🎯 Key Takeaways for quick navigation: 06:03 🏥 *Ascites associated with decreased urine output and Insidious onset points towards liver origin.* 16:42 🔄 *Majority of the audience favors Non-Alcoholic Steatohepatitis (NASH) as the likely etiology in a 63-year-old presenting with decompensated cirrhosis and ascites.* 19:21 🩺 *Syndromic diagnosis: Decompensated cirrhosis with ascites, Insidious onset of abdominal distension, preceded by decreased urine output, and followed by peripheral edema.* 23:50 🚑 *In hypertensive cirrhosis, the blood pressure may be higher due to sympathetic overactivity.* 28:19 🚰 *Ascites in chronic kidney disease is not frequent; it may occur in patients on hemodialysis or with significant hypoalbuminemia, but it is less common in common kidney diseases.* 31:15 📏 *Triceps skinfold thickness is measured midway between the olecranon and acromion processes, using Lange calipers, and a value above 15mm suggests adequate fat reserves.* 32:42 📊 *Bedside nutritional assessment tools include dynamometer for hand grip strength.* 33:23 🩺 *Subjective Global Assessment (SGA) has five parameters and is validated in cirrhotics.* 34:10 🔄 *Abdominal examination in cirrhosis reveals distended abdomen, shiny skin, and dilated veins.* 34:55 📏 *Measurement of liver span involves identifying upper and lower borders, and assessing distance between them.* 35:33 🌐 *General examination in cirrhosis includes assessing respiratory, cardiovascular, and central nervous systems.* 36:36 🎤 *Liver span measurement in ascitic patients involves percussing downwards till the dull note is heard in the Pentecostal space.* 39:22 📝 *Final diagnosis: Decompensated liver cirrhosis with portal hypertension, splenomegaly, and ascites. Suspected etiology: Hepatitis C.* 46:49 🩹 *Four essential tests for diagnosis include hemogram, ascitic fluid analysis, abdominal ultrasound, and AFP.* 50:15 🤔 *Lesion in segment eight with washout on venous phase indicates neoplastic etiology. Presence of portal vein thrombus is crucial in decompensation.* 57:24 📈 *AFP level above 1000 is highly diagnostic for HCC. Combination of imaging and AFP helps confirm the diagnosis.* 01:05:40 📊 *Patients with hepatocellular carcinoma (HCC) are classified based on ECOG performance, Child-Pugh score, and tumor size/behavior.* 01:06:38 📉 *A Child-Pugh score above one indicates no curative therapy; stages zero and one offer curative options.* 01:07:35 💼 *For a decompensated cirrhosis patient with a two-centimeter liver lesion, transplantation is the preferred option.* 01:08:39 🚫 *Ascites patients with HCC should not undergo transarterial embolization (TAE) due to clinical deterioration risk.* 01:09:27 📅 *Patients with bilirubin above 1.1, viruses, and Child's A1 should not undergo liver resection.* 01:09:56 💵 *For liver transplant candidates, waiting for more than three months provides an opportunity to observe tumor behavior.* 01:10:44 🧪 *Liver biopsies are gaining importance to assess tumor behavior in HCC, especially in patients awaiting liver transplant.* 01:12:21 🔄 *If liver transplant is not an option, RFA (Radiofrequency Ablation) is a preferred curative treatment for HCC.* 01:13:35 🔍 *RFA's success rate for a two-centimeter lesion in decompensated cirrhosis is around 60-70% at five years.* 01:14:42 ⚠️ *RFA may be technically challenging for high tumors; if not feasible, TACE (Transarterial Chemoembolization) is an alternative.* 01:15:23 📏 *RFA's effectiveness is limited to lesions up to two centimeters; for larger lesions, combining TACE and RFA yields better outcomes.* 01:17:59 🔄 *HCC staging systems like BCLC may not encompass all patients; HKLC offers better stratification, allowing more patients to receive curative treatments.* 01:19:45 📈 *HKLC staging helps in extending the boundaries of liver resection for HCC patients, offering curative treatments to a wider range of individuals.* 01:22:04 📊 *HKLC staging increases the number of patients eligible for curative therapy, especially those who do not fit within the BCLC grading system.* 01:25:19 🔄 *Combining TACE and RFA is effective for tumors larger than three centimeters but not suitable for curative intent alone.* 01:28:11 🌡️ *Post-embolization syndrome after TACE may be managed symptomatically; steroids have been explored but need cautious consideration.* 01:28:52 📉 *Predictors of post-TACE liver failure include elevated bilirubin, low albumin, and the presence of portal vein thrombosis.