Liver Tumours + Benign + Genetic Disease Flashcards
(42 cards)
What is most common tumour in liver
Metastases from lung breast/ GI
Primary = cholangiocarcinoma / HCC
Hepatoblastoma / sarcoma = very rare
What are symptoms of liver mets
Fever Weight loss RUQ pain due to stretch Jaundice late except cholangiocarcinoma Hepatomegaly CLD signs inc decompensation Intraperitoneal haemorrhage if rupture
How do you investigate mets
FBC, LFT, hepatitis serology, AFP USS or CT MRI to distinguish benign / malignanct ERCP for cholangiocarcinoma Liver biopsy Find primary
How do you treat mets
Chemo
Resection
Radiofrequency ablation
Prognosis <6 months
What is carcinoid syndrome
Release of serotonin due to lung or liver mets (from GI)
What are symptoms of carcinoid syndrome
Abdo pain FLushing Palpitations DIarrhoea - proceeds Dx by 2 years Bronchospasm / wheeze Hypotension
Other effects
R valve stenosis and triscupid insufficiency
ACTH / GnRH = CUshing’s
What is the Ddx for carcinoid
Phaeochromocytoma
How do you Dx and treat carcinoid
Urinary 5-HIAA Somatostatin analogue (octeoride)
What causes HCC
Cirrhosis - secondary to any cause
HBV or HCV= most common
What are the symptoms of HCC
Cirrhosis + mass on screening Fatigue Anorexia Weight loss RUQ pain Jaundice Ascites HSM Pruritus Haemorrhage Decompensated CKD
How do you Dx HCC
AFP + USS for surveillance if cirrhotic
CT / MRI
AVOID biopsy as risk of seeding
Examine testis as AFP raised in testicular tumour
How do you treat
Resection or transplant
Radiofrequency ablation
Chemo or RT as palliative - generally resistance
What is Wilson’s disease
Excess deposition of copper in the liver
Autosomal recessive
Onset usually between 10-25 where as Haemochromatosis is older
What are symptoms in children
LIver hepatitis / cirrhosis / failure
How do adults with Wilsons present
CNS Signs Basal ganglia degeneration Dysarthria Dysphagia Dystonia Dementia Parkinsonism - tremor, Brady, rigid Ataxia Speech and behaviour Chorea - jerky + myoclonus
Psych
- Depression / psychosis / mania
Hepatic
- Cirrhosis
- Astrexia - liver flap
Other Dark ring round eyes due to copper Blue nails Decreased libido Fatigue Renal tubular acidosis Haemolystic anaemia Osteopenia
How do you Dx Wilson
Serum cereoplasmin = 1st line = decreased (carries copper in the blood) as all in liver
Serum copper = decreased
Urine copper excretion increased
Biopsy = gold standard
LFT
Genetic test to confirm
How do you treat Wilson’s
DIet
Penicillamine - chelator= 1st line
Liver transplant
What is most common liver disease in children
Anti-trypsin deficiency
Leads to an excess of protease that attacks liver and lung
More likely to cause emphysema in adult
What are signs of A1 anti-trypsin deficiency
SOB due to emphysema
CIrrhosis
Cholestatic jaudnice
How do you Dx A1 and how is it inherited
Autosomal recessive A1AT level low = screening Genetic test Obstructive lung disease on spirometry Liver biopsy Dx pre-natal
How do you treat A1AT deficienct
Smoking cessation
Liver transplant if decompensate
Lung transplat
Monitor for complications
What is haemochromotosis
AR
Increased iron absorption whcih deposited in joints / liver / heart / pancreas / pituitary / adrenal and skin
What are symtpoms
Fatigue Arthralgia - X-ray shows chondrocalcinosis Decreased libido and erectile dysfunction Bronzed skin Type 2 DM Hypogonadism Amenorrhoea Cognitive - mood / memory CLD / hepatomegaly / cirrhosis / HCC Dilated cardiomyopathy -> IHD Hypothyroid if deposited there Pseudogout Diabetes insidious
What are the reversible symptoms
Cardiomyopathy
Skin - pigmentation
