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Cristobal Rue

Williams Brenda Garcia Ruth Jackson Amy

French Belgium criterion lt

Gonzalez Richard Wilson Lisa Thomas Deborah

I have hpylori I'm following keenly

Op

Good class

Thanku sir

Am I right in saying that much more funds go into the research for pancreatic cancer rather than acute pancreatitis, a grave disease that probably kills as many people as pancreatic cancer does.

ppt slide available .? if yes please upload..

Hi Sir, Could you please suggest me the best DR for this. I have been suffering for past 10 yrs eosinophil gastroenteritis desase. Still not got proper medication. Its repeated every 2-3 months. How i do allergy test.

Excellent explanation. Thank you Vineet sir

👍informative

Excellent overview of an imp yet complex disease. The revised BCLC ( 2020 ) includes upto 5 cm single lesion in A stage and following liver directed therapy stage B disease may be eligible for curative therapy. Whereas BCLC is followed in the west, it’s considered restrictive as regards surgery / curative therapy in Asia. Several Asian centers have given their own staging & management algorithms ie Korea, Japan, China, Hong Kong. In the developing countries with limited facilities for transplant liver resection of operable intermediate stage hcc would be highly desirable. Finally an HPB surgeon to highlight the role of Surg, the only curative option would have been appropriate.

Wonderful presentation.

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Sir plz keep taking regular lectures as none of the institutions are teaching. We will be highly obliged.

