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GIHEP > 10. Liver, Pancreas and Biliary Tract > Flashcards

10. Liver, Pancreas and Biliary Tract Flashcards

1
Q

What are the primary benign liver tumours?

A

Hepatic adenoma
Bile duct adenoma
Haemangioma

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2
Q

What are the primary malignant liver tumours?

A

Hepatocellular carcinoma
Intrahepatic cholangiocarcinoma
Haemangiosarcoma

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3
Q

What are the most common secondary tumours in the liver?

A

Breast
Lung
GIT
Lymphoma and leukaemia

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4
Q

Where is hepatocellular carcinoma most common?

A

Southeast Asia and Africa where there are high rates of chronic hepatitis

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5
Q

How is a hepatocellular carcinoma diagnosed?

A

Ultrasound, CT and MRI
Assess nodules >1 cm in patients with cirrhosis
AFP tumour marker

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6
Q

How is hepatocellular carcinoma treated?

A

Resection if early
Transplant
Local ablative treatments; radiofrequency or arterial chemo-embolisation

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7
Q

What is the aetiology of hepatocellular carcinoma?

A

Cirrhosis and hepatitis

Aflatoxins; fungal contaminants of food sources

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8
Q

What is a cholangiocarcinoma?

A

Adenocarcinoma arising from bile duct epithelium

Most commonly found at hilum of liver

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9
Q

What is a Klatskin tumour?

A

Cholangiocarcinoma that obstructs the bifurcation of the common bile duct

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10
Q

What disease is cholangiocarcinoma associated with?

A

Primary sclerosing cholangitis

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11
Q

What is the treatment for cholangiocarcinoma?

A

Surgical resection

Palliatively a stent to hold duct open

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12
Q

Who is most likely to get a gall bladder adenocarcinoma?

A

Older females with long standing gall stones

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13
Q

What is a tumour of the exocrine pancreas known as?

A

Pancreatic adenocarcinoma

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14
Q

What are tumours of the endocrine pancreas associated with?

A

Inherited multiple endocrine neoplasia syndrome type 1

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15
Q

Which patient group is most likely to get pancreatic carcinomas?

A

Older men

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16
Q

Where do pancreatic carcinomas spread to?

A 
Peritoneum
Duodenum
Common bile duct
Lymph nodes
Liver
17
Q

What symptoms are associated with pancreatic carcinomas?

A

Painless obstructive jaundice and weight loss

Abdominal pain radiating to the back

18
Q

How is a diagnosis of pancreatic carcinoma made?

A

CA19-9 serum marker
Imaging
FNA cytology

19
Q

What is the treatment of pancreatic carcinomas?

A

Mostly palliative as disease is aggressive; stenting and analgesia
Whipple’s procedure
Chemo

20
Q

What is the difference between type 1 and 2 drug induced liver injury?

A
  1. dose dependent and predictable

2. not dose related, hypersensitivity

21
Q

Give an example of drug hypersensitivity related liver damage

A

Halothane

22
Q

Which drugs can cause hepatocellular damage?

A 
Antibiotics
NSAIDs
Statins
Anti-epileptics
Isoniazid
23
Q

Which drugs cause chronic hepatitis?

A

Methyldopa

Nitrofuratoin

24
Q

Which drugs cause cholestatic reactions?

A

Erythromycin
Co-amoxiclav
OCP

25
Q

What drug is associated with steatohepatitis?

A

Amiodarone

26
Q

What drug is associated with fibrosis?

A

Methotrexate

27
Q

What conditions increase the toxicity of paracetemol?

A

Glutathione depleted in malnutrition

Enzymes being used elsewhere; alcohol and anticonvulsants

28
Q

What happens to the liver in a paracetemol overdose?

A

Conjugation is overwhelmed
Increase NAPQI
Causes acute liver necrosis

29
Q

What is the treatment for paracetemol overdose?

A

<2 hours activated charcoal prevents absorption

8-10 hours N-acetylcysteine increases glutathione

30
Q

What is acute liver failure?

A

Sudden severe liver injury in an otherwise healthy liver

31
Q

Differentiate between hyperacute, acute and subacute liver failure

A

Hyper: <1 week
Acute: 1-4 weeks
Subacute: 4-12 weeks

32
Q

What are the causes of acute liver failure?

A 
Drugs
Acute hepatitis A and E
Mushroom poisoning
Budd Chiari syndrome
Wilson's disease
Pregnancy
33
Q

What complications are associated with acute liver failure?

A 
Progressive hepatic encephalopathy and cerebral oedema
High risk of sepsis
Renal failure
Hypovolaemic shock
Jaundice
34
Q

What are the indications for liver transplant?

A

Decompensated cirrhosis
Acute liver failure
Childhood diseases

GIHEP (30 decks)

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