric pain
36.8C, 98% @ RA prob sec to
no melena
choledocholithiasis

+icteric sclerae CLD prob sec to NFLD

+jaundice Anemia prob sec to

+soft, globular, UGIB from 1) BPUD from

Stress induced mucosal
+epigastric tenderness
injury
2) r/o BEV
Type 2 DM
Non-covid
 PT/PTT

01/07
WORK UP

01/03
PT 29.6 PT 25.40
PTT 38.20 PTT 43.10
INR 2.56 INR 2.16
% Act 28.10
 HOSPITAL DAY 4

SUBJECTIVE OBJECTIVE ASSESSMENT PLAN

I&O: 2186 vs 1780 Acute Pancreatitis BISAP 1 May progress diet to clear liqs
+hunger pangs but no
90/60, 80bpm, 20 t/c Obstructive Jaundice IVF: 100cc/hr
epigastric pain
36.8C, 98% @ RA prob sec to Measure abd girth daily
no melena
choledocholithiasis
Dx: for CEA, AFP
+icteric sclerae CLD prob sec to ALD
Tx:
+jaundice Anemia prob sec to Start Spironolactone 25mg OD
+soft, globular compared UGIB from Stress induced Ciprofloxacin 400mg IV q12
mucosal injury
to past few days
Type 2 DM
GS notes appreciated:
Non-covid ● for Triphasic WAB Ct Scan
● start Vit K 1 amp q8
 HOSPITAL DAY 5

SUBJECTIVE OBJECTIVE ASSESSMENT PLAN

PLAN
I&O: 3520 vs 1900 t/c HAP late onset May
Soft progress
diet diet to soft
no epigastric pain
90/60, 70bpm, 20 Acute Pancreatitis BISAP 1 diet
IVF: 100cc/hr
no melena
36.8C, 98% @ RA t/c Obstructive Jaundice IVF:
Dx: 100cc/hr
occ cough
CBG: 124-153 prob sec to Measure
repeat CXR
abd girth daily
no febrile episode
+crackles, bibasal R<L, with choledocholithiasis
no DOB/desaturation repeat Pt PTT post correction
dec BS on Left mid tobasal t/c CLD prob sec to ALD Tx:
area Anemia prob sec to Start
Ff upSpironolactone
WAB CT Scan sched
+icteric sclerae UGIB from Stress induced 25mg OD
mucosal injury
+jaundice Ciprofloxacin 400mg IV
+soft, globular compared to Type 2 DM
q12
past few days Non-covid

Abd girth: 40 from 38 in

WORK UP
 HOSPITAL DAY 6

SUBJECTIVE OBJECTIVE ASSESSMENT PLAN

PLAN
I&O: 3050 vs 2100 Pleural effusion prob from May
Mayprogress
progressdiet
diettotoclear
soft liqs
no epigastric pain
90/60, 70bpm, 20 HAP late onset IVF:
dietPNSS at 80cc/hr
no melena
36.8C, 98% @ RA Acute Pancreatitis BISAP 1 Dx:
IVF:
cultures,
100cc/hrrepeat CBC, for
occ cough
CBG: 124-153 t/c Obstructive Jaundice chest
Measure
utz with
abdmapping
girth daily
no febrile episode
+crackles, bibasal R<L, with prob sec to
no DOB/desaturation Ff up hepa profile and Pt aPTT
choledocholithiasis
dec BS on Left mid to basal result
Tx:
t/c CLD prob sec to ALD
area Tx:
Start Spironolactone
Anemia prob sec to
+icteric sclerae To
25mg
startOD
Cefepime 2g IV q8
UGIB from Stress induced
+jaundice Azithromycin
Ciprofloxacin500mg
400mgod
IV
mucosal injury-resolving
+soft, globular compared to Continue
q12 Ciprofloxacin 400mg
Type 2 DM
past few days q12
Non-covid
Abd girth: 40 from 38 in Continue other meds
 PT/PTT

01/07 01/08 01/04

WORK UP

01/03
PT 29.6 PT 25.40 PT 17.9 ANTI-HAV
PTT 38.20 PTT 43.10 PTT 33.8 IGg:
INR 2.56 INR 2.16 INR 1.5 REACTIVE
% Act 28.10 % Act 44
 HOSPITAL DAY 7