Thank you sir. We need teachers like you

You are a treasure of information & inspiration Pankaj sir

Dr Abby Philips 👍

Thankyou doctor

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🎯 Key Takeaways for quick navigation: 00:11 🎙️ *The 11th ISC Masterclass focuses on managing hepatocellular carcinoma (HCC).* 01:16 🗣️ *Dr. Anil Arora, a renowned speaker from Sir Ganga Ram Hospital, discusses HCC management, emphasizing prevention.* 08:29 🕵️ *Surveillance for HCC is essential, with criteria including commonality, affordability, acceptability, and effectiveness.* 11:26 🌐 *Ultrasonography is a key surveillance modality, offering high sensitivity in detecting early HCC, especially in countries like Japan.* 13:03 📸 *Radiological diagnosis of HCC, using criteria like arterial phase hyperenhancement, can often eliminate the need for a tissue biopsy.* 15:47 ⚖️ *Biopsy is indicated for indeterminate lesions, and staging considers tumor size, performance status, and liver function.* 19:15 🚑 *Curative therapies for early HCC include ablation, surgery, and liver transplantation, with options like percutaneous ethanol injection and radiofrequency ablation.* 21:10 ❓ *Radiological diagnosis of HCC includes arterial hyperenhancement, total venous washout, and underlying cirrhosis, but not a size less than one centimeter.* 24:57 🩺 *Early diagnosis of HCC involves recognizing well-differentiated carcinoma and assessing fat positivity. PET has no role in early HCC diagnosis.* 25:41 🔄 *Surveillance for HCC in non-cirrhotic patients with portal hypertension depends on thrombosis presence; hypercoagulable state may be a focus.* 26:09 🌐 *BCLC staging system, particularly BCLC, is widely used in India for HCC, validated and considered best. The speaker suggests an easier algorithm as an alternative.* 27:17 🩸 *Larger HCCs, preserving liver function, may not exhibit elevated alpha-fetoprotein. Surgery is the primary curative option, with no significant difference in radiological features based on cirrhosis presence.* 28:13 📉 *AFP of 170 in a <1 cm dysplastic nodule poses a challenge. Replication status check is crucial; if positive, follow-up; if negative, consider further imaging after 2 cm.* 29:30 📊 *Surgical resection for HCC depends on the number, extent of lesions, and Child-Pugh or MELD scores, ensuring low mortality and morbidity.* 31:39 ⚖️ *RFA is comparable to local resection for lesions up to 3 cm. Criteria for major or minor resection depend on portal hypertension and liver function.* 32:18 🔄 *Liver transplantation, particularly meeting Milan's criteria, is a curative option for HCC. Living donor liver transplantation has expanded criteria, including UCSF criteria.* 34:51 🎯 *For multinodular, unresectable HCC with preserved liver function (BCLC B), transarterial chemoembolization (TACE) is a classical local-regional therapy.* 38:23 🎯 *Transarterial radioembolization (TARE) uses microspheres to target hepatocellular carcinoma, showing potential advantages but not universally recommended over TACE.* 39:45 🌐 *Systemic therapy considerations involve sequential use of sorafenib and lenvatinib. Immunotherapy, particularly immune checkpoint inhibitors, shows promise.* 43:44 🤝 *Prevention of HCC includes lifestyle modifications, hepatitis B vaccination, and treating hepatitis B and C. Coffee consumption may reduce HCC risk.* 44:52 🧬 *Liquid biopsy, detecting tumor-associated protein biomarkers and genomic patterns in extracellular vesicles, shows promise for early HCC diagnosis.* 51:43 🩹 *Use of TCP and Alpha-fetoprotein fraction L3 in management helps characterize lesions likely to recur, guiding decisions on liver transplantation.* 52:25 🧐 *CT, MRI, and EUS are crucial for distinguishing multicentric HCC from a single HCC with multiple intrapatic metastases. Prior imaging history is essential for accurate diagnosis.* 53:54 🚫 *Non-cirrhotic HCC requires biopsy for diagnosis, as radiological criteria are specified only for cirrhosis cases. Three requisites include underlying cirrhosis, lesion >1cm, and arterial enhancement with venous washout.* 54:50 🩸 *Fibroscan's role in HCC diagnosis is minimal, and its advantage diminishes after obtaining CT and MRI results. Diagnosis is effectively done through CEUS, CT scan, and MRI.* 55:31 📊 *Comparison of Hong Kong (HKLC) and Barcelona Clinic (BCLC) liver cancer scores in Indian patients varies across centers. Validation is needed, and deviations require prospective evaluation.* 57:24 🔄 *Post-SVR HCV cirrhosis surveillance frequency should remain consistent. Starting direct-acting antivirals (DAAs) at HCC diagnosis aids recovery, reducing subsequent HCC development.* 59:06 💡 *Surveillance strategy for alcoholic cirrhosis and NASH cirrhosis aligns with incidence and cost-effectiveness. Non-cirrhotic NASH surveillance is subjective, considering individual factors.* 01:00:17 🔄 *HCC management algorithm: Begin by assessing performance status (PS), presence of extrahepatic spread, and lesion size in Milan criteria. Tailor treatment based on PS, tumor size, and underlying cirrhosis.* 01:06:28 ☕ *Coffee reduces oxidative stress, potentially lowering HCC risk. Its impact is associated with stimulating MAPK3 kinase and decreasing inflammation caused by etiological agents.* 01:08:10 🚫 *Sorafenib's efficacy in HCC treatment is not significantly enhanced by adding statins. Clear risk reduction data is lacking for statins in HCC prevention.* 01:08:59 📊 *Des-γ-carboxy prothrombin (DCP) and Alpha-fetoprotein fraction L3 have limited roles in HCC diagnosis but play a crucial role in prognosis, guiding decisions on surgery, recurrence, and transplantation.* 01:09:12 🩸 *In pediatric HCC, management approach is uncertain due to limited experience. Liquid biopsy, recently published, may provide additional diagnostic insights.* 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

Hats off to Dr sarin sir.. great personality.. great lecture..

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Great Gastroenterologist and Hepatologist Dr Shiv Kumar Sharan ❤❤

Great Gastroenterologist and Hepatologist Dr Shiv Kumar Sharin ❤❤

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Nice presentation. Very comprehensive review. Just wanted to point out a very vital mistake on the slide @ 20:03 - All the UC trials have been listen under CD and vise versa. Must be a mistake in labeling the headings.

Thanks

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