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GIHEP > L10: Liver, Pancreas and Biliary Tract > Flashcards

L10: Liver, Pancreas and Biliary Tract Flashcards

1
Q

List 3 primary benign liver tumours

A
  1. Hepatic Adenoma (Hepatocellular Adenoma)
  2. Bile Duct Adenoma
  3. Haemangioma
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2
Q

List 1 risk factor for a hepatic adenoma

A

anabolic steroids (e.g. oral contraceptive pill - OCP)

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3
Q

List 3 primary malignant tumours

A
  1. Hepatocellular Carcinoma
  2. Intrahepatic Cholangiocarcinoma
  3. Haemangiosarcoma
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4
Q

What is another term for an intrahepatic cholangiocarcinoma?

A

intrahepatic bile duct adenocarcinoma

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5
Q

Are primary or secondary tumours of the liver more common?

A

secondary tumours (liver mets)

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6
Q

List 3 of the most common cancers that metastasize to the liver

A

Carcinoma of the…

  1. GIT
  2. Lung
  3. Breast
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7
Q

What is a hepatocellular carcinoma?

A

primary, malignant liver tumour

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8
Q

List some of the risk factors/aetiology for hepatocellular carcinoma

A
  • cirrhosis
  • chronic hepatitis
  • HBV
  • Aflatotoxins
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9
Q

What tumour marker is a/w hepatocellular carcinoma?

A

Alpha-Fetoprotein (AFP)

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10
Q

What are aflatotoxins? What are they a/w?

A
  • fungal contaminants of food stores

- a/w the risk of developing HCC

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11
Q

List 3 possible treatments for HCC

A
  • resection (if early)
  • OLT
  • local ablative treatments (radiofrequency, arterial chemo-embolisation)
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12
Q

List 2 cancers of the biliary tract

A
  1. Cholangiocarcinoma

2. Gall Bladder Adenocarcinoma

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13
Q

What is a cholangiocarcinoma?

A
  • carcinoma of the bile duct
  • mainly extrahepatic (but can be intrahepatic)
  • commonest site: hilum of liver
  • a/w PSC
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14
Q

What is the commonest site for a cholangiocarcinoma?

A

hilum of the liver

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15
Q

What is a Klatskin tumour?

A
  • a cholangiocarcinoma

- obstructing tumour at bifurcation of the common hepatic duct

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16
Q

What is the principal cause of gall bladder adenocarcinoma?

A

long standing gallstones

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17
Q

What would an ultrasound of gall bladder adenocarcinoma show?

A

“polyps” of the gall bladder

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18
Q

Is the pancrine mainly exocrine or endocrine?

A

exocrine

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19
Q

Where does the pancreatic duct enter the duodenum?

A
  • at the Ampulla of Vater

- surrounded by the Sphincter of Oddi

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20
Q

Pancreatic enzymes are secreted in their inactive form. How do they become activated?

A

require activation by gut enzymes

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21
Q

What cancer is common in the exocrine pancreas?

A

malignant: pancreatic (ductal) adenocarcinoma

22
Q

What cancers may be present in the endocrine pancreas?

A

pancreatic neuroendocrine tumours

23
Q

What is a pancreatic carcinoma?

A
  • malignant
  • adenocarcinoma
  • ductal (arises in ducts)
  • usually affects the head of the pancreas
24
Q

MEN Type 1 is associated with cancer of which 3 organs?

A
  1. parathyroid gland
  2. islet cells of pancreas
  3. pituitary gland
25
Q

List some of the risk factors for pancreatic carcinoma

A
  • smoking
  • diabetes mellitus
  • chronic pancreatitis
  • family history
26
Q

Which part of the pancreas do pancreatic carcinomas normally affect?

A

head of the pancreas

27
Q

Pancreatic carcinomas are typically only symptomatic with advanced disease. List some of the possible symptoms of pancreatic cancer.

A
  • anorexia
  • weight loss
  • painless obstructive jaundice*
  • vague abdominal pain (may radiate to the back)
  • Trousseau’s Sign*
28
Q

What is Trousseau’s Sign and what type of cancer is it a/w?

