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Flashcards in Liver Lecture 3 Deck (17):
1

budd chiari syndrome

hepatic vein obstruction/ thrombosis
-hepatic ascites, abdominal pain and hepatic dysfunction
-centrilobular congestion

2

sinusoidal obstructive syndrome or veno-occlusive disease

***`1.bone marrow transplants
-first 3 weeks
-25% of recipients of allogeneic BMT
2. chemotherapy patients
3. drugs-azathioprine

-toxic injury to the sinusoidal endothelium with resulting fibrotic occlusion of small hepatic veins
*Classic triad: Acute RUQ tenderness, hepatomegaly, ascites, weight gain, and jaundice

Histology:
fibrous obliteration of central vein

3

Acute fatty liver of pregnancy

sudden catastrophic illness occurring exclusively in the 3rd trimester

Microvesicular fatty infiltration
-acute liver failure and encephalopathy
-significant perinatal and maternal mortality

4

Focal Nodular hyperplasia

-solitary
-central stellate scar
-20-40
-no malignant potential
-doesnt need to be removed?

5

Nodular regenerative hyperplasia

widespread transformation of the hepatic parenchyma into small regenerative nodule in the ABSENCE OF FIBROSIS
-partial or diffuse
-non cirrhotic portal hypertension
-associated with solid organ transplant, bone marrow transplant, vasculitis, and HIV

6

Hepatic adenoma

-young women
-associated with hormones and oral contraceptives
-usually solitary lesion
-cord of normal hepatocytes with absent portal tracts
-prominent solitary arterial vessels

-risk of:
rupture, transform to hepatocellular carcinoma,
-resection indicated if >5cm as risk of malignant
transformation increases

associated with rare metabolic disorder and glycogen diseases

7

Hemangioma

-most common benign tumor
-discrete red-blue nodules
-microscopically: benign vascular changes and fibrotic tissue

8

Angiosarcoma

most common primary sarcoma of liver
-malignant vascular tumor
-associated with exposure to vinyl chloride, arsenic

lots of nuclei and deformed vessels

9

HEpatoblastoma

-most common malignant liver tumor of CHILDHOOD
-male>female
-RUQ mass found on physical exam
-elevated alpha fetoprotein (AFP)
-primary hepatocellular malignancy
epithelial type: fetal and embryonal hepatocytes
mixed epithelial and mesenchymal: fetal and embryonal hepatocytes with foci of mesenchymal differentiation

10

Hepatocellular carcinoma

third most common cancer death
-incidence rising due to HCV endemic
-vague symptoms
-95% occur in patients with cirrhosis
-HCC can occur independent of cirrhosis in hepB
-50% elevated AFP

Treatment:
surgery
radiofrequency ablation
transarterial chemoembolization
(TACE)
radioembolization
liver transplant

11

What can cause hepatocellular carcinoma?

1.Cirhosis:
NASH
Alcohol
Hep C-repeated cycles on cell death and regeneration
Hemochromatosis
2. chronic hep b-integration of viral dna
3. aflatoxin
4. hereditary tyrosinemia (highest risk-40%)

12

How does hepatocellular carcinoma look grossly and microscopically?

gross
-single lesion
-multifocal
-diffusely infiltrative

microscopically
-trabecular, acinar/pseudoglandular and undifferentiated
-bile production
-well different (resembling hepatocytes) to poorly differentiated forms

13

Fibrolamellar variant of HCC

younger person
-not associated with cirrhosis or HBV
-characterized by areas of dense collagenous fibrosis and large polygonal tumor cells
-thought to have better prognosis

14

Cholangiocarcinoma

malignancy of bile ducts
10% intrahepatic
extrahepatic arising from bile ducts outside the liver
-perihilar (50-60%)
-distal bile duct (20-30%)
-periampullary

15

What are the risk factors for cholangiocarcinoma?

1. primary sclerosing cholangitis
2. congenital fibropolycystic disease of the biliary system
-caroli's disease
3 cirrhosis
4. exposure to thorotrast
5. liver fluke: opisthorchis sinensis

16

What are the clinical findings of cholangiocarcinoma intrahepatic and extrahepatic?

Intrahepatic
-not detectable until late; massive lesion of tree like tumor along the portal system
-bile flow obstruction

adenocarcinoma
dense fibrous stroma
sometimes combined with HCC


Extrahepatic
-small lesion at the time of diagnosis
-biliary obstruction, cholangitis, RUQ pain
-obstructive jaundice

adenocarcinoma
special variant-klatskin tumor--->perihilar/hilar

17

metastatic to liver from where most commonly

Adult: breast, lung, colon, pancreas
Children: neuroblastoma, wilms tumor, rhabdomyosarcoma