Liver Tumours and Biliary Flashcards Preview

Clinical Pathology > Liver Tumours and Biliary > Flashcards

Flashcards in Liver Tumours and Biliary Deck (43):
1

4 reasons you can die from cirrhosis

Bleeding varices
Liver cell failure
Infection
Hepatocellular carcinoma

2

Risk factors for hepatocellular carcinoma

Cirrhosis
Male
Obesity
Alcohol

3

Cause of malignant tumour in non-cirrhotic patients

Metastatis

4

Cause of malignant tumour in cirrhotic patients

70% hepatocellular carinoma

5

Clinical features of hepatocellular carinoma

Worsening liver function
Weight loss

6

Treatment for cirrhosis

Surveillance- 6 month ultrasound scan

7

Blood test for hepatocellular carcinoma

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

8

Macroscopic structure of HCC

Expansile soft nodules, often green (bile)

9

What other hepatic vessels are affected by HCC?

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

10

Is HCC usually unifocal or multifocal in cirrhosis?

Multifocal

11

Microscopic structure of HCC

Cancer cells may produce bile

12

Prognosis of HCC

Very poor (

13

Treatment for HCC

Surgery- if non cirrhotic or small and peripheral
Transplant

14

In what circumstances would you consider liver transplant with HCC

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

15

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

Ablation-radiofrequency
Embolisation
Chemotheraphy-sorafenib

16

Solitary tumour without vascular invasion

pT1

17

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

PT2

18

Multiple tumours, any more than 5cm

PT3a

19

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

pT3b

20

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

pT4

21

What is more common, primary or secondary liver cancer?

Secondary (more common that tumour metastasise to the liver)

22

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

Large bowel

23

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

Surgery

24

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

Lung, pancreas, breast, stomach, melanoma

25

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

Biopsy to decide best treatment

26

Primary liver cancer (adenocarcinoma)

Cholangiocarcinoma

27

2 sites of cholangiocarcinoma

Intrahepatic
Perihilar

28

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

Intrahepatic
Peripheral
Late
None or cirrhosis

29

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

Perihilar
Bile duct disease
Primary sclerosing cholangitis
Liver flukes

30

How much bile is excreted by the liver each day?

0.5-1 litre

31

Where is bile concentrated?

In the gall bladder

32

Constituents of bile

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

33

What occurs when bile constituents precipitate

Gall stones

34

How common are gallstones

10-20% in adults

35

Risk factors for gall stones

Female
Obesity
Diabetes
All results in imbalance of bile constituents

36

5 main types of gallstones

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

37

When might you get pigment stones

Haemolytic anaemia

38

Complications of gallstones

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

39

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

Gallstone ileus

40

Indications for cholecystectomy

Pain
Gallstones
Pancreatitis
Gall bladder polyp

41

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

Acute Cholecystitis

42

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

Chronic cholecystitis

43

Macroscopic display of chronic cholecystitis

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