liver cancer

Question 1

HCC/hepatoma

Answer 1

Most common malignant in adults

Increased risk with HepB, HCV, Wilson’s dz, hemochromatosis, alpha1 antitrypsin deficiency, alcoholic cirrhosis and carcinogens (aflatoxin from aspergillus)

Finding: jaundice, tender hepatomegaly, ascites, polycythemia, and hypoglycemia.

Question 2

HCC

Cancer characteristiccs

Answer 2

Spread by hematogenous dissemination
Increased AFP

May lead to Budd-Chiari syndrome (via EPO production)

Question 3

Cavernous hemangioma

Answer 3

Common, benign liver tumor
Typically at 30-50 yrs
Bx contraindicated bc of hemorrhage

Question 4

Hepatic adenoma

Answer 4

Benign liver tumor
Related to OCP or steroid use
Can regress spontaneously

Question 5

Angiosarcoma

Answer 5

Malignant of endothelial origin

Exposure to arsenic, polyvinyl chloride

Question 6

Nutmeg liver

Answer 6

Backup of blood to liver

1) R sided HF
2) Budd Chiari syndrome

If the condition persists, centrilobular congestion and necrosis can result in cardiac cirrhosis.

Question 7

Budd Chiari syndrome

Answer 7

Occlusion of IVC or hepatic veins with centrilobular congestion and necrosis, leading to congestive liver failure.

Varices on abd and back veins but absence of JVD

Associated with hypercoagulable state, polycythemia vera, pregnancy, and HCC.

Question 8

Alpha1 antitrypsin deficiency

Answer 8

Misfolded gene product protein aggregates in hepatocellular ER.

Cirrhosis with PAS positive globules in liver

Lung, lack of functioning enzymes => decrease elastic tissue => panacinar emphysema

Codominant trait

Question 9

Jaundice

Answer 9

Yellow skin and or sclerae resulting from elevated bilirubin

1) Direct hepatocellular injury
2) Obstruction to bile flow
3) Hemolysis

Question 10

Jaundice:

Direct hematocellular injury

Answer 10

Hyperbilirubinemia: direct and indirect
Urine bilirubin: increased
Urine urobilinogen: normal or decreased

Question 11

Jaundice:

Obstruction of bile flow

Answer 11

Hyperbilirubinemia: direct
Urine bilirubin: increased
Urine urobilinogen: decreased

Question 12

Jaundice:

Hemolysis

Answer 12

Hyperbilirubinemia: indirect
Urine bilirubin: absent (acholuria)
Urine urobilinogen: increase

Question 13

Physiologic neonatal jaundice

Answer 13

At birth,
immature UDP-glucuronyl transferase
Unconjugated hyperbilirubinemia
Jaundice/kernicterus

Tx: phototherapy (converts UCB to water soluble form)