59 - Diseases of the hepatobiliary system b Flashcards Preview

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Flashcards in 59 - Diseases of the hepatobiliary system b Deck (20):
1

Dying from cirrhosis - how?

Liver cell failure
Varices
Infection
Cancer

2

Risk for hepatocellular carcinoma

70% malignant due to cirrhosis

2% malignant tumours from non-cirrhotic (98% are metastatic)

M>F
Obesity, alcohol
Geographical, viral hepatitis

3

Hepatocellular carcinoma - clinical features

Worsening liver function, weight loss

4

Hepatocellular carcinoma - surveillance

6 month USS for cirrhotic patients

5

Hepatocellular carcinoma - blood tests

Raised alpha-feto-protein in serum in 75% of cirrhotic patients

Non-cirrhotic patients, small HCC

6

Hepatocellular carcinoma - macroscopic

green due to bile

7

Hepatocellular carcinoma - involvement

portal vein (60%)
hepatic vein
bile duct

often multifocal

8

Hepatocellular carcinoma - microscopic

cancer cells may look like hepatocytes

may produce bile = diagnostic

confirm with immunohistochemistry

targeted liver biopsy if diagnosis unclear - benign vs malignant based on differentiation

9

Hepatocellular carcinoma - prognosis

Very poor

10

Hepatocellular carcinoma - treatment

surgery - if non-cirrhotic or small, peripheral

transplant - if one tumour

11

Hepatocellular carcinoma - TNM staging for HCC

pT1,2,3a,3b,4

if

12

Tumours that met to liver

Few large nodules = large bowel

Multinodular or infiltrative - lung, pancreas, breast, stomach, melanoma

13

Cholangiocarcinoma -

adenocarcinoma arising in the bile ducts

intra-hepatic: from small intra-hepatic ducts; peripheral, mass forming, presents late - no risk factors inc. cirrhosis

Perihilar: large duct. Cause obstructive jaundice early. Risk factor: bile duct disease: primary sclerosing cholangitis with liver flukes.

14

Gallstones -

viscid green liquid build up containing bile salts, phospholipids, cholesterol, bilirubin and Ca salts + mucin from peribiliary glands.

Gallstones are when these constituents precipitate

15

Gallstones - who?

10-20% of adults in UK
Female
Obesity
Diabetes

16

Gallstones - types

cholesterol stones - yellow, opalescent
pigmented stones - small black in haemolytic anaemia
mixed stones
10% contain calcium

17

Gallstones - complications

cholecystitis
mucocele
predisposition to carcinoma of the gallbladder
Obstruction of the biliary system resulting in biliary colic and jaundice
infection of static bile, causing cholangitis and liver abscess
Gallstone ileus (rarer)
Pancreatitis

18

Cholecystectomy - indications

pain, gallstones, pancreatitis
gall bladder polyp (rarely)

19

Cholecystitis - acute

Duct blocked by stone, initially sterile, later infected.

Large, swollen, congested, ulcerated

Complications - empyema, rupture

20

Cholecystitis - chronic

Usually gallstones
Small, fibrotic, stones, fibrosis, Rokitansky Aschoff sinuses

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