HPB - Liver Malignancy, Cirrhosis and the Portal system Flashcards
(101 cards)
1
Q
Malignant causes of liver enlargement (3)
A
Mets
Hepatoma
Cholangiocarcinoma
2
Q
Metabolic storage diseases causing liver enlargement (3)
A
Glycogen
Fatty liver
Amyloid
3
Q
Inflammatory causes of liver enlargement (4)
A
Hepatitis
Parasites
Abscesses
TB
4
Q
Vascular causes of liver enlargement (3)
A
HF
Pericarditis
Tricuspid regurg
5
Q
Haematological causes of liver enlargement (3)
A
Myelofibrosis
Lymphoma
Leukaemia
6
Q
What are the 3 main routes bacteria infiltrate the liver?
A
Ascending infection (cholangitis) Portal spread from focus of sepsis in abdomen Septic bloodstream (septicaemia)
7
Q
Cause of pyogenic liver abscess
A
Ascending spread - appendicitis, perf
8
Q
Most common causative organisms - pyogenic liver abscess
A
E.coli
Strep
9
Q
PS pyogenic liver absccess
A
Long Hx malaise
Usually not acutely unwell
Can PS w/ abdo sepsis + tender hepatomegaly
10
Q
Ix pyogenic liver abscess
A
USS/CT
CXR
11
Q
CXR findings pyogenic liver abscess
A
Elevation R diaphragm
+/- pleural effusion
12
Q
Mx pyogenic liver abscess (3)
A
Aspirate under USS
+ IV Abx
Tx underlying cause
13
Q
When to suspect amoebic abscess
A
If Hx of travel
14
Q
Causative agent amoebic abscess
A
Entamoeba histolytica
15
Q
Acute PS etnamoeba histolytica
A
Asymp
Or profuse bloody diarrhoea
16
Q
PS amoebic abscess
A
Swinging high fever
RUQ pain
Tenderness
17
Q
Ix amoebic abscess
A
USS
CT
18
Q
Mx amoebic abscess (2)
A
Metronidazole 5 days
USS drainage
19
Q
Cause - hyatid abscess
A
dog tapeworm
20
Q
Sx hyatid cyst
A
Asymp
Or dull ache RUQ
21
Q
Ix hyatid cyst (5_
A
\+ve hyatid complement fixation test Eosinophilia AXR USS CT
22
Q
AXR findings hyatid cyst
A
Calcification of wall
23
Q
Mx hyatid cyst (3)
A
Albendazole
FNA under USS
Deworm doggo
24
Q
Are the majority of liver cancers 1’ or 2’
A
2’
25
Where do liver mets tend to come from?
```
Lung
Stomach
Colon
Breast
Uterus
```
26
What cancer makes up the vast majority of 1' liver cancers
Hepatocellular carcinoma
27
Which areas of the world is hepatocellular carcinoma > common? (2)
China
| Africa
28
Causes hepatocellular carcinoma (PRAT COST COC)
```
Parasite schistomiasis
Rare diseases e.g. tyrosinaemia, a-1-a deficiency
Arsenic
Tobacco use
Cirrhosis
Obesity
Steroids
T2DM
Chronic hepatitis
OCP
Chem exposure - alfrotoxins, vinyl chloride, thorium dioxide
```
29
Sx hepatocellular carcinoma (4)
Non-specific fever
Malaise
W loss
RUQ pain
30
Signs hepatocellular carcinoma (4)
Hepatomegaly
Signs chronic liver disease
Abdo mass/bruit
Jaundice (late)
31
Ix hepatocellular carcinoma (9)
```
FBC
LFT
Clotting
Hepatitis serology
AFP
USS/CT
MRI
ERCP/biopsy
```
32
Why screen for AFP if suspecting Hepatocellular carcinoma
= raised in 50%cases
33
Mx solitary <3cm HCC
Surgery
34
Prognosis HCC
<6m
35
What is cholangiocarcinoma?
Adenocarcinoma arising from biliary tree
36
PS cholangiocarcinoma?
Painless jaundice
37
What predisposes to cholangiocarcinoma
Any type of chronic inflamm e.g. 1'SC
38
Spread - cholangiocarcinoma
Direct invasion of liver
39
If caught early - what is mx cholangiocarcinoma
Extended liver resection
40
If caught late - what is Mx cholangiocarcinoma
Palliatoin w/ ERCP
41
E.g.s of benign liver tumours
Haemangiomas
| Liver cell adenoma
42
Which benign tumour of the liver is found in young F on COCP
Liver cell adenoma
43
What are the 3 key characteristics of liver cirrhosis
Destruction of liver cells
Assoc chornic inflamm, stimulating fibrosis
Regen of hepatocytes --> nodules
44
What does micronodular cirrhosis (nodular <3mm) due to
Alcoholic liver damage
| Biliary tract disease
45
Macronodular cirrhosis (nodules >3mm) occur due to
Previous hepatitis
46
What is biliary cirrhosis
Fibrosis centred around intrahepatic bile ducts
47
Common causes liver cirrhosis (4)
Alcohlic liver disease
Cryptogenic liver disease
NAFLD
Chronic viral hepatitis
48
What is primary biliary cirrhosis
Autoimmune destruction of intra-hepatic bile canaliculi
49
Who gets primary biliary cirrhosis
40-60y/o F
50
Which condition is primary biliary cirrhosis related to?
