Kurume Chuo Hospital

What is Hepatitis and Cirrhosis

• Hepatitis:
  A disease where inflammation occurs in the liver due to infection with hepatitis viruses. Symptoms such as general fatigue and loss of appetite may occur, but many cases are asymptomatic. It should be considered as a "high-risk group for liver cancer" and managed accordingly.
• Cirrhosis:
  A disease where chronic hepatitis progresses, leading to the destruction of liver cells followed by the deposition of fibrous tissue, causing the liver to become hardened. Symptoms such as edema, ascites, and jaundice appear as it progresses. Prolonged cirrhosis increases the risk of liver cancer significantly.

The Causes of Hepatitis and Cirrhosis

Most cases of hepatitis are caused by infection with hepatitis viruses, but fatty liver hepatitis due to excessive alcohol consumption, obesity, diabetes, and other factors can also be causes.

Treatment for Hepatitis and Cirrhosis

Antiviral drug therapy is crucial for viral hepatitis and cirrhosis. Adrenal cortical steroids are used for autoimmune hepatitis, while abstinence from alcohol, dietary therapy, and exercise are important for fatty liver hepatitis.

Cell-free and Concentrated Ascites Reinfusion Therapy (CART) is a treatment for refractory ascites. This method involves extracting ascites fluid from the abdomen, filtering and concentrating it, and then reinfusing protein components and other substances back into the patient's body.

Key Features of KM-CART Method

• Complete Processing:
  All ascites fluid is drained and fully processed.
• Membrane Cleaning System:
  Unlike traditional CART methods that had limitations on the amount of ascites fluid that could be processed, the KM-CART method employs a membrane cleaning system that allows for rapid and large-volume processing even with easily clogged ascites fluid.
• High Effectiveness:
  By processing large amounts of ascites fluid and infusing a significant amount of proteins via intravenous drip, each treatment session yields a high therapeutic effect.

Achievements

CART treatment began in 2010, with the introduction of the KM-CART method in 2017. From 2017 to 2021, there were approximately 640 cases treated with KM-CART. The maximum processed ascites fluid volume per case was approximately 18 liters, with an average processed volume of about 7 liters.

Treatment Schedule

• The treatment typically spans 2 nights and 3 days.
• On the first day, preoperative examinations are conducted, CART treatment is administered on the second day, and discharge occurs on the third day after confirming blood test results.
• CART is an insurance-covered treatment and can be received once every two weeks.
• To undergo treatment, patients must first consult their primary care physician and make an appointment for examination with a medical information release form.

The KM-CART method is an advanced approach to effectively treating refractory ascites, contributing to symptom relief in patients by processing large volumes of ascites fluid.

Hepatocellular Carcinoma Diagnosis

• Blood Tests:
  Examining liver function and virus-related markers.
• Imaging Diagnosis:
  Using ultrasound, CT scans, MRI, etc., to evaluate the presence and condition of hepatocellular carcinoma.
  ーUltrasound is non-invasive and useful for screening.
  ーCT scans show intense staining in the early phase and low absorption in the late phase for typical hepatocellular carcinoma.
  ーMRI is particularly effective with gadolinium contrast agents or liver-specific contrast agents in dynamic MRI.
• Tumor Markers:
  Markers like AFP (Alpha-Fetoprotein) and PIVKA-II serve as indicators of hepatocellular carcinoma.

Hepatocellular Carcinoma Treatment

There are various treatment methods for hepatocellular carcinoma, tailored to the tumor's characteristics and the patient's liver function.

Hepatocellular carcinoma treatment involves utilizing these methods individually or in combination based on tumor characteristics and patient liver function. Treatment advancements in hepatitis are crucial for controlling hepatocellular carcinoma progression, leading to improved treatment outcomes in digestive system cancers.