A

Trousseau’s Sign = migratory thrombophlebitis (moving inflammation of superficial veins)
– a/w pancreatic carcinoma

29
Q

The serum marker CA 19-9 is a/w which type of cancer?

A

pancreatico-biliary cancer

30
Q

Which tumour serum marker is associated with pancreatico-biliary cancer?

A

CA 19-9

31
Q

What is the MAIN treatment of a pancreatic carcinoma?

A

Palliation (stenting, analgesia)

32
Q

If a patient has an extrahepatic cholestasis/obstructive jaundice and weight loss, what should be suspected?

A

pancreatico-biliary malignancy

33
Q

The liver has a central role in drug metabolism. What are conjugation enzymes?

A

the liver takes insoluble compounds and stick it to something to make it soluble (so that it can be excreted)

34
Q

What are the 2 types of drug-induced liver injury? Explain them

A

Type 1: predictable, dose-related injury

Type 2: not dose-related; hypersensitivity rxn or metabolic defect

35
Q

Give an example of a type 2 drug-induced liver injury

A

Halothane

- causes acute hepatic necrosis on repeat exposure in sensitized individuals

36
Q

What is halothane and what does it cause?

A
  • causes type 2 drug-induced liver injury

- causes acute hepatic necrosis on repeat exposure in sensitized individuals

37
Q

List some of the possible consequences of drug induced liver injury [6]

A
  • hepatocellular injury
  • acute liver failure
  • chronic hepatitis
  • cholestatic reactions
  • fatty change/steatohepatitis
  • fibrosis
38
Q

List some of the drugs that may cause hepatocellular drug-induced liver injury

A
  • antibiotics
  • NSAIDs
  • statins
  • anti-epileptics
  • isoniazid
39
Q

List 2 drugs that may cause chronic hepatitis

A
  • methyldopa

- nitrofurantoin

40
Q

List 3 drugs that may cause cholestatic reactions (drug-induced liver injury)

A
  • erythromycin
  • chlorpromazine
  • augmentin
41
Q

List 1 drug that may lead to fatty change in the liver/steatohepatitis

A

amiodarone

42
Q

List 1 drug that may cause fibrosis in the liver

A

methotrexate

43
Q

Lower doses of paracetamol can be toxic if the patient has…

A

glutathione depletion (e.g. fasting, alcohol, anti-convulsants)

44
Q

NAPQI is a toxic by-product of the metabolism of paracetamol. How is it gotten rid of?

A

rendered inactive by -SH portion of glutathione (which is stored in hepatocytes)

45
Q

If NAPQI accumulates due to overdose of paracetamol, where would acute liver necrosis occur in the liver?

A

in zone 3 - closest to central vein

46
Q

What are the 2 possible treatment for paracetamol toxicity?

A

if < 2 hours = oral activated charcoal

if up to 8-10 hours: N-Acetylcysteine effective

47
Q

What is N-Acetylcysteine and what is it used to treat?

A
  • treats paracetamol toxicity up to 8-10 hours
  • is an -SH group donor
  • replenishes glutathione stores (reduces NAPQI)
48
Q

What is another name for acetaminophen?

A

paracetamol

49
Q

List some of the causes of acute liver failure

A
  • drugs (paracetamol, anticonvulsants, isoniazid, rare antibiotics, rare NSAIDs)
  • acute hepatitis A or E
  • mushroom poisoning
  • Budd-Chiari Syndrome
  • Wilson’s Syndrome
  • pregnancy-associated
50
Q

What is biliary atresia and what may be required to treat this condition?

A
  • congenital condition
  • occurs when the bile ducts inside or outside the liver do not develop normally
  • so there is a blockage in the ducts

Liver Transplant may be required

51
Q

List some of the indications of an orthotopic liver transplant

A
  • decompensated cirrhosis
  • acute liver failure
  • biliary atresia (in childhood)
  • metabolic disorders (in childhood)

GIHEP (24 decks)

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