10. Liver, Pancreas and Biliary Tract Flashcards
What are the primary benign liver tumours?
Hepatic adenoma
Bile duct adenoma
Haemangioma
What are the primary malignant liver tumours?
Hepatocellular carcinoma
Intrahepatic cholangiocarcinoma
Haemangiosarcoma
What are the most common secondary tumours in the liver?
Breast
Lung
GIT
Lymphoma and leukaemia
Where is hepatocellular carcinoma most common?
Southeast Asia and Africa where there are high rates of chronic hepatitis
How is a hepatocellular carcinoma diagnosed?
Ultrasound, CT and MRI
Assess nodules >1 cm in patients with cirrhosis
AFP tumour marker
How is hepatocellular carcinoma treated?
Resection if early
Transplant
Local ablative treatments; radiofrequency or arterial chemo-embolisation
What is the aetiology of hepatocellular carcinoma?
Cirrhosis and hepatitis
Aflatoxins; fungal contaminants of food sources
What is a cholangiocarcinoma?
Adenocarcinoma arising from bile duct epithelium
Most commonly found at hilum of liver
What is a Klatskin tumour?
Cholangiocarcinoma that obstructs the bifurcation of the common bile duct
What disease is cholangiocarcinoma associated with?
Primary sclerosing cholangitis
What is the treatment for cholangiocarcinoma?
Surgical resection
Palliatively a stent to hold duct open
Who is most likely to get a gall bladder adenocarcinoma?
Older females with long standing gall stones
What is a tumour of the exocrine pancreas known as?
Pancreatic adenocarcinoma
What are tumours of the endocrine pancreas associated with?
Inherited multiple endocrine neoplasia syndrome type 1
Which patient group is most likely to get pancreatic carcinomas?
Older men
Where do pancreatic carcinomas spread to?
Peritoneum Duodenum Common bile duct Lymph nodes Liver
What symptoms are associated with pancreatic carcinomas?
Painless obstructive jaundice and weight loss
Abdominal pain radiating to the back
How is a diagnosis of pancreatic carcinoma made?
CA19-9 serum marker
Imaging
FNA cytology
What is the treatment of pancreatic carcinomas?
Mostly palliative as disease is aggressive; stenting and analgesia
Whipple’s procedure
Chemo
What is the difference between type 1 and 2 drug induced liver injury?
- dose dependent and predictable
2. not dose related, hypersensitivity
Give an example of drug hypersensitivity related liver damage
Halothane
Which drugs can cause hepatocellular damage?
Antibiotics NSAIDs Statins Anti-epileptics Isoniazid
Which drugs cause chronic hepatitis?
Methyldopa
Nitrofuratoin
Which drugs cause cholestatic reactions?
Erythromycin
Co-amoxiclav
OCP
What drug is associated with steatohepatitis?
Amiodarone
What drug is associated with fibrosis?
Methotrexate
What conditions increase the toxicity of paracetemol?
Glutathione depleted in malnutrition
Enzymes being used elsewhere; alcohol and anticonvulsants
What happens to the liver in a paracetemol overdose?
Conjugation is overwhelmed
Increase NAPQI
Causes acute liver necrosis
What is the treatment for paracetemol overdose?
<2 hours activated charcoal prevents absorption
8-10 hours N-acetylcysteine increases glutathione
What is acute liver failure?
Sudden severe liver injury in an otherwise healthy liver
Differentiate between hyperacute, acute and subacute liver failure
Hyper: <1 week
Acute: 1-4 weeks
Subacute: 4-12 weeks
What are the causes of acute liver failure?
Drugs Acute hepatitis A and E Mushroom poisoning Budd Chiari syndrome Wilson's disease Pregnancy
What complications are associated with acute liver failure?
Progressive hepatic encephalopathy and cerebral oedema High risk of sepsis Renal failure Hypovolaemic shock Jaundice
What are the indications for liver transplant?
Decompensated cirrhosis
Acute liver failure
Childhood diseases
