Diseases of the Hepatobiliary System 2 Flashcards
Cirrhosis is a major risk factor for what cancer?
hepatocellular carcinoma
Is hepatocellular carcinoma (HCC) more common in males or females?
males
Why is the incidence of HCC thought to be rising in the UK?
Obesity and alcohol
HCC can show geographical variantion based on the prevelance of which infection?
Viral hepatitis
what are the 2 clinical features of HCC, when in the disease course do they arise?
Worsening liver function
Weight loss
What are the 2 possible surveillance methods for patients with cirrhosis?
1) 6 monthly USS
2) Blood test possibly - raised alpha feto-protein in serum in 75% (less than 50% in non cirrhotic patients and small HCC less than 3cm)
What is the macroscopic appearance in HCC, is there just one lesion?
Expansile soft nodule which are often green (bile), this is often multifocal in cirrhosis
Well differentiated HCC is likely to produce what?
Bile
What are the 2 main differential diagnosis in liver biopsy investigation when unclear diagnosis?
1) benign liver v well differentiated HCC
2) Metastatic carcinoma v poorly differentiated HCC
What is the prognosis of HCC?
very poor (less than 1 year) unless diagnosed early - hence surveillance of cirrhosis is v important
What are the 2 treatments for confined HCC?
1) surgery is non cirrhotic, small and peripheral
2) Transplant is 1 tumour less than 5 cm or less than 3 less than 3cm
What is the 3 treatment options for non resectable (multiple, large, metastasised) HCC?
1) Ablation - radiofrequency
2) Embolisation
3) Chemo - sorafenib
What is considered diagnosis HCC early in terms of TMN staging?
pT1 (solitary tumour, no vascular invasion) and pT2 (solitary tumour with vascular invasion or multiple tumours, none more than 5cm in greatest diameter)
What is more common, primary liver cancer or metastasis to liver?
Metastasis to liver
What metastasis results in few large nodules in liver?
Large bowel
What 5 metasases result in multinodular or infiltrative?
1) Lung
2) Pancreas
3) Breast
4) Stomach
5) Melanoma
In addition to HCC what is the other primary liver cancer?
Cholangiocarcinoma - and adenocarcinoma arising in the bile ducts
What are the 2 classifications of cholangiocarcinoma?
1) intrahepatic - from small intrahepatic ducts
2) perihilar - from large ducts
Does intrahepatic cholangiocarcinoma present early or later?
Later - is it mass forming
What is the 1 risk factor for intrahepatic cholangiocarcinoma?
Cirrhosis
Does perihilar cholangiocarcinoma present early or late?
Early as it causes obstructive jaundice early
What are the 2 risk factors for perihilar cholangiocarcinoma?
Bile duct disease:
1) Primary sclerosing cholangitis
2) Liver flukes
What are gall stones caused by?
Precipitation of the constituents of bile when it is concentrated in the gall bladder
What is the prevelance of gall stones amongst UK adults?
10-20%
What are the 3 risk factors for gall stones?
1) Female
2) Obesity
3) Diabetes
ie an imbalance of bile constituents
What are the 4 main types of gall stones?
1) Cholesterol stones - yellow/opaque
2) Pigments stones - small, black - in haemolytic anaemia
3) Mixed stones - most comon
4) 10% contain calcium - visible on plain x ray
Gallstones predispose to what cancer?
Cancer of the gall bladder
Give the 3 inflammatory complications of gall stones?
1) Cholecystitis (inflammation of gall bladder)
2) Pancreatitis
3) Cholangitis (inflammation of bile duct)
Why do gall stones lead to biliary colic and jaundice?
Due to obstruction of the bile system
Gall stones can cause mucocele, what does this refer to?
Mucous retention cyst in the gall bladder
Why can gall stones lead to cholangitis and liver abscesses?
Due to infection of the static bile
How can gall stones lead to gall stone ileus?
Due to intestinal obstruction by a gall stone that has entered the gut through a fistulous connection with bladder
How common is cholecystectyomy?
1200 per year in leeds
What are the 4 indications for cholecystectomy?
1) Pain
2) gall stones
3) Pancreatitis
4) Gall stone polyp - rarely
What is acute cholecystisis caused by?
Duct blocked by a stone, initially sterile then becomes infected
What are the 2 complications of acute cholecystitis?
1) Empyema
2) Rupture
What is the cause of chronic cholecystitis?
Usually caused by small fibrotic stones
How do the macroscopic appearances of acute and chronic cholecystitis differ?
Acute - large, swollen, congested, ulcerated
Chronic - fibrosis, rokitansky aschoff sinuses
Why are all removed gall bladders examined histologically?
To detect bladder cancer
What percentage of gall bladder cancers are known about before surgery?
50%, the other 50% found in routine cholecystectomy
What is the associated pre malignant lesion in gall bladder cancer?
Polyp showing dysplasia