* 01:31:56 🔄 *Assessment of TACE efficacy is typically done with a dynamic MRI at four to six weeks, focusing on enhancing lesions.* 01:33:10 📏 *M-RECIST criteria are used to assess local-regional therapy response in HCC, emphasizing complete and partial responses.* 01:34:23 🔄 *In intermediate-stage HCC, combining systemic therapy post-TACE may be explored for potential adjuvant benefits.* 01:34:56 🧬 *Recent studies explore the use of lenvatinib in combination with super-selective TACE for intermediate-stage HCC.* 01:36:07 🦠 *Immunotherapy, targeting CTLA4 and PD1/PDL1 pathways, is a promising treatment for HCC; however, its efficacy needs further validation.* 01:37:24 🌐 *Combination therapies, such as radio-sensitizers and drugs delivered via arteries, show potential benefits, but more research is needed.* 01:38:17 🎯 *Selecting between TEER, TACE, and SBRT for unresectable tumors depends on factors like portal vein thrombosis, with recent focus on SBRT.* 01:40:23 🌐 *Stereotactic radiation (SBRT) causes tumor injury, releases cytokines, making CD8 cells responsive. Combining SBRT with immune checkpoint inhibitors is promising.* 01:41:05 🔄 *Surveillance for HCC in cirrhosis patients includes ultrasound every six months and monitoring Alpha-fetoprotein (AFP) levels. AFP levels above 5 may indicate HCC.* 01:43:29 ⚖️ *In HCC diagnosis, CT scan or MRI with all four phases is crucial. Liver biopsy is rarely needed for routine diagnostics but has an increasing role in prognostication.* 01:45:17 🏥 *Treatment decisions are based on classifications like BCLC, HKLC, and Child-Pugh score. Curative options include resection, RFA, and liver transplantation, with considerations based on tumor size.* 01:46:56 🔄 *Emerging approaches in HCC treatment include immune checkpoint inhibitors (e.g., atezolizumab) and external beam radiation therapy (SBRT) combined with immune checkpoint inhibitors.* 01:48:06 💊 *High-dose Vitamin K may be considered for inoperable jaundiced cirrhotic patients, potentially reducing tumor progression, especially in cases with high AFP but no tumor.* 01:51:39 🎓 *Masterclass emphasizes the importance of understanding radiological patterns and variants of HCC. Residents actively participate, gaining insights into the complex subject.* Made with HARPA AI
🎯 Key Takeaways for quick navigation:
06:03 🏥 *Ascites associated with decreased urine output and Insidious onset points towards liver origin.*
16:42 🔄 *Majority of the audience favors Non-Alcoholic Steatohepatitis (NASH) as the likely etiology in a 63-year-old presenting with decompensated cirrhosis and ascites.*
19:21 🩺 *Syndromic diagnosis: Decompensated cirrhosis with ascites, Insidious onset of abdominal distension, preceded by decreased urine output, and followed by peripheral edema.*
23:50 🚑 *In hypertensive cirrhosis, the blood pressure may be higher due to sympathetic overactivity.*
28:19 🚰 *Ascites in chronic kidney disease is not frequent; it may occur in patients on hemodialysis or with significant hypoalbuminemia, but it is less common in common kidney diseases.*
31:15 📏 *Triceps skinfold thickness is measured midway between the olecranon and acromion processes, using Lange calipers, and a value above 15mm suggests adequate fat reserves.*
32:42 📊 *Bedside nutritional assessment tools include dynamometer for hand grip strength.*
33:23 🩺 *Subjective Global Assessment (SGA) has five parameters and is validated in cirrhotics.*
34:10 🔄 *Abdominal examination in cirrhosis reveals distended abdomen, shiny skin, and dilated veins.*
34:55 📏 *Measurement of liver span involves identifying upper and lower borders, and assessing distance between them.*
35:33 🌐 *General examination in cirrhosis includes assessing respiratory, cardiovascular, and central nervous systems.*
36:36 🎤 *Liver span measurement in ascitic patients involves percussing downwards till the dull note is heard in the Pentecostal space.*
39:22 📝 *Final diagnosis: Decompensated liver cirrhosis with portal hypertension, splenomegaly, and ascites. Suspected etiology: Hepatitis C.*
46:49 🩹 *Four essential tests for diagnosis include hemogram, ascitic fluid analysis, abdominal ultrasound, and AFP.*
50:15 🤔 *Lesion in segment eight with washout on venous phase indicates neoplastic etiology. Presence of portal vein thrombus is crucial in decompensation.*
57:24 📈 *AFP level above 1000 is highly diagnostic for HCC. Combination of imaging and AFP helps confirm the diagnosis.*
01:05:40 📊 *Patients with hepatocellular carcinoma (HCC) are classified based on ECOG performance, Child-Pugh score, and tumor size/behavior.*
