Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item An ABO-incompatible living donor liver transplant in an infant with acute liver failure in the Sri Lankan setting(The Sri Lanka Medical Association, 2023) Fernando, M.; Tillakaratne, S.; Gunetilleke, B.; Liyanage, C.; Appuhamy, C.; Weerasuriya, A.; Dissanayake, J.; Siriwardana, R.Liver transplant (LT) is the standard therapy for medically refractory acute liver failure (ALF). Finding a deceaseddonor graft in an emergency is challenging and often overcome by living-donation. Blood group matching is practised for LT though ABO-incompatible liver transplant (ABOi-LT) is performed inselected circumstances. We report an infant who underwent successful ABOincompatible living donor LT for ALF of unknown aetiology. This being the country’s first ABOi-LT, the youngest LT recipient to date and the youngest receiving emergency LT for ALF; we describe the novel experience at a resource-limited setting in Sri Lanka (SL).Item Optimizing intraoperative haemodynamics and haemostasis to enhance recovery after liver transplantation for cirrhosis in adults(College of Anaesthesiologists of Sri Lanka, 2022) Gunetilleke, B.; Welikala, N.; Ranamuni, R.; Jayaweera, D.; de Silva, T.; Amerasinghe, O.; Liyanage, C.; Dissanayake, J.; Appuhamy, C.; Fernando, M.; Thilakarathne, S.; Dassanayake, A.; Niriella, M.; Siriwardana, R.; Gilbert-Kawai, E.Cirrhosis with end stage liver disease is a leading cause of non-communicable disease related deaths in Sri Lanka. Liver transplantation remains the only curative treatment for such patients. Multi-organ dysfunction characteristic of end stage liver disease, surgical and anaesthetic factors, quality of the graft, coagulopathy and haemodynamic instability, all lead to the complexity of the perioperative care for liver transplant. Aggressive management focused particularly on maintaining intra-operative haemodynamic stability and optimizing haemostasis, directly impacts successful patient outcomes and forms the core of the anaesthetic strategy.Item Fifty liver transplants: a single centre experience of haemodynamic management in liver transplantation for cirrhosis [part 2](The College of Surgeons of Sri Lanka, 2021) Gunetilleke, B.; Ranamuni, R.; Jayaweera, D.; Welikala, N.; Kerner, V.; Hettiarachchi, D.; Munasinghe, N.; Withanage, R.; Wickremasinghe, N.; Hewage, S.; Fernando, M.; Hettiarachchi, D.; Niriella, M.; Dassanayake, A.; Thilakaratne, S.; Wijesuriya, R.; Liyanage, C.; Siriwardana, R.; Dissanayake, J.; Wijesuriya, N.; Rodrigo, U.; Rodrigo, U.; Mudalige, A.; de Silva, J.Globally, an estimated one million deaths occur annually due to complications of cirrhosis. Cirrhosis with end stage liver disease [ESLD] is a leading cause death due to non- communicable diseases in Sri Lanka. Non-alcoholic fatty liver disease [NAFLD] and alcohol related liver disease [ARLD] are the principal causes of ESLD due to cirrhosis in Sri Lanka. Liver transplantation remains the only curative treatment for such patients. Multiorgan dysfunction and hemodynamic instability characteristic of ESLD adds to the complexity of perioperative care in liver transplantation. Maintenance of stable hemodynamics including optimal hemostasis forms the core of the anaesthetic strategy in liver transplantation.Item Fifty liver transplants: a single centre experience of haemodynamic management in liver transplantation for cirrhosis [part 1](College of Surgeons of Sri Lanka, 2021) Gunetilleke, B.; Ranamuni, R.; Jayaweera, D.; Welikala, N.; Kerner, V.; Munasinghe, N.; Withanage, R.; Wickremasinghe, N.; Hewage, S.; Wijesuriya, N.; Rodrigo, U.; Mudalige, A.; Fernando, M.; Hettiarachchi, D.; Dissanayake, J.; Niriella, M.; Dassanayake, A.; Thilakaratne, S.; de Silva, J.; Siriwardana, R.; WIjesuriya, R.; Liyanage, C.ABSTRACT: Cirrhosis with end stage liver disease (ESLD) is a leading cause of non-communicable disease related deaths in Sri Lanka. Liver transplantation is the only curative treatment for patients with ESLD. The complex multisystem involvement and unique cardiovascular profile characteristic of ESLD present formidable challenges during liver transplantation. Management of the rapid and varied hemodynamic changes during surgery requires an in depth understanding of the physiological effects of each intervention. Based on the current literature and the experience gained at our center during the management of 50 liver transplants, we present optimization strategies and perioperative hemodynamic interventions which we use to ‘Fast track’ recovery following liver transplantation. KEYWORDS: Liver transplantation, cirrhosis, non-alcoholic fatty liver disease, alcohol related liver diseaseItem Clinical characteristics and outcome of hepatocellular carcinoma in alcohol related and cryptogenic cirrhosis:a prospective study(Elsevier, 2015) Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; Liyanage, C.; Gunetilleke, B.; Jayathunge, S.; de Silva, H.J.BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is becoming a leading cause of chronic liver disease. Hepatocellular carcinoma (HCC) is one of its complications. Although the pathophysiology is unclear, it is reasonable to expect that cryptogenic cirrhosis related HCC (cryptogenic HCC) behaves differently to other types of HCC. This study prospectively compared patients with cryptogenic HCC and those with HCC related to alcoholic cirrhosis. METHODS: A total of 150 consecutive patients with HCC (89 cryptogenic HCC and 61 alcohol related HCC) referred to our unit over a 23-month period were studied. Their demographic data, liver function, tumor characteristics and outcomes were compared. RESULTS: Alcohol related HCC was seen only in males. Compared with cryptogenic HCC, alcohol related HCC had significantly higher aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio (1.7 vs 1.4, P=0.002), model for end-stage liver disease score (13 vs 11, P=0.018) and Child's score (7 vs 6, P=0.037). No significant difference was seen in platelet counts, serum sodium and AST to platelet ratio index. Single nodular tumors were more common in cryptogenic HCC, while diffuse type tumors and macroscopic vascular invasion were common in alcohol related HCC. In patients who could not be offered any treatment because of advanced tumors or poor liver function, alcohol related HCC had a significantly lower median survival (5.3 months) compared with cryptogenic HCC (9.3 months, P=0.034). CONCLUSIONS: Compared with cryptogenic HCC, alcohol related HCC had worse liver function and aggressive tumor morphology at presentation, and a higher proportion was untreatable. In patients who could not be treated, median survival was lower in patients with alcohol related HCC than in those with cryptogenic HCC.Item Umbilical endometriosis-A simple but challenging diagnosis for surgeons(College of Surgeons of Sri Lanka, 2014) Jayathilake, K.G.H.; Withana, S.; Siriwardana, R.; Mahendra, G.; Liyanage, C.Item Total pancreatectomy for cholangiocarcinoma of the distal common bile duct associated with lipomatous pseudohypertrophy of pancreas(EDORIUM Journals, 2015) Jayatunge, S.P.; Mahendra, G.; Siyabalapitiya, S.; Siriwardana, R.C.; Liyanage, C.Introduction: Fatty replacement of the exocrine pancreas also known as lipomatosis, adipose atrophy or lipomatous pseudohypertrophy is a well recognize benign condition. This fatty infiltration can occur either focally or involving the whole pancreas. Case Report: We report a rare case of lipomatous pseudohypertrophy of the pancreas associated with cholangiocarcinoma of the distal common bile duct (CBD). A 51-yearold female presented to our unit with a history of obstructive jaundice. Radiological imaging suggested a cholangiocarcinoma of the distal CBD with pancreatic lipomatosis, without any clinical evidence of exocrine or endocrine dysfunction. She underwent a radical bile duct excision and a total pancreatectomy. Histology revealed lipomatosis of the pancreatic body and tail with sparse pancreatic tissue adjacent to the tumor. After an uneventful recovery, she was started on lifelong insulin and pancreatic enzyme supplements. Even though pathogenesis of pancreatic lipomatosis remains controversial, it is most likely due to obstruction of the pancreatic duct in this presentation. Conclusion: It is import to undertake total pancreatectomy for this dual presentation with specialized endocrinological support in the stormy postoperative period.Item Nasojejunal feeding versus feeding jejunostomy after upper gastrointestinal surgery(College of Surgeons of Sri Lanka, 2014) Ranjithatharsini, M.; Deen, K.I.; Kumarage, S.; Liyanage, C.; Siriwardana, R.; Gunetilleke, B.The use of enteral nutrition over parenteral nutrition is recommended in the case of patients undergoing major gastrointestinal surgery for cancer, as it reduces sepsis related morbidity. In this study we compared ourexperience of nasojejunal tube feeding with feeding jejunostomyItem Obstructive jaundice caused by a biliary mucinous cystadenoma in a woman: a case report(BioMed Central, 2013) Chandrasinghe, P.C.; Liyanage, C.; Deen, K.I.; Wijesuriya, S.R.E.INTRODUCTION: Mucinous cystadenoma of the liver is a rare (less than 5%) neoplasm. This condition is more common in young women and accounts for non-specific symptoms. Cyst adenomas commonly affect the intrahepatic system (90%) and are rarely found in the extrahepaticbiliary system or affecting both the systems. CASE PRESENTATION: A 39-year-old Sinhalese woman presented with features of obstructive jaundice and was found to have a biliaryneoplasm on imaging. In the absence of a definitive diagnosis despite extensive imaging she underwent preoperative endoscopic biliarydrainage followed by a left hemihepatectomy with Roux-en-Y hepaticojejunostomy. A pathological examination of the specimen revealed an obstruction of the bile duct caused by a biliary mucinous cystadenoma affecting both the intrahepatic and extrahepatic systems. CONCLUSIONS: Biliary mucinous cystadenoma rarely present with obstructive jaundice affecting both intrahepatic and extrahepatic ducts. Exhaustive investigation might not help in the diagnosis and may need to be treated based on clinical judgment. The definitive treatment modality is surgery due to its malignant potential. The operative procedure is technically demanding and is best performed at specialist centers to minimize complications. © 2013 Chandrasinghe et al.; licensee BioMed Central Ltd.