Liver capsule

Turler and coworkers81 (Germany) examined the effectiveness of ECT, in colorectal metastases established in BDIX rats by injection of colon cancer cells under the liver capsule. The tumors thus induced in the liver were subjected to low current level ECT applied via five platinum electrodes (Figure 10). Four different applications were used ... 

Of 20 autoclave cleaners with exposure to vinyl chloride, 16 had thrombocytopenia, 7 had splenomegaly, 6 had hepatomegaly, 4 had fibrosis of the liver capsule, and 4 had signs of acroosteolysis. ... 

A medio-ventral incision is made from the pubic symphisis to the thorax. A catheter is inserted into the portal vein and the liver is perfused with collagenase solution. At the end of the perfusion, the liver is taken out, the liver capsule is removed and the cells are mechanically dispersed by gentle shaking. After dispersion of the liver cells in medium, the vessels and remaining conjunctive tissue are removed and collagenase activity is neutralized. Cell viability is assessed by the percentage of refringent cells. Only cell suspensions with more than 70 % viability should be retained. 

What treatment options are now available to Mrs CR and what are the goals of therapy for her with regard to (a) chemotherapy, (b) management of malignant hypercalcaemia/bone metastases, and (c) management of liver capsule pain ... 

This may be due to liver capsular pain from liver metastases. Mrs CR s abnormal liver function tests may indicate this. If metastatic cancer has spread to her liver, the resultant disease within the liver capsule may cause pain. Another possible cause could be the high dosage of senna that she is taking (8 tablets a day) -excessive dosages of stimulant laxatives such as senna can cause abdominal cramp and pain due to their effect of increasing intestinal motility. 

Right upper quadrant pain can be caused by stimulation of nerve endings in the liver capsule as a result of being stretched when the liver is enlarged or inflamed. It can also be as a result of gallbladder or colon problems. Ascites can cause abdominal pain as the tension of fluid in the abdominal cavity accumulates. The extent of the pain does not give an indication of liver function. 

This development may progress through to the formation of numerous lymphcysts in the area of the vascularized liver capsule and to the extravasation of protein-rich lymph, above all via ruptured lymphcysts. Such a finding has often been observed during laparoscopy as so-called liver weeping , (s. fig. 16.5)... 

Fig. 16.4 Lymphostasis in the region of the liver capsule of the left liver lobe (lower part) and the falciform ligament...

Morphology Haemangiomas appear in solitary or (in some 20-30% of cases) multiple form. (83) They are usually located beneath the liver capsule and are clearly differentiated from the parenchyma by a pseudocapsule. Their usual size is 1-4 cm and they are found in both liver lobes, apparently with a higher frequency in the left lobe. It is worth mentioning that the haemangiomas... 

Bile-duct adenomas are rare. Usually, they are solitary and < 2 cm in size. This type of adenoma is more often detected in men than in women (3 1) and it occurs in patients mainly over the age of 50. It is nearly always localized beneath the liver capsule. This adenoma has the form of a firm, whitish node and consists of bile-duct proliferations. It contains biliary acini and tubules which are lined with a layer of cuboid epithelium within loose fibrous, partially hyaline stroma. There is evidence of mononuclear inflammatory cells and, occasionally, lymph follicles. It is discussed that such biliary adenomas are peribiliary gland hamartomas. (162) There are no clinical or biochemical abnormalities, nor is there any tendency towards malignant degeneration. (161,163)... 

A so-called porcelain liver should be clarified by differential diagnosis. (188) This condition is characterized by focal calcareous deposits in the liver capsule, which can be detected by X-ray examination as well as by sonography and CT. It may be caused by phleboliths, pseudolipoma, histoplasmosis, calcified larvae, small capsule haematomas, small abscesses, etc. 

The patient is suspected to be suffering from HCC when the subjective complaints continue to worsen and when an increase in complaints, which may occur quite abruptly in some cases, cannot be explained by the progression of cirrhosis. Most patients are affected by pain radiating into the right side of the back or into the right shoulder and neck area. This is due to an irritation of the phrenic nerve caused by expansion of the tumour towards or even into the liver capsule. Anorexia is more pronounced. Occasionally, the course of HCC is acute, resembling liver failure or liver abscess. 

Fig. 37.30 Laparoscopic staging Melanotic and non-melanotic metastases of melanoma (right liver lobe with transition to right abdominal peritoneum liver capsule/peritoneal adhesions)...

Constrictive pericarditis The clinical picture and hepatic changes of the liver are similar to those of the Budd-Chiari syndrome. Considerable thickening of the liver capsule may resemble sugar icing. The liver is enlarged and firm. Tense ascites is present. Histologically, the changes resemble those of cardiac cirrhosis. 

CT may demonstrate multiple cysts adjacent to the liver capsule, with ill-defined margins. 

Ottoson, R. and Snellman, O. Attempts to Prepare Heparin From Ox Liver Capsules With a Mild Method , Acta Chem. Scand. 13, 473-479 (1959). 

Fig. 2.1.8. a In this patient with recurrent HCC after liver transplantation, colonic adhesions to the hepatic capsule in the area of recurrence (arrow) were encountered. On the CT the tumour nodule can be appreciated as faint hypervascularization. Note three tiny clips of the liver capsule resulting from a laparoscopic capsular probe excision, b Before starting the process of RFA - the electrode is already in place and the tines are partially deployed - a 21-gauge needle is inserted (arrow) to insufflate room air in the space between colon and liver capsule, c After the injection of 20 ml room air, the 21-gauge needle is advanced into the space between colon and liver capsule (arrows), thus more air can be injected if needed. The ablation can easily be performed down to the capsule, because adjacent structures are insulated by the injected air... 

A total of 49% of the lesions showed a relationship to the liver capsule, 7% presented a relationship to the central portal vein structures and only 29% of the metastases were at a location which was classified as easy. 

Fig. 17.6a-d. Epithelioid hemangioendothelioma. MR findings. a Coronal true FISP imaging refers to multiple moderate hyperintense lesions, b In a T2-weighted unenhanced HASTE sequence a retraction of the liver capsule (black arrow) as well as portal infiltration (black arrowhead) and relatively low-hyperintense multiple lesions (white arrow) are depicted. Diffuse hypointense masses are seen on Tl-weighted imaging, d On delayed Gd-enhanced scans, rim enhancement (white arrows), retraction of the liver (black arrow), and portal invasion (black arrowhead) are excellently documented... 

Soyer P, Bluemke DA, Vissuzaine C, et al (1994) CT of hepatic tumors prevalence and specificity of retraction of the adjacent liver capsule. AJR Am J Roentgenol 162 1119-1122... 

RF ablation is a good method of palliation in patients who have severe pain caused by distension of the liver capsule by large tumours. In such cases, coagulation of the tumour often provides rapid relief of pain (Fig. 24.2). 

Ideal tumours for RF ablation are smaller than 3 cm in diameter, completely surrounded by hepatic parenchyma, 1 cm or more deep to the liver capsule, and 2 cm or more away from large hepatic or portal veins. Subcapsular liver tumours can be ablated, but... 

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