9%20ECOGRAFIA%20ABDOMINAL%20COMO%20CUANDO%20DONDE

110
ABDOMINAL ULTRASOUND
RHV
A
Figure 4.29 Liver infarct in pregnancy in a patient with
HELLP syndrome.
The recognition and prompt diagnosis of acute
fatty liver and HELLP syndrome reduce maternal
morbidity by enabling emergency caesarean section
to be performed.
Causes of changes in liver reflectivity are listed in
Table 4.5. Causes of free intraperitoneal fluid are
listed in Table 4.6.
B
Figure 4.28 (A) The waveform of the hepatic vein in a
patient with mitral valve disease demonstrates increased
pulsatility. (B) The portal vein has an abnormal, highly
pulsatile flow waveform in this patient with tricuspid
regurgitation. This is quite distinct from the low-velocity
‘balanced flow’ of portal hypertension.
Its complications include areas of haemorrhage
(either subcapsular haematoma or intraparenchymal
bleeding), infarction or necrosis within the
liver which can be identified with ultrasound or
MRI scanning (Fig. 4.29).
LIVER TRANSPLANTS
Indications for transplant
Liver transplantation has now become a successful
treatment for many chronic liver conditions and is
also used in the treatment of fulminant hepatic failure.
The range of indications has steadily increased
as surgical techniques have developed and
immunosuppression has improved (Table 4.7). The
majority of hepatic transplants (80%) are still performed
in patients with cirrhosis and primary
cholestatic disease. 31
The 5-year survival rate is between 65 and 90%. 32,33
This is highly dependent upon both the primary disease
and upon the clinical state of the patient.
Currently, seven centres in the UK perform liver
transplants, totalling around 700 patients per year.