10. Liver, Pancreas and Biliary Tract

Question 1

What are the primary benign liver tumours?

Answer 1

Hepatic adenoma
Bile duct adenoma
Haemangioma

Question 2

What are the primary malignant liver tumours?

Answer 2

Hepatocellular carcinoma
Intrahepatic cholangiocarcinoma
Haemangiosarcoma

Question 3

What are the most common secondary tumours in the liver?

Answer 3

Breast
Lung
GIT
Lymphoma and leukaemia

Question 4

Where is hepatocellular carcinoma most common?

Answer 4

Southeast Asia and Africa where there are high rates of chronic hepatitis

Question 5

How is a hepatocellular carcinoma diagnosed?

Answer 5

Ultrasound, CT and MRI
Assess nodules >1 cm in patients with cirrhosis
AFP tumour marker

Question 6

How is hepatocellular carcinoma treated?

Answer 6

Resection if early
Transplant
Local ablative treatments; radiofrequency or arterial chemo-embolisation

Question 7

What is the aetiology of hepatocellular carcinoma?

Answer 7

Cirrhosis and hepatitis

Aflatoxins; fungal contaminants of food sources

Question 8

What is a cholangiocarcinoma?

Answer 8

Adenocarcinoma arising from bile duct epithelium

Most commonly found at hilum of liver

Question 9

What is a Klatskin tumour?

Answer 9

Cholangiocarcinoma that obstructs the bifurcation of the common bile duct

Question 10

What disease is cholangiocarcinoma associated with?

Answer 10

Primary sclerosing cholangitis

Question 11

What is the treatment for cholangiocarcinoma?

Answer 11

Surgical resection

Palliatively a stent to hold duct open

Question 12

Who is most likely to get a gall bladder adenocarcinoma?

Answer 12

Older females with long standing gall stones

Question 13

What is a tumour of the exocrine pancreas known as?

Answer 13

Pancreatic adenocarcinoma

Question 14

What are tumours of the endocrine pancreas associated with?

Answer 14

Inherited multiple endocrine neoplasia syndrome type 1

Question 15

Which patient group is most likely to get pancreatic carcinomas?

Answer 15

Older men

Question 16

Where do pancreatic carcinomas spread to?

Answer 16

Peritoneum
Duodenum
Common bile duct
Lymph nodes
Liver

Question 17

What symptoms are associated with pancreatic carcinomas?

Answer 17

Painless obstructive jaundice and weight loss

Abdominal pain radiating to the back

Question 18

How is a diagnosis of pancreatic carcinoma made?

Answer 18

CA19-9 serum marker
Imaging
FNA cytology

Question 19

What is the treatment of pancreatic carcinomas?

Answer 19

Mostly palliative as disease is aggressive; stenting and analgesia
Whipple’s procedure
Chemo

Question 20

What is the difference between type 1 and 2 drug induced liver injury?

Answer 20

1. dose dependent and predictable

2. not dose related, hypersensitivity

Question 21

Give an example of drug hypersensitivity related liver damage

Answer 21

Halothane

Question 22

Which drugs can cause hepatocellular damage?

Answer 22

Antibiotics
NSAIDs
Statins
Anti-epileptics
Isoniazid

Question 23

Which drugs cause chronic hepatitis?

Answer 23

Methyldopa

Nitrofuratoin

Question 24

Which drugs cause cholestatic reactions?

Answer 24

Erythromycin
Co-amoxiclav
OCP

Question 25

What drug is associated with steatohepatitis?

Answer 25

Amiodarone

Question 26

What drug is associated with fibrosis?

Answer 26

Methotrexate

Question 27

What conditions increase the toxicity of paracetemol?

Answer 27

Glutathione depleted in malnutrition | Enzymes being used elsewhere; alcohol and anticonvulsants

Question 28

What happens to the liver in a paracetemol overdose?

Answer 28

Conjugation is overwhelmed Increase NAPQI Causes acute liver necrosis

Question 29

What is the treatment for paracetemol overdose?

Answer 29

<2 hours activated charcoal prevents absorption | 8-10 hours N-acetylcysteine increases glutathione

Question 30

What is acute liver failure?

Answer 30

Sudden severe liver injury in an otherwise healthy liver

Question 31

Differentiate between hyperacute, acute and subacute liver failure

Answer 31

Hyper: <1 week Acute: 1-4 weeks Subacute: 4-12 weeks

Question 32

What are the causes of acute liver failure?

Answer 32

``` Drugs Acute hepatitis A and E Mushroom poisoning Budd Chiari syndrome Wilson's disease Pregnancy ```

Question 33

What complications are associated with acute liver failure?

Answer 33

``` Progressive hepatic encephalopathy and cerebral oedema High risk of sepsis Renal failure Hypovolaemic shock Jaundice ```

Question 34

What are the indications for liver transplant?

Answer 34

Decompensated cirrhosis Acute liver failure Childhood diseases