IBD
51
PS primary biliary cirrhosis (3)
jaundice
pruritis
skin xanthomas
52
What Ix is diagnostic for primary biliary cirrhosis
AMA
53
Av survival 1' biliary cirrhosis
6y
54
Mx 1'BC
replace fat soluble vits
55
What is primary sclerosing cholangitis
Autoimmune inflammation + fibrosis around bile ducts in liver
56
What condition does 15% of 1'SC progress into
Cholangiocarcinoma
57
Mx 1'SC
Transplant
58
Classical PS chronic liver disease
```
Fatigue
W loss/anorexia
Jaundice
Leg swelling
Bleeding/bruising
Itching
```
59
Nail signs in liver disease (3)
leukonychia
koilonychia
clubbing
60
Hand signs chronic liver disease (3)
Palmar erythema
Dupuytren's contracture
Liver flap
61
What is palmar erythema a sign of
High Oestrogen levels
62
what is Dupuytren's contracture a sign of
Alcoholism
63
What is leukonychia is a sign of
Low albumin
64
Skin changes chronic liver disease (4)
pigmentation
Striae
Spider naevi
bruising
65
Eye signs chronic liver disease (4)
Yellow sclera
Kayser Fleisher rings
Xanthalsma
Pale conjunctiva
66
what is xanthalasma a sign of
Primary biliary sclerosis
67
Signs of portal hypertension (4)
Caput medusae
HSmegaly
Ascites
Varices
68
Signs decompensated liver disease (3)
Encephalopathy
Ascites
Jaundice
69
Why do you get encephalopathy in decompensated liver disease
Liver = unable to clear toxins from the blood which originate in the gut
70
why do you get ascites in decompensated liver disease
hyponatraemia b/c decr synthesis plasma protein in liver
2' hyperaldosteronism after activation RAAS b/c reduced circ volume
--> portal HTN
71
Precipitants of chronic liver disease 'decompensating'
Alcohol binge
Variceal bleed
Hepatotoxic drugs
Portal/hepatic vv thrombosis
72
Complications of chornic liver disease (4)
Hepatocellular failure
Portal HOTN
Malignant change
Renal failure
73
Which steroids are importantly metabolised in the liver and accumulate in chronic liver disease?
Aldosterone
| Oestrogen
74
What is Wilson's disease
Error of Cu metabolism --> depositon in organs
75
Which organs does Wilsons disease classically effect (3)
Liver\
BG
Cornea
76
Ix Wilsons disease (3)
Se caeruloplasmin reduced
Urinary Cu increased
Liver biopsy - incr Cu
77
Mx Wilsons ddisease
Chelating agents e.g. D-penicillamine
78
What is Haemochromatosis
inherited condition --> XS Fe deposition in organs --> fibrosis + organ failure
79
Triad of Sx Haemochromatosis
Bronze skin
Hepatomegalyt
DM
80
Ix haemochromatosis (4)
Se Fe/ferritin raised
TIBC decreased
Genetic testing
Liver biopsy
81
Mx haemochromatosis
Weekly venesection
82
What % of pt w/ cirrhosis will develop G-O varices over 10y
90%
83
Pathology G-O varices
Cirrhosis --> backlog of blood in portal vv --> splenic cc --> HSmegaly --> AV anatomoses in oesophagus
84
mx ascites
Bed rest _ fl restrict
Low Na diet
Spironolactone
Furosemide added if response poor
85
Grade I encephalopathy
Altered mood/behaviour, sleep disturbance
86
Grade II encephalopathy
Increased drowsiness, confusion
87
Grade III encephalopathy
Stupor, incoherence, restlessness
88
Grade IV encephalopathy
Coma
89
Mx encephalopathy
ICU + 20' head tilt
PO lactulose
+ IV mannitol + hyperventilation if evidence cerebral oedema
90
E.g.s of porto-systemic anastomoses locations (4)
```
Cardia stomach (G-O varices)
Anus - rectal varices
Retroperitoneal organs - stomal varices
paraumbilical vv ant abdo wall - caput medusae
```
91
Def portal HTN
P in portal vv >10mmHg
92
Pre-hepatic causes portal HTN
Portal vv thrombosis
93
Hepatic causes portal HTN (5)
```
Cirrhosis
Hepatitis
Idiopathic non-cirrhotic portal HTN
Shisctosomiasis
Congental hepatic fibrosis
```
94
Post-hepatic causes portal HTN
Budd-Chairi syndrome
95
What is Budd-Chairi syndrome
Obstruction of hepatic vv (due to thrombosis or ext mass)
96
How can portal HTN PS (5)
```
Variceal bleeding
Haemorrhoids/caput medusae
Ascites
Splenomegaly
Porto-systemic encephalopathy
```
97
mx acute variceal bleed
```
A-E
Vit K +FFP
IV terlipressin
IV Abx prophylaxis
Endoscopic banding + adrenaline under GA
```
98
Alt Mx variceal bleed (to endoscopic stapiling)
Balloon tamponade devide
| Or transjugular intrahepatic portosystemic shunting
99
2' prophylaxis variceal bleed
Endoscopy
| Non-selective B blockers
100
1; prophylaxis variceal bleeed
Banding + B vlocker if asymp varices are found
101
Dx Mx - pruritis
Cholestyramine
