DrMKZ

Rooftop scars. 

young Malay boy, who complained abdominal pain. Jaundiced, pink, thin with dried and scaly skin.

Rooftop scar, a midline laparatomy scar, with small horizontal scar at the iliac region.

No hepatosplenomegaly  palpated.

What is the significant of having a rooftop scar?

• The indications for liver transplantation can be classified into four broad categories:
  1. Acute liver failure (fulminant hepatic failure).
  2. Chronic liver failure.
  3. Metabolic liver disease.
  4. Liver cancer.
  5. Other metabolic diseases caused by liver based inborn errors of metabolism.

but this list is a broad categorization

so this list

Primary recipient disease

Discuss the case on the basis of likely clinical findings

1. Biliary atresia and complication- rooftop scar+ young + jaundice
2. Autoimmune disease – female + rooftop scars or partial rooftop scars + signs of steroids use + Primary biliary cirrhosis
3. Hepatitis B – Chronic hepatitis B with low virus burden when patient on hepatitis treatment – risk of recurrent hepatitis B infection- Orthotopic liver transplantation (OLT) is now a well-established treatment for liver failure and hepatocellular carcinoma. (Link) http://cid.oxfordjournals.org/content/41/10/1461.full
4. Some really awesome stuff – LCAT deficiency http://www.ncbi.nlm.nih.gov/pubmed/27490864

Read more of BTS Clinical Guideline  http://www.bts.org.uk/Documents/Guidelines/Active/BTS_Clinical_Practice_Guidelines_-_final_25%2011%2011.pdf

Liver and pancreas transplant

MELD scores- Model for End Stage Liver Disease