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SBCP Pathology > Liver: Surgical > Flashcards

Liver: Surgical Flashcards

1
Q

Primary benign liver masses (4)

A

Cysts
Haemangioma

Focal nodular hyperplasia (has bile duct elements)

Hepatocellular adenoma

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2
Q

Primary malignant liver masses (3)

A

HCC (malignnat epithelial)

Cholangiocarcinoma

Angiosarcoma (vascular tumour, quite rare)

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3
Q

Hyatid cysts are caused by which organism?

A

Enchinococcus

Benign cyst

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4
Q

Common origin sites for secondary malignant liver tumour?

A

Much more common than primary cancer

From colon, lung, breast, stomach, pancreas, melanoma etc..

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5
Q

Difference between primary and secondary liver tumours?

A

Primary usually solitary, secondary usually multiple

Exceptions: eg solitary metastasis from colon

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6
Q

Aetiological factors of HCC?

A

Hepatitis B and C
Aflatoxins
Cirrhosis of any cause

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7
Q

Clinical features of HCC?

A

Rapid increase in liver size in cirrhotic patient

Worsening of ascites, fever, pain

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8
Q

Prognosis of HCC?

A

Usually incurable

Median survival is 7 months

Small lesions may be resectable

Embolisation of tumour may be used palliatively

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9
Q

Morphology of HCC

A

Can be unifocal, multifocal or diffusely infiltrative

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10
Q

Which liver tumour is most commonly associated with the use of OCP?

A

Hepatocellular adenoma

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11
Q

Risk factors for cholelithiasis and cholecystits

A 
Female
Fair
Fat
Forties
Fertile

Also diabetes

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12
Q

What colour are cholesterol gallstones?

A

Pale

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13
Q

What colour are bile gallstones?

A

Dark green

Most stones are a mix of cholesterol and bile

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14
Q

Complications of gallstones

A

Can impact in Hartmann’s pouch or neck of gallbladder:

Cholecystitis
Mucocele
Biliary colic
Obstructive jaundice
Ascending cholangitis
Pancreatitis

VERY RARE: GB carcinoma

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15
Q

Prognosis of gallbladder carcinoma?

A

Rare complication of gallstones

Usually elderly females

Advanced stage at presentation, poor prognosis

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16
Q

True/false: gallbladder papillomas are the most common benign tumours of the gallbladder

A

True

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17
Q

True/false: Cholangiocarcinoma is the commonest malignancy seen in the gallbladder

A

False, adenocarcinoma

18
Q

Causes of extrahepatic biliary tract obstruction

A

Lumen: stones

Within wall: Stricture, tumour

Outsdie wall: Pancreas tumour, ampulla carcinoma, lymphoma, surgical ligation of bile duct

19
Q

Clinical features of biliary obstruction

A

Obstructive jaundice (raised bili, pale stools, dark urine)

Raised ALP

Complications: cholangitis, abscesses

20
Q

Radiology investigations for biliary tract obstruction

A

USS first line for gallstones

Percutaneous transhepatic cholangiogram (PTCA) to inject DYE

ERCP ?stone, benign or malignant stricture

Cytology of bile duct brushing ?malignancy

CT/MRI

21
Q

What is a cholangiocarcinoma?

A

Adenocarcinoma of bile ducts (intra or extrahepatic)

Presents at early stage with obstructive jaundice

22
Q

Risk factors for cholangiocarcinoma

A

Sclerosing cholangitis/UC

Liver fluke

Congenital biliary tree anomaly

23
Q

How is cholangiocarcinoma diagnosed?

A

Diagnosis of exclusion (need to exclude primary tumours from pancreas or stomach which can closely mimic intrahepatic cholangiocarcinoma)

24
Q

Where does an Ampullary carcinoma occur?

A

Ampulla of Vater, origin may be in duodenum, pancreas, bile duct, or ampulla itself

Important to distinguish from periampullary duodenal carcinoma or metastatic spread

25
Q

Pathology of acute pancreatitis

A
  • Due to acinar cell injury and inflammation
  • Causes release of exocrine enzymes and autodigestion of pancreas
  • Associated inflammatory response by cytokines, which leads to pancreas necrosis, surround FAT NECROSIS, and haemorrhage
26
Q

Pathology of chronic pancreatitis

A

Repeated inflammation leads to loss of pancreas parenchyma and fibrosis

Also get inspissation of secretions in pancreas ducts, forming DUCTAL PLUGS

This results in calcification which can be picked up on imaging

27
Q

Causes of pancreatitis (metabolic, mechanical, vascular, infectious)

A

Metabolic: alcohol, cholesterol, hypercalcaemia, drugs (THIAZIDES AND CICLOSPORIN)

Mechanical: Gallstones, trauma, post ERCP

Vascular: shock, embolism, vasculitis

Infectious: Mumps, mycoplasma, cocksackie virus

28
Q

Presentation of acute pancreatitis

A

Epigastric pain radiating to back

Acute abdomen
Shock
ARDS, organ failure

Raised serum amylase
HYPOCALCAEMIA
Rarely jaundice
Hyperglycaemia

29
Q

Clinical effects of chronic pancreatitis

A

Common cause: alcohol
Relapsing episodes of pain
Malabsorption due to enzyme loss

Exocrine more affected than endocrine

DM is late sign

Pseudocyst formation

30
Q

How does chronic pancreatitis appear on imaging?

A

Calcification on CT/xray

Distorted ducts on ERCP

31
Q

Risk factors fro pancreatic carcinoma

A

Smoking
Chronic pancreatitis
Genetic factors

32
Q

Where is the most common site for carcinoma in the pancreas?

A

Head (60-70%)

33
Q

Symptoms of pancreatic carcinoma

A

Painless jaundice (due to tumour on the head. Body and tail tumours present later)
Cachexia
Metastases
Thrombophlebitis

34
Q

Serum markers for pancreatic cancer

A

CA19.9 most useful

CEA and CA125 may be elevated but are less specific

35
Q

Diagnosis of pancreatic carcinoma

A

Definitive: needle/core biopsy under CT guidance

36
Q

Prognosis of pancreatic cancer

A

<5% 5 year survival rate

37
Q

What surgical procedure can be used to resect a pancreas head tumour?

A

Whipple’s pancreaticoduodenectomy

38
Q

What are the 3 syndromes associated with pancreatic endocrine neoplasms (PENs)?

A

Insulinomas

Gastrinoma

MEN type 1

39
Q

What is an insulinoma?

A

Syndrome of pancreatic endocrine neoplasm

Usually sporadic, single and benign

Secrete insulin, resulting in hypoglycaemia

Worsened by exercise or fasting

Can present with confusion

40
Q

What are gastrinomas?

A

Syndrome linked to pancreatic endocrine neoplasm

Ofent multiple, can be malignant

Arise from G cells which secrete gastrin

Causes Zollinger Ellison syndrome (peptic ulceration)

41
Q

WHich MEN type is associated with pancreatic endocrine neoplasms (PEN)?

A

MEN type 1

Autosomal recessive inherited condition.

Tumours in pancreas, pituitary gland, and parathyroid glands (remember PPP!!!!)

SBCP Pathology (24 decks)

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