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HBP > HCC > Flashcards

HCC Flashcards

1
Q

Risk factor of HCC

A

Hep B/ C
Liver cirrhosis
Alcohol
NAFLD
Hereditary hemochromatosis
Autoimmune hepatitis
Metabolic liver disease

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2
Q

What is the diagnostic CT feature for HCC?

A

Arterial enhancement with rapid washout in portal venous phase

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3
Q

Explain why HCC exhibit arterial enhancement and portal venous washout?

A

HCC has arterial supply which makes up only 30% of liver arterial supply, thus HCC will light up in arterial phase and contrast will leave HCC while normal parenchyma received major supply of blood from portal venous system

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4
Q

What is Child Pugh criteria?

A

Clinical criteria to predict mortality of cirrhotic patients

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5
Q

What are the components of Child Pugh criteria?

A

Albumin

Bilirubin

INR

Ascites

Hepatic Encephalopathy

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6
Q

What accumulated points signify a Grade A Child Pugh and what is the associated one year survival rate?

A

5-6 points

Well compensated disease

1 year survival rate 100%

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7
Q

What accumulated points signify a Grade B Child Pugh and what is the associated one year survival rate?

A

7-9 points

significant functional compromise

1 year survival rate of 80%

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8
Q

What accumulated points signify a Grade C Child Pugh and what is the associated one year survival rate?

A

10-15 points

Decompensated disease

40% 1 year survival

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9
Q

What does an ICG 15 min retention rate >14% signify?

A

Cannot withstand a formal/ extended hepatectomy

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10
Q

What is a normal ICG retention rate?

A

4%

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11
Q

Milan’s criteria

A

Criteria used to evaluate patients for orthopic liver transplantation

  • Solitary tumor <5cm
  • Multifocal < 3cm, each < 3cm
  • No gross vascular invasion or regional/distant metastasis
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12
Q

Curative treatments for HCC

A

Resection

Local ablation

Transplant

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13
Q

What are the phases in a triphasic scan?

A

Non-contrast

Arterial phase

Portal venous phase

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14
Q

What is MELD?

A

Model for End Stage Liver Disease

Assesses severity of liver disease, predicts 3 month mortality

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15
Q

How to calculate MELD?

A

Serum creatinine

Total bilirubin

INR

  • >15 benefit from transplant
  • >9 higher perioperative mortality 30%
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16
Q

What is the adequate future liver remnant in CT volumetry

A

Normal liver: 20%

Post-chemo: 30%

Cirrhotic liver: 40%

17
Q

Indications for liver transplantation in HCC

A
  • Child C
  • Meets Milan criteria
18
Q

Arguments for liver transplantation in HCC

A
  • Pros:
    • better survival
    • lower recurrence
    • treats liver cirrhosis
  • Cons:
    • severe shortage of grafts
    • lengthens waiting list in cases where resection can be done
    • treatment morbidity & mortality
19
Q

What types of bridging therapy are there prior to transplantation?

A
  • TACE
  • Ablation
  • Resection

Reduces dropout rate due to tumor growth with long waiting times > 6 months

20
Q

UCSF criteria

A
  • Single nodule ≤ 6.5 cm or
  • 3 nodules ≤ 4.5 cm and with a total volume no greater than 8 cm
  • Give similar result to Milan’s
21
Q

Indications for percutaneous ablation in HCC

A
  • Curative
    • Child’s A/B
    • small HCC < 2-3 cm
  • Palliative
    • Child’s A/B
    • solitary tumor <5 cm
    • two to three nodules < 3cm
22
Q

Arguments of RFA vs Resection in resectable tumors

A

Resection better long term overall survival

RFA better if borderline liver function, lower post tx complications, shorter hospital stay but incomplete clearance of tumor at specific sites of liver

23
Q

What is radio-frequency ablation?

A

High frequency radiowaves delivered through needle electrode to destroy tumor by local heating

24
Q

HIFU

A

High Intensity Focused Ultrasound

  • extracorporeal
  • non-invasive

well tolerated in advanced cirrhosis and gross ascites

25
Q

What is TACE?

A

Transcatheter arterial chemoembolisation:

  • intra-arterial administration of chemo drugs
  • carried by lipidol through feeding artery of tumor
  • effect potentiated by simultaneous delivery of embolic agent (ex. Gelfoam)
26
Q

Components of injected TACE agent

A
  • Lipiodol
  • Cytotoxic drugs
  • Embolization agent
27
Q

DDX for cystic liver mass

A
  • Benign:
    • Hemangioma
    • Hepatic cyst
    • Hepatic abscess
    • Hydatid cyst
  • Malignant:
    • Cystadenoma
28
Q

DDX for solid liver mass

A
  • Benign:
    • Adenoma
    • Focal Nodular Hyperplasia
    • Lipoma
  • Malignant:
    • HCC
    • Cholangiocarcinoma
    • Metastasis
29
Q

Contraindications to liver transplant

A
  • Active alcoholic/ substance abuse
  • Cancer other than liver
  • HIV
  • Advanced heart and lung disease
  • Massive liver failure associated with brain damage
  • Severe infection
30
Q

Imaging characteristics of hemangioma

A

CT:

  • irregular contrast enhancement in early arterial phase followed by central filling in delayed phase
  • peripheral nodular
31
Q

Imaging characteristics of hepatic adenoma

A

CT features identical to HCC. Arterial phase contrast enhancement, delayed phase washout

32
Q

Imaging characteristics of FNH

A
  • CT/MRI: Central scarring in portal venous phase
  • Angiogram: spokewheel
33
Q

Imaging characteristics of liver secondaries

A
34
Q

Definition of portal hypertension

A

Portal venous pressure > 5mmHg

Clinical significance >10mmHg

35
Q

Stigmata of chronic liver disease

A

Jaundice

Spider naevi

Gynaecomastia

Palmer erythema

Flapping tremor

36
Q

Signs of portal hypertension

A

Ascites

Splenomegaly

Caput medusa

37
Q

What portosystemic shunt leads to oesophageal varices?

A

Left gastric vein to lower esophageal veins to azygous vein

38
Q

What portosystemic shunt leads to gastric varicoses?

A

Short gastric veins

HBP (5 decks)

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