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Pancreas, Liver, Colorectal - Coggle Diagram

- - - - 1- Jaundice
      - 2- Belly or back pain
      - 3- Weight loss and poor appetite
      - 4- Nausea and vomiting
      - 5- Gallbladder or liver enlargement
      - 7- Diabetes, rarely, pancreatic cancers cause diabetes because they destroy the insulin-making cells.
      - 6- Deep vein thrombosis or DVT. Symptoms can include pain, swelling, redness, and warmth in the affected leg.
- - - - Abdominal ultrasound every 6 months, with or without measurement of serum alpha-fetoprotein (AFP), are widely used by professional societies such as American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL).
    - - Patients at high risk of liver cancer development as defined by an estimated annual risk higher than 1.5%.
        
        Specifically:
        
        Cirrhotic patients of any etiology, Child-Pugh A and B.
        
        Cirrhotic patients of any etiology, Child-Pugh C awaiting liver transplantation.
      - Noncirrhotic hepatitis C virus (HCV) patients with advanced fibrosis defined as F3.
      - Noncirrhotic HBV carriers with active hepatitis or family history of HCC.
      - Noncirrhotic HBV carriers older than 40 (males) or 50 (females) years; or African Americans older than 20 years (AASLD guidelines).
- - - - All patients with established cirrhosis should be considered at risk for HCC development.
      - Past medical history should include active assessment for known risk factors for chronic liver disease, such as HCV or HBV infection (e.g. blood transfusion, intravenous drug use, tattoos, unprotected sex with multiple partners), alcohol abuse, non-alcoholic fatty liver disease (NAFLD) (e.g. high BMI, diabetes) and hemochromatosis (e.g. joint pain, fatigue, diabetes).
    - - Look for signs of chronic liver disease:
        
        1- Spider nevi
        
        2- Palmar erythema
        
        3- Gynaecomastia
        
        4- Ascites
        
        5- Oedema
        
        6- Peripheral oedema
        
        7- Flapping tremor.
    - - List of diagnostic tests
        
        Complete liver screen to identify potential causes of chronic liver disease:
        
        Hepatitis B and C serology
        
        Alpha-1 antitrypsin
        
        Ceruloplasmin
        
        Ferritin
        
        Autoimmune work-up to include anti-nuclear antibody (ANA)
        
        Anti-smooth muscle antibody (SMA)
        
        Anti-liver kidney microsomal antibody (LKM)
        
        Anti-mitochondrial antibody (AMA)
        
        Laboratory data of liver dysfunction and/or portal hypertension.
        
        Low platelet count (<100 000) is an indicator of significant portal hypertension.
        
        Elevated bilirubin
        
        Decreased albumin
        
        Decreased INR
        
        Mild elevation of ALT, AST, and ALP.
        
        Elevated AFP (tumor marker, not always present). Also useful as a prognostic biomarker, particularly AFP >400 ng/ml, indicates poor outcome.