GI - Pathology (Liver Part II: Cancer & other conditions) Flashcards
Pg. 362-363 in First Aid 2014 Sections include: -Hepatocellular carcinoma/Hepatoma -Other liver tumors -Budd-Chiari syndrome -alpha1-antitrypsin deficiency -Physiologic neonatal jaundice
What is the most common primary malignant tumor of the liver in adults? What is another name for it?
Hepatocellular carcinoma/hepatoma
What are 6 conditions/factors associated with hepatocellular carcinoma/hepatoma?
Associated with (1) hepatitis B and C, (2) Wilson disease, (3) hemochromatosis, (4) alpha1-antitrypsin deficiency, (5) alcoholic cirrhosis, and (6) carcinogens (e.g., aflatoxin from Aspergillus)
To what complication may hepatocellular carcinoma/hematoma lead?
May lead to Budd-Chiari syndrome
What are 4 historical/physical exam findings associated with hepatocellular carcinoma/hepatoma?
Findings: (1) jaundice (2) tender hepatomegaly (3) ascites (4) anorexia
How does hepatocellular carcinoma/hepatoma spread?
Spreads hematogenously
How is hepatocellular carcinoma/hepatoma diagnosed?
Diagnosis: High alpha-fetoprotein; ultrasound or contrast CT
Besides hepatocellular carcinoma, what are 3 other liver tumors?
(1) Cavernous hemangioma (2) Hepatic adenoma (3) Angiosarcoma
Is cavernous hemangioma of the liver common or rare? Is it benign or malignant? Also, at what patient age range does it typically occur?
Common, benign liver tumor; typically occurs at age 30-50 years
What is important to note about diagnostic methods in cavernous hemangioma, and why?
Biopsy contraindicated because of risk of hemorrhage
Is hepatic adenoma common or rare? Is it benign or malignant? To what factor/condition(s) is it often related?
Rare, benign liver tumor, often related to oral contraceptive or anabolic steroid use
What are 2 possible outcomes of hepatic adenoma?
May regress spontaneously or rupture (abdominal pain and shock)
Is angiosarcoma of the liver benign or malignant? What is its origin?
Malignant tumor of endothelial origin
With what 2 exposures is angiosarcoma of the liver associated?
Associated with exposure to arsenic, vinyl chloride
In general, what causes nutmeg liver? Give 2 clinical contexts in which this may occur?
Due to back up of blood into liver. Commonly caused by right-sided heart failure and Budd-Chiari syndrome.
Briefly describe the appearance of nutmeg liver.
The liver appears mottled like a nutmeg
What complication can result from persistence of nutmeg liver, and how does it occur?
If the condition persists, centrilobular congestion and necrosis can result in cardiac cirrhosis
What defines Budd-Chiari syndrome? In what condition does it result, and what are 4 symptoms of that condition?
Occlusion of IV or hepatic veins with centrilobular congestion and necrosis, leading to congestive liver disease (hepatomegaly, ascites, abdominal pain, and eventual liver failure).
What visible physical findings (positive or negative) may patients with Budd-Chiari develop?
May develop varices and have visible abdominal and back veins. Absence of JVD.
What are 4 conditions with which budd-chiari syndrome is associated?
Associated with (1) hypercoagulable states, (2) polycythemia vera, (3) pregnancy, and (4) HCC
What is the pathophysiology of alpha1-antitrypsin deficiency in the liver? What classing clinical finding does this cause?
Misfolded gene product protein aggregates in hepatocellular ER => cirrhosis with PAS (+) globules in liver
What is the mode of inheritance of alpha1-antitrypsin deficiency?
Codominant trait
What effects does alpha1-antitrypsin deficiency have in the lungs?
In lungs, decreased alpha1-antitrypsin => uninhibited elastase in alveoli => decreased elastic tissue => panacinar emphysema