Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive abdominal distension, right upper quadrant (RUQ) discomfort, and constitutional symptoms including unintentional weight loss, fatigue, and night sweats. History notable for potential exposure to vinyl chloride, arsenic, or thorium dioxide. No prior history of chronic viral hepatitis or cirrhosis. Symptoms are subacute in onset with increasing severity.
Clinical Examination Findings
Physical examination reveals cachexia and scleral icterus. Abdominal exam demonstrates hepatomegaly with a firm, irregular, and tender liver edge. Presence of ascites confirmed by shifting dullness. No evidence of peripheral edema or stigmata of chronic liver disease (e.g., spider angiomata, palmar erythema). Cardiovascular exam is unremarkable.
Treatment Protocol
Management plan involves multidisciplinary tumor board review. Given the aggressive nature and high risk of rupture, surgical resection is considered if localized. For unresectable or metastatic disease, systemic chemotherapy (e.g., taxane-based regimens) is indicated. Palliative care consultation for symptom management and pain control. Close monitoring for hepatic rupture and internal hemorrhage.