Liver Tumours and Biliary

Question 1

4 reasons you can die from cirrhosis

Answer 1

Bleeding varices
Liver cell failure
Infection
Hepatocellular carcinoma

Question 2

Risk factors for hepatocellular carcinoma

Answer 2

Cirrhosis
Male
Obesity
Alcohol

Question 3

Cause of malignant tumour in non-cirrhotic patients

Answer 3

Metastatis

Question 4

Cause of malignant tumour in cirrhotic patients

Answer 4

70% hepatocellular carinoma

Question 5

Clinical features of hepatocellular carinoma

Answer 5

Worsening liver function

Weight loss

Question 6

Treatment for cirrhosis

Answer 6

Surveillance- 6 month ultrasound scan

Question 7

Blood test for hepatocellular carcinoma

Answer 7

Alpha feto-protein (liver cells often synthesise this) Although by the point this is detected, usually too poor a prognosis for surgical treatement

Question 8

Macroscopic structure of HCC

Answer 8

Expansile soft nodules, often green (bile)

Question 9

What other hepatic vessels are affected by HCC?

Answer 9

Portal vein 60%
Hepatic vein 20%
Bile duct 5%

Question 10

Is HCC usually unifocal or multifocal in cirrhosis?

Answer 10

Multifocal

Question 11

Microscopic structure of HCC

Answer 11

Cancer cells may produce bile

Question 12

Prognosis of HCC

Answer 12

Very poor (

Question 13

Treatment for HCC

Answer 13

Surgery- if non cirrhotic or small and peripheral

Transplant

Question 14

In what circumstances would you consider liver transplant with HCC

Answer 14

If tumour is smaller than 5cm or 3 or less tumours smaller than 3cm

Question 15

Treatment for non-resectable tumours e.g. multiple, large, metastasised

Answer 15

Ablation-radiofrequency
Embolisation
Chemotheraphy-sorafenib

Question 16

Solitary tumour without vascular invasion

Answer 16

pT1

Question 17

Solitary tumour with vascular invasion or multiple tumours, none more than 5 cm in greatest dimension

Answer 17

PT2

Question 18

Multiple tumours, any more than 5cm

Answer 18

PT3a

Question 19

Single or multiple tumours of any size involving a major branch of the portal vein or hepatic vein.

Answer 19

pT3b

Question 20

Tumour(s) with direct invasion of adjacent organs other than the gall bladder or with perforation of visceral peritoneum

Answer 20

pT4

Question 21

What is more common, primary or secondary liver cancer?

Answer 21

Secondary (more common that tumour metastasise to the liver)

Question 22

Where might a tumour have metastasised from if it presents in the liver with few large nodules?

Answer 22

Large bowel

Question 23

Treatment for tumours in the liver than have metastasised from the large bowel

Answer 23

Surgery

Question 24

Where might tumours in the liver that are multinodular or infiltrative, come from?

Answer 24

Lung, pancreas, breast, stomach, melanoma

Question 25

Treament for secondary metastases to the liver which present as multinodular or infiltrative?

Answer 25

Biopsy to decide best treatment

Question 26

Primary liver cancer (adenocarcinoma)

Answer 26

Cholangiocarcinoma

Question 27

2 sites of cholangiocarcinoma

Answer 27

Intrahepatic | Perihilar

Question 28

Cholangiocarcinoma from small intrahepatic ducts, where are they found, when do they present and what are the risk factors?

Answer 28

Intrahepatic Peripheral Late None or cirrhosis

Question 29

Cholangiocarcinoma from large ducts, causing obstructive jaundice early, risk factors

Answer 29

Perihilar Bile duct disease Primary sclerosing cholangitis Liver flukes

Question 30

How much bile is excreted by the liver each day?

Answer 30

0.5-1 litre

Question 31

Where is bile concentrated?

Answer 31

In the gall bladder

Question 32

Constituents of bile

Answer 32

Bile salts, phospholipids, cholesterol, bilirubin and calcium salts +mucin from peribiliary glands

Question 33

What occurs when bile constituents precipitate

Answer 33

Gall stones

Question 34

How common are gallstones

Answer 34

10-20% in adults

Question 35

Risk factors for gall stones

Answer 35

Female Obesity Diabetes All results in imbalance of bile constituents

Question 36

5 main types of gallstones

Answer 36

Cholesterole stones Pigment stones Mixed stones 10% contain calcium-visible on Xray

Question 37

When might you get pigment stones

Answer 37

Haemolytic anaemia

Question 38

Complications of gallstones

Answer 38

``` Cholecystitis Mucocele Predisposed to carcinoma of the gallbladder Biliary colic and jaundice Cholangitis and liver abscesses Gasstone ileus Pancreatitis ```

Question 39

intestinal obstruction by a gallstone that has entered the gut through a fistulous connection with the gallbladder

Answer 39

Gallstone ileus

Question 40

Indications for cholecystectomy

Answer 40

Pain Gallstones Pancreatitis Gall bladder polyp

Question 41

– duct blocked by stone, Initially sterile, later infected. Large, swollen, congested, ulcerated. Complications – empyema, rupture

Answer 41

Acute Cholecystitis

Question 42

usually gall stones small, fibrotic, stones, Fibrosis, Rokitansky Aschoff sinuses

Answer 42

Chronic cholecystitis

Question 43

Macroscopic display of chronic cholecystitis

Answer 43

Fibrosis and inflammation usually gall stones small, fibrotic, stones, Fibrosis, Rokitansky Aschoff sinuses