Flashcards in Quiz 5 Deck (54)
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1
what is the most common tumor of the liver?
hepatic hemangioma
2
what is the most frequent form of primary liver cancer?
hepatocellular carcinoma
sometimes referred to as hepatoma
3
the majority of cases of cancer found in the liver occurs as a consequence of what? how?
occurs as a consequence of metastasis from another tissue
primary site is the GI tract (colon cancer)
occurs also in cases of BC, ovarian cancer, lung cancer, renal cancer and prostate cancer
4
what term is used to describe a benign glandular tumor of the liver? what population do these occur in and what is the greatest risk? what is seen histologically?
hepatic adenoma
-tend to occur in women taking oral contraceptives
- though benign, have potential to rupture and cause intraperitoneal hemorrhage
- cells closely resemble normal hepatocytes, but neoplastic liver tissue is disorganized and does not contain normal lobular architecture LESS abundant cytoplasm, LESS eosinophilic
5
there are two main types of primary carcinoma of the liver, they are? which is most common and what are their locations?
hepatocellular carcinoma
- MOST COMMON
- arises from hepatocytes
- globally - most common hepatic tumor, Hep B is a common etiology or alcohol abuse leading to cirrhosis
cholangiocarcinoma
- arises from bile duct epithelium
6
what are the major risk factors for Hepatocellular carcinoma?
Alcoholism
Hep B - MOST COMMON WORLDWIDE
Hep C
- all of these lead to cirrhosis of the liver which increases risk for HCC
7
what would be elevated in hepatocellular carcinoma?
serum alpha-fetoprotein
may also obstruct biliary tract and lead to elevated serum alkaline phosphatase
8
what is seen microscopically in HepatoCellular Carcinoma?
can be either normal liver cell cords or pseudo-glandular formation
as tumor grows, presence of snake-like masses invading portal vein or IVC
9
What tumor markers are present in Cholangiocarcinoma, but not HCC? what form of cholangiocarcinoma is most common?
CA 19-9, CA-50
peripheral cholangiocarcinoma develops intralobular ducts in the liver - most common form of this tumor
(other form is hilar, less common)
10
what is of notable interest in hepatic angiosarcomas?
angiosarcomas of the liver are rare, but notable because of the association of occurrence after EXPOSURE TO ARSENIC (pesticides) and exposure to high levels of POLYVINYL CHLORIDE in plastics industry.
11
acquired biliary atresia occurs concomitantly with? one of the prinicipal forms of?
autoimmune disease
one of the principal forms of chronic rejection of a transplanted liver allograft
12
biliary atresia is also known as?
extrahepatic ductopenia
progressive obliterative cholangiopathy
13
biliary atresia has two forms, what are they and what is so important about each
congenital - babies are born with this with an occurrence rate of 1/10,000-1/15,000
acquired - generally occurs in the setting of autoimmune disorders, one of the principal forms of chronic rejection of a transplanted liver allograft
14
what type of cyst is most common with choledochal cysts?
Type I
represent 80-90%, consisting of saccular dilations of the common bile duct
15
if gallstone migrate into the ducts of the biliary tract - what is this called? what can this condition lead to?
choledocholithiasis
- can obstruct the biliary tree leading to acute infection - ascending cholangitis
If the gallstones exist in the ampulla of Vater - can obstruct exocrine glands of the pancreas causing pancreatitis
16
acute cholecystitis is more often caused by?
cholelithiasis (especially when the cystic duct is blocked)
17
what is it called when the gallbladder becomes inflamed in the absence of cholelithiasis and what increases a patient's risk of acquiring this infection?
acute acalculous cholecystitis
- can result from obstructing tumors or an inadequate blood supply, but more frequently seen in patients with
CAD, Trauma, Immunosuppression
18
infectious agents that cause cholecystitis are? what will be observed in laboratory work for these infections?
gram negatives (mostly)
- e. coli
- klebsiella
- pseduomonas
- b. fragilis
- enterococcus
lab tests frequently show increased AST, ALT and a high WBC count
19
what is seen histologically for acute cholecystitis?
extensive ulceration of the mucosa, hemorrhage, edema and dense transmural infiltrate of neutrophils and mononuclear inflammatory cells
20
Compare and contrast the 3 different types of cholelithiasis stones.
Choelsterol Stones (MOST COMMON), must be 80% cholesterol by weight, not visible radiographically
Pigment Stones
- small, dark stones made of bilirubin and calcium salts found in bile - contain less than 20% cholesterol, radiographically visible (depending on calcium content)
Mixed Stones
-contain 20-80% cholesterol, radiographically visible (depending on calcium content)
21
what is unique about cholesterol gallstones?
cholesterol gallstones may present as a single stone or as dozens of stones.
the have too much cholesterol and not enough bile to move.
REMEMBER - SINGLE STONE PRESENTATION!
22
what can contribute to gallstone formation in females?
increased levels of Estrogen (baby on board, hormone therapy, OCs)
- may increase cholesterol levels in the bile, while decreasing the movements of the gallbladder.
23
for cholesterolosis - where do the cholesterol and triglyceride filled macrophages deposit? what condition is this often associated with? what is this condition often referred to as?
lamina propria of the gallbladder
- often associated with chronic cholecystitis
- cholesterolosis with diffuse mucosal involvement is often referred to as a "strawberry gallbladder" where the mucosa tends to be red, flecked with numerous yellowish spots
24
In approximately 1/4-1/3 of chronic cholecystitis cases, what is found within the gallbladder?
bacteria can be cultured from fluids within the gallbladder
25
what is seen histologically for chronic cholecystitis?
lose of normal delicate papillary appearance
increase in fibrous tissue
mild chronic inflammation in the lamina propria
Rokitansky-Aschoff sinuses (pockets in the wall of the gallbladder) in the muscularis - seen occasionally in cholesterolosis
26
what is porcelain gallbladder?
inflammatory scarring of the gallbladder wall combined with calcification whiten the wall that transforms the gallbladder into a porcelain-like vessel (thought to be brought on by persistent inflammation)
27
acute cholangitis carries a significant risk of death, what is the leading cause? what precedes this condition in general? what causes acute cholangitis?
irreversible shock with multiple organ failure (a possible complication of severe infection)
gallstones are noted in 70-90% of cases
usually caused by bacteria ascending from the bile duct's junction with the duodenum
28
what is the difference between - pyema, empyema, abscess?
pyemia - type of septicemia that leads to widespread abscesses of a metastatic nature, usually caused by Staphyloccocus. Expect to see pus.
empyema - collection or gathering of pus within a naturally existing anatomical cavity
abscess - collection of pus that has built up within the tissue of a body, creating it's own cavity.
29
ascending cholangitis histologically can have..
onion skin-like concentric peri-ductal necrosis..
this is indistinguishable from the onion skin-like staining of PSC
30
