THESIS

An Analysis of Diagnosis and Management of Ruptured Hepatoma: Single Center Experience Over 10 Years

By



ACKNOWLEDGEMENT

The researcher tends to identify this as the opportunity to value the efforts of the teachers for cultivating the ideas and formulating the first move in the context of this project. The researcher would take this opportunity to appreciate the hard work and the patience shown by the staff for providing the world class teaching and research facility as this project would have ceased to exist without their due support.

DECLARATION

I …………………substantiate that this research work acquiesced for evaluation is my own and is a construction of my words. Any part of this paper which tends to integrate the works of other authors in any comportment has been properly accredited.

Signed __________________ Date _________________

Table of Contents

ACKNOWLEDGEMENTi

DECLARATIONiii

CHAPTER 1: INTRODUCTION2

Background of the Study2

Aims and Objectives5

Analysis of data5

Results6

Clinical Examination Findings7

Analysis of Blood Investigation Results8

Analysis of Alpha FetoProtein(AFP)9

History of alcoholism and Hepatitis Status10

Classification Of Child's Score - A, B, C10

Embolization (TAE)11

Types of Surgery11

Recurrence and Mortality12

ANALYSIS OF SURVIVAL CURVES15

Discussion16

Conclusion17

CHAPTER 2: LITERATURE REVIEW19

JOURNALS19

Multi-DisciplinaryManagement19

By Nejmeddine, Bassem21

Treatment of ruptured hepatoma23

Other Occurrences of Ruptured Hepatoma26

Prognosis of Ruptured Hepatoma28

REFERENCES31

CHAPTER 1: INTRODUCTION

This chapter of the research tends to develop an understanding and identify the reasons for conducting a research onto the identified topic. However, in the context of this paper this chapter would develop the primary understanding regarding the intensity and the nomenclature of the threat caused by HCC. HCC has been a significant health problem especially in the developing countries and the incidence is rising in developed countries. About ¾ of HCC are attributed to chronic HBV and HCV infections. According to the data from Globocan 2008, HCC has been identified as 5th most common cancer in men and seventh in the women. The survey also reported estimated 748,300 cases of liver cancer surfaced in the year of 2008; in which 85% of these cases were from developing countries (Nejmeddine, et al2010). It was noted liver cancer rates are highest in west and Central Africa and in East and Southeast Asia.

HCC is 2nd leading cause of carcinoma death in men and sixth leading cause among women. About 695,500 patients lost the battle gaisnt liver cancer in the year 2008.In Malaysia, HCC was noted among the 10th most common cancer among males in Peninsular Malaysia by National Cancer Registry report in 2004. Spontaneous rupture of HCC is a dramatic presentation of the disease. The presentation in ruptured HCC may vary from asymptomatic to hypovolemic shock which makes the diagnosis difficult. The condition carries high mortality rate. Its incidence is as high as 15% in Asia (Hung, et al 2008).

Background of the Study

Ruptured HCC is a life threatening condition. The manifestation also can be considered as one the uncommon complication of HCC. Its incidence is as high as 15% in Asia and the mortality rate has been reported in the range of 32% to 100%. There are few options of treatment available for the patients presenting with ruptured HCC: emergency hepatic resection, packing, ligation of hepatic artery and ...