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year 5 - GIT Internal medicine > heepatobillary malignancies > Flashcards

heepatobillary malignancies Flashcards

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1
Q

what are the malignant liver lesions ?

A

hepatocellular carcinoma
cholangiocarcinoma

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2
Q

what is one of the most important risk factors for HCC ?

A

cirrhosis

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3
Q

how can primary prevention of HCC be achieved ?

A

HBV vaccination

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4
Q

how can progression to cirrhosis and HCC be prevented ?

A

antiviral treatment in patients with chronic Hep BB
adoption of healthy lifestyle measure to reduce the incidence of NAFLD

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5
Q

what is the interval in which screening for HCC should be performed in high risk populations ?

A

every 6 months

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6
Q

how is a diagnosis of HCC madee ?

A

in cirrhotic patients it should be based on non invasive criteria with no need for histopathology

in non cirrhotic patients diagnosis should be confirmed by biopsy

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7
Q

what are the non invasive criteria that should be used for diagnosis of HCC in cirrhotic patients ?

A

multiphasic CT
MRI
contrast enhanced US

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8
Q

what is seen in multiphasic CT of HCC ?

A

there are 4 phases associated -

non enhanced
arterial - hyperenhancement of the lesion
portal venous - washout of the lesion
equilibrium

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9
Q

what staging system is used for HCC in cirrhotic liver ?

A

BCLC

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10
Q

what does the BCLC system show ?

A

very early stage - single nodule less than 2 cm
early - single or multiple / 2-3 cm nodules
intermediate - multinodular/ unresectable
advanced - portal invasion, extrahepatic spread
Terminal - non transplantable HCC

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11
Q

what iis the management for each stage in the BCLC ?

A

1 - ablation or resection
2- if solitary nodule then resect , can’t resect transplant , if multiple nodules transplant, if can’t transplant perform ablation
3- chemoembolization
4- systemic therapy
5- best supportive care

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12
Q

what is cholangiocarcinoma divided into ?

A

intrahepatic and extrahepatic

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13
Q

why is the survival rate low for cholangiocarcinoma ?

A

because the diagnosis is usually made at an advanced stage

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14
Q

what are the risk factors for cholangiocarcinoma ?

A

primary sclerosing cholangitis
smoking and alcohol
older agee
liver fluke infestation
caroli’s disease
choledochal cyst
bile duct adenoma
chronic intrahepatic stones
chemical agents ( vinyl chloride)
cirrhosis

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15
Q

which serum marker can be used to identify ICCA ?

A

Ca 19-9

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16
Q

what are the associated findings of CCA ?

A

hepatic capsular retraction
vascular encasement
dilatation of the peripheral ducts

17
Q

what is the standard therapy for unresectable CCA ?

A

combination chemotherapy with gemcitabine plus cisplatin

18
Q

what is the most common benign primary lesion of the liver ?

A

cavernous hemangioma

19
Q

what age and gender are hepatocellular adenomas common in ?

A

younger women especially those taking OCPs

20
Q

what are the key features of cavernous hepatic hemangiomas ?

A

patient with a normal healthy liver, a hyperechoic lesion is very likely to be a liver hemangioma

in multiphasic CT - It shows nodular peripheral enhancement followed by central enhancement in delayed phases and tending to homogenization in the equilibrium phase

21
Q

what is a common misconception about hepatic hemangioma ?

A

OCPs and pregnancy are a contraindication
they are not

22
Q

what is the management for hepatic hemangioma ?

A

conservative management

23
Q

what is the gold standard for the diagnosis of focal nodular hyperplasia ?

A

MRI - to visualize the central scar

24
Q

what is the management for focal nodular hyperplasia ?

A

conservative

25
Q

what is the association of sex hormones and hepatocellular adenoma ?

A

associated with prolonged OCP use in women
and associated with androgenic steroids in men

26
Q

why must hepatocellular adenomas be watched more carefully out of all the benign lesions ?

A

carry a significant risk of haemorrhage and malignant transformation

27
Q

why is there an increasing prevalence of hepatocellular adenoma ?

A

associated with rising prevalence of obesity and metabolic syndrome

28
Q

how is HCA diagnosed ?

A

MRI and liver biopsy

29
Q

what type of mutation is associated with a higher risk of malignant transformation in HCA ?

A

beta catenin

30
Q

what is thee most appropriate management for HCA ?

A

1- discontinue OCPs and advisee to lose weight
2- resection irrespective of size is recommended in men and patient with beta cateeniin mutation
3- resection is also indicated wiith lesions larger than 5 cm

31
Q

what is the best route of management for a bleeding HCA with haemodynamic instability ?

A

embolizattionn

32
Q

when should reassessment of lesions less than 5 cm occur ?

A

at 1 year with annual imaging

year 5 - GIT Internal medicine (25 decks)

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