SUBJECTIVE OBJECTIVE ASSESSMENT PLAN

PLAN
I&O: 4250 vs 2100 HAP late onset For
MayEGD
progress
todaydiet to soft
no epigastric pain
90/60, 70bpm, 20 Acute Pancreatitis BISAP 1 diet
no melena
36.8C, 98% @ RA IVF: 100cc/hr
occ cough t/c Obstructive Jaundice
CBG: 145-168 prob sec to Measure abd girth daily
no febrile episode
VBS choledocholithiasis
no DOB/desaturation
+icteric sclerae t/c CLD prob sec to ALD Tx:
+jaundice Anemia prob sec to Start Spironolactone
+soft, globular compared to UGIB from Stress induced 25mg OD
past few days mucosal injury-resolving
Ciprofloxacin 400mg IV
Abd girth: 40 from 38 in Type 2 DM q12
Non-covid
 EGD WITH BIOPSY SEROLOGY
WORK UP

01/10
Esophagus: 7-9 columns of varices seen at the distal esophagus.
No signs of recent bleeding 01/09
Stomach: patterns of erythema seen, including the corpus and
antrum. Antral mucosal surface is granular and hyperemic. Biopsy CEA: 3.38
is taken

Duodenum: Normal

IMPRESSION:
Esophageal varices
Portal hypertensive gastropathy
 HOSPITAL DAY 10-11

SUBJECTIVE OBJECTIVE ASSESSMENT PLAN

PLAN
I&O: 2500 vs 1800 HAP late onset Follow
May progress
up AFP diet to soft
no epigastric pain
100/70, 85bpm, 19 Acute Pancreatitis BISAP 1 Facilitate
diet WAB CT Scan with
no melena
36.8C, 98% @ RA t/c Obstructive Jaundice IVIVF:
Contrast
100cc/hr
occ cough
CBG: 145-168 prob sec to Measure abd girth daily
no febrile episode
Less crackles, bibasal choledocholithiasis
no DOB/desaturation
+icteric sclerae t/c CLD prob sec to ALD Tx:
+jaundice Anemia prob sec to Start Spironolactone
+soft, globular, NT UGIB from Stress induced 25mg OD
mucosal related injury-
Ciprofloxacin 400mg IV
resolving
q12
Type 2 DM
Non-covid
I WORK UP
 HOSPITAL
HOSPITAL DAYDAY 11
2hhhhhooo

SUBJECTIVE OBJECTIVE ASSESSMENT PLAN

PLAN
I&O: 4250 vs 2100 HAP late onset For
Maychest
progress
utz with
dietmapping
to soft
no epigastric pain
90/60, 70bpm, 20 Acute Pancreatitis BISAP 1 diet
no melena
36.8C, 98% @ RA t/c Obstructive Jaundice IVF: 100cc/hr
occ cough
CBG: 145-168 prob sec to Measure abd girth daily
no febrile episode
VBS choledocholithiasis
no DOB/desaturation
+icteric sclerae t/c CLD prob sec to ALD Tx:
+jaundice Anemia prob sec to Start Spironolactone
+soft, globular compared to UGIB from Stress induced 25mg OD
mucosal injury-resolving
past few days Ciprofloxacin 400mg IV
Abd girth: 40 from 38 in Type 2 DM
q12
Non-covid
I WORK UP

01/08

PT 17.9
PTT 33.8
INR 1.5
% Act 44
 HOSPITAL DAY 12

SUBJECTIVE OBJECTIVE ASSESSMENT PLAN

PLAN
I&O: 4250 vs 2100 HAP late onset For
Maychext
progress
utz with
dietmapping
to soft
no epigastric pain
90/60, 70bpm, 20 Acute Pancreatitis BISAP 1 diet
no melena
36.8C, 98% @ RA t/c Obstructive Jaundice IVF: 100cc/hr
occ cough
CBG: 145-168 prob sec to Measure abd girth daily
no febrile episode
VBS choledocholithiasis
no DOB/desaturation
+icteric sclerae t/c CLD prob sec to ALD Tx:
+jaundice Anemia prob sec to Start Spironolactone
+soft, globular compared to UGIB from Stress induced 25mg OD
mucosal injury-resolving
past few days Ciprofloxacin 400mg IV
Abd girth: 40 from 38 in Type 2 DM
q12
Non-covid
 01/08
WORK UP

