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GI 4 > Biliary tumors > Flashcards

Biliary tumors Flashcards

1
Q

demographics of gallbladder cancer

A
  • 3X more common in women
  • more common in people over 65, whites
  • most common GI malignancy in native americans
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2
Q

etiology of gallbladder cancer

A
  • gallbladder disease (especially if >40)
  • calcification of GB
  • usually associated with cholesterol stones
  • Salmonella typhi carriage increases risk
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3
Q

gastric surgery and cancers

A
  • gastric surgery INCREASES risk of gallbladder cancer after 20 years
  • gastric surgery DOES NOT INCREAsE the risk of bile duct cancer
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4
Q

most common benign tumor of gallbladder

A
  • adenoma
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5
Q

most common malignant tumor of gallbladder

A
  • adenocarcinoma
  • lymphatic, neural, vascular spread due to lack of well-defined muscularis
  • direct extension to liver, bile duct, colon, duodenum
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6
Q

location of gallbladder cancer

A
  • 60% in fundus
  • 30% in body
  • 10% in neck
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7
Q

Krukenberg tumor

A
  • adenocarcinoma that starts in the stomach or gallbladder and spreads to the pelvis (intraperitoneal spread)
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8
Q

symptoms of gallbladder cancer

A
  • PAIN is the most common complaint
  • hepatomegaly
  • palpable mass
  • ascites
  • jaundice
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9
Q

diagnosis of gallbladder cancer

A
  • increased ALP and bilirubin
  • CEA and CA 19-9 may be elevated
  • US, CT, MRI
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10
Q

treatment of gallbladder cancer

A
  • 80% are unresectable

- chemo and radiation do not work

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11
Q

etiology of bile duct cancer

A
  • no association with cirrhosis
  • most intrahepatic cancers in China and Southeast Asia are from liver flukes
  • associated with PSC, CUC (10X)
  • occurs in younger age with CUC and without stones
  • occurs after 15 years of CUC
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12
Q

Klatskin tumor

A
  • cholangiocarcinoma at junction of left and right hepatic ducts
  • presents with PAINLESS jaundice
  • death from hepatic failure or cholangitis
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13
Q

clinical manifestations of bile duct cancer

A
  • N/V, anorexia, weight loss, rarely painful unless with stone, PAINLESS jaundice
  • increased ALP and bilirubin
  • often bilirubin > 12 - cancer until proven otherwise
  • best diagnosed with EUS
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14
Q

treatment of bile duct cancer

A
  • intrahepatic, Klatskin, or mild bile duct tumor - resection
  • distal bile duct - whipple procedure
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15
Q

pancreatic exocrine tumors

A
  • 95% are pancreatic ductal adenocarcinoma
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16
Q

pancreaticoblastoma

A
  • found in CHILDREN
17
Q

risk factors for pancreatic adenocarcinoma

A
  • 80% occur between 60-80
  • male and urban setting
  • if < 40, usually female
  • diabetes and chronic pancreatitis
  • 5X risk for hereditary pancreatitis
18
Q

most common pancreatic exocrine tumor

A
  • ductal cell mucin-producing adenocarcinoma
19
Q

symptoms of ductal adenocarcinoma

A
  • if its in the head - jaundice
  • if its behind the ampulla - pancreatic insufficiency and chronic obstructive pancreatitis
  • if its in the body/tail - severe back pain and weight loss
20
Q

clinical manifestations of pancreatic adenocarcinoma

A
  • ab pain
  • > 10% weight loss
  • worse when supine
21
Q

insulinoma

A
  • secretes excessive insulin thus causing hypoglycemia
  • 60% are women
  • headache, confusion, light-headedness, VISUAL SYMPTOMS, irrational behavior, DROWSINESS, coma
22
Q

insulinoma diagnosis

A
  • Hypoglycemia plus elevated insulin levels in patient with pancreatic mass
  • determined during 72 hour fast with close observation
  • insulin/glucose > 0.3 = insulinoma
  • tumor of BETA islet cell
23
Q

VIPoma

A
  • secretes vasoactive intestinal peptide

- AKA pancreatic cholera - fasting large volume diarrhea, hypokalemia, hypochlorohydria

24
Q

VIPoma diagnosis

A
  • diarrhea with increased serum VIP
25
Q

glucagonoma symptoms

A
  • secrete glucagon
  • dermatitis (necrolytic migratory erythema) - snake like rash on skin that is improved with amino acids
  • angular chelitis, glucose intolerance, anemia
  • nail dystrophy, thinning hair, weight loss
  • thromboemboli are common
  • tumor of the ALPHA islet cell
26
Q

somatostatinoma

A
  • can be in pancreas or intestine
  • somatostatin stops things from being secreted - gastric acid, insulin, CCK, etc.
  • 2X more common in females
  • intestinal tumors usually in men
  • somatostatin normally produced by D islet cells
27
Q

symptoms of somatostatinoma

A
  • mild DM, GB disease, weight loss, megaloblastic anemia, diarrhea, steatorrhea, hypochlorhydria
28
Q

GRFoma

A
  • causes acromegaly
  • tumor usually > 6 cm
  • associated with Zollinger-Ellison syndrome and MEN1
29
Q

GRFoma diagnosis

A
  • acromegaly
  • increased GH
  • pancreatic mass
30
Q

ampullary carcinoma

A
  • tumor of ampulla of Vater
  • presents with jaundice, iron deficiency, weight loss
  • treated with whipple procedure
31
Q

jaundice due to malignancy

A
  • tumor in the liver
  • malignant nodes in porta heptatis
  • Klatskin tumor
  • ampullary/pancreatic carcinoma
  • GB tumor

GI 4 (11 decks)

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