01:06:38 📉 *A Child-Pugh score above one indicates no curative therapy; stages zero and one offer curative options.*
01:07:35 💼 *For a decompensated cirrhosis patient with a two-centimeter liver lesion, transplantation is the preferred option.*
01:08:39 🚫 *Ascites patients with HCC should not undergo transarterial embolization (TAE) due to clinical deterioration risk.*
01:09:27 📅 *Patients with bilirubin above 1.1, viruses, and Child's A1 should not undergo liver resection.*
01:09:56 💵 *For liver transplant candidates, waiting for more than three months provides an opportunity to observe tumor behavior.*
01:10:44 🧪 *Liver biopsies are gaining importance to assess tumor behavior in HCC, especially in patients awaiting liver transplant.*
01:12:21 🔄 *If liver transplant is not an option, RFA (Radiofrequency Ablation) is a preferred curative treatment for HCC.*
01:13:35 🔍 *RFA's success rate for a two-centimeter lesion in decompensated cirrhosis is around 60-70% at five years.*
01:14:42 ⚠️ *RFA may be technically challenging for high tumors; if not feasible, TACE (Transarterial Chemoembolization) is an alternative.*
01:15:23 📏 *RFA's effectiveness is limited to lesions up to two centimeters; for larger lesions, combining TACE and RFA yields better outcomes.*
01:17:59 🔄 *HCC staging systems like BCLC may not encompass all patients; HKLC offers better stratification, allowing more patients to receive curative treatments.*
01:19:45 📈 *HKLC staging helps in extending the boundaries of liver resection for HCC patients, offering curative treatments to a wider range of individuals.*
01:22:04 📊 *HKLC staging increases the number of patients eligible for curative therapy, especially those who do not fit within the BCLC grading system.*
01:25:19 🔄 *Combining TACE and RFA is effective for tumors larger than three centimeters but not suitable for curative intent alone.*
01:28:11 🌡️ *Post-embolization syndrome after TACE may be managed symptomatically; steroids have been explored but need cautious consideration.*
01:28:52 📉 *Predictors of post-TACE liver failure include elevated bilirubin, low albumin, and the presence of portal vein thrombosis.*
01:31:56 🔄 *Assessment of TACE efficacy is typically done with a dynamic MRI at four to six weeks, focusing on enhancing lesions.*
01:33:10 📏 *M-RECIST criteria are used to assess local-regional therapy response in HCC, emphasizing complete and partial responses.*
01:34:23 🔄 *In intermediate-stage HCC, combining systemic therapy post-TACE may be explored for potential adjuvant benefits.*
01:34:56 🧬 *Recent studies explore the use of lenvatinib in combination with super-selective TACE for intermediate-stage HCC.*
01:36:07 🦠 *Immunotherapy, targeting CTLA4 and PD1/PDL1 pathways, is a promising treatment for HCC; however, its efficacy needs further validation.*
01:37:24 🌐 *Combination therapies, such as radio-sensitizers and drugs delivered via arteries, show potential benefits, but more research is needed.*
01:38:17 🎯 *Selecting between TEER, TACE, and SBRT for unresectable tumors depends on factors like portal vein thrombosis, with recent focus on SBRT.*
01:40:23 🌐 *Stereotactic radiation (SBRT) causes tumor injury, releases cytokines, making CD8 cells responsive. Combining SBRT with immune checkpoint inhibitors is promising.*
01:41:05 🔄 *Surveillance for HCC in cirrhosis patients includes ultrasound every six months and monitoring Alpha-fetoprotein (AFP) levels. AFP levels above 5 may indicate HCC.*
01:43:29 ⚖️ *In HCC diagnosis, CT scan or MRI with all four phases is crucial. Liver biopsy is rarely needed for routine diagnostics but has an increasing role in prognostication.*
01:45:17 🏥 *Treatment decisions are based on classifications like BCLC, HKLC, and Child-Pugh score. Curative options include resection, RFA, and liver transplantation, with considerations based on tumor size.*
01:46:56 🔄 *Emerging approaches in HCC treatment include immune checkpoint inhibitors (e.g., atezolizumab) and external beam radiation therapy (SBRT) combined with immune checkpoint inhibitors.*
01:48:06 💊 *High-dose Vitamin K may be considered for inoperable jaundiced cirrhotic patients, potentially reducing tumor progression, especially in cases with high AFP but no tumor.*
01:51:39 🎓 *Masterclass emphasizes the importance of understanding radiological patterns and variants of HCC. Residents actively participate, gaining insights into the complex subject.*
Made with HARPA AI