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Diagnostic laparoscopy in radiation-induced liver disease

      Radiation-induced liver disease (RILD) is a well-described syndrome characterized by weight gain, ascites, and elevated serum alkaline phosphatase occurring within 4 to 8 weeks of the conclusion of radiotherapy.
      • Lawrence TS
      • Robertson JM
      • Anscher MS
      • Jirtle RL
      • Ensminger WD
      • Fajardo LF.
      Hepatic toxicity resulting from cancer treatment.
      The incidence of RILD is not known, but radiation dose, liver volume radiated, and functional reserve of the liver are important with regard to the pathogenesis and prognosis of the disease.
      • Shen-Gunther J
      • Walker JL
      • Johnson GA
      • Mannel RS.
      Hepatic veno-occlusive disease as a complication of whole abdominopelvic irradiation and treatment with the transjugular intrahepatic portosystemic shunt: case report and literature review.
      RILD has been inappropriately termed “radiation hepatitis” and must be distinguished from chemoradiation-induced liver disease observed in patients undergoing bone marrow transplantation and total body irradiation. The former typically presents at 4 to 8 weeks after the conclusion of therapy as anicteric ascites and a substantial elevation in the alkaline phosphatase. The onset of the latter, however, is earlier, generally at 1 to 4 weeks after the bone marrow transplantation; jaundice is usually marked and prognosis is less favorable. Microscopically, the abnormalities of RILD are typical for veno-occlusive disease and therefore are predominantly evident around the central vein (zone 3) as endothelium swelling, terminal hepatic venule narrowing, sinusoidal congestion, parenchymal atrophy of zone 3, and proliferation of collagen. Formation of microthrombi because of hepatic venule endothelial damage also contributes to the outflow obstruction. In addition to liver biopsy, imaging studies are important to support the clinical diagnosis and to rule out disorders likely to occur in patients with underlying malignancy, such as Budd-Chiari syndrome and metastatic diseases.
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