PT 17.9
PTT 33.8
INR 1.5
% Act 44
WORK UP WHOLE ABDOMINAL CT-SCAN

01/13
LIVER PARENCHYMAL DISEASE WITH CHRONIC FEATURES AND MASS
LESION IN SEGMENTS VII AND VIII EXHIBITING FEATURES(ARTERIOPORTAL
SHUNTING AND POSSIBLE RIGHT PORTAL VEIN THROMBOSIS) THAT
SUGGEST THE POSSIBILITY OF HEPATOCELLULAR CARCINOMA. ASSOCIATED
MASS EFFECTS INCLUDE INTRAHEPATIC DUCTAL ECTASIA.
INTRA-ABDOMINAL AND RETROPERITONEAL LYMPHADENOPATHY,
WORRISOME FOR METASTASIS
GALLBLADDER SLUDGE FORMATION
ANSARCA
FECAL RETENTION
CONSIDER CYSTITIS. PLLEASE CORRELATE CLINICALLY
SPONDYLOSIS
FINAL DIAGNOSIS/SIGN OUT:

Septic Shock sec to 1) SBP 2) HAP nonresolving

ARF Type 1 sec to HAP
Hepatocellular carcinoma with probable metastasis
CLD sec to ALD (Child Pugh C, MELD 19)
Gallstone pancreatitis, BISAP 1
Type 2 DM
Non covid
DISCUSSION
HEPATOCELLULAR
CARCINOMA
 6th most common cancer worldwide

LIVER 4th leading cause of cancer-related deaths

CANCER
LEADING cause of death among cirrhotic
patients
 Different histologic features:
• Hepatocellular carcinoma (85–90% cases)

LIVER • Intrahepatic cholangiocarcinoma (10%)

• Other malignancies accounting for <1% of tumors :

CANCER • Fibrolamellar HCC

• Mixed-iCCA
• Epithelioid hemangiothelioma
• Pediatric cancer hepatoblastoma
HEPATOCELLULAR EPIDEMIOLOGY AND RISK
CARCINOMA FACTORS
• Highest incidence in Asia and sub-Saharan Africa
• Male predominance (Male:Female = 2.5)
• Peak: 65-70 years
HEPATOCELLULAR
CARCINOMA
RISK FACTORS
HEPATOCELLULAR RISK FACTORS
CARCINOMA
• LESS COMMON in cases of:
- alcohol, nonalcoholic steatohepatitis (NASH), α1
antitrypsin deficiency, autoimmune hepatitis, Wilson’s
disease, and cholestatic liver disorders

● Predictors in cirrhotic patients:

○ Disease severity :
■ Platelet count of <100,000/μL
■ Portal hypertension
■ Degree of liver stiffness (by transient elastography)
■ Liver gene signatures
HEPATOCELLULAR
CARCINOMA
RISK FACTORS
HEPATOCELLULAR
CARCINOMA
RISK FACTORS
HEPATOCELLULAR
CARCINOMA
HEPATOCELLULAR ■PREVENTION AND EARLY
CARCINOMA DETECTION
HEPATOCELLULAR
CARCINOMA
HEPATOCELLULAR
CARCINOMA
HEPATOCELLULAR
CARCINOMA
HEPATOCELLULAR
CARCINOMA
HEPATOCELLULAR
CARCINOMA
 /06
Did you know?

30
micrograms

a day is the recommended adequate

intake for vitamin B7.
Presentations are communication tools that can be used as

demonstrations, lectures, speeches, reports, and more. It is

mostly presented before an audience.

Biotin Benefits | Arizzia Medical Center

 /22

Biotin in Your
Bloodstream
Presentations are communication tools that

can be used as demonstrations, lectures,

speeches, reports, and more. It is mostly

presented before an audience.

Biotin Benefits | Arizzia Medical Center