Hepatobiliary disease Flashcards
the liver is divided into how many segments?
8
the left and right liver lobes are divided by what vessel?
middle hepatic vein
what are the benign liver lesions?
FNH
simple cyst
hemangioma
adenoma
liver cell adenomas are associated with what medication?
oral contraceptives
oral contraceptives are associated with what type of liver lesion?
liver cell adenomas
what is the morphology of FNH?
nodular hyperplastic parenchyma with one or more macroscopic CENTRAL SCARS
how is FNH imaged?
arterial phase CT
what types of cells are involved in FNH?
hepatocytes
scar
biliary tracts
what is the most common benign tumor of the liver?
hemangioma
what is the morphology of hemangiomas?
endothelium lined, blood filled spaces
which hepatobiliary malignancies are intrahepatic?
primary hepatoma
bile duct
what are the HCC risk factors?
male aflatoxin hep B and C cirrhosis hemochromatosis wilsons disease a1AT deficiency NASH
what is the leading cause of cirrhosis?
alcohol abuse
what is the main diagnostic feature of primary hepatic CA?
increased alpha feto protein
is AFP used for screening?
no
what are the challenges of liver surgery?
dual blood supply
hepatic reserve
coagulopathy
what is the child pugh score?
assessing operative risk of liver resection base on hepatic reserve
what makes the best operative candidate?
early stage HCC
child pugh class A
solitary mass
no vascular invasion
what are the ablation type therapies for liver cancer?
cryo microwave radio ethanol acetic acid injection
most liver tumors are fed by which hepatic blood supply?
arterial
what is the MOA of sorafenib?
blocks tumors from forming new blood vessels
slows growth of tumors by targeting surface proteins
what are the 3 classifications of cholangiocarcinoma? where is the majority of cholangiocarcinomas?
intrahepatic
perihilar
distal
perihilar
what are the risk factors for bile duct cancer?
most patients have no known risk factor
what is the only cure for bile duct cancer?
surgical resection
what is the main clinical presentation for bile duct carcinomas?
signs of biliary tract obstruction
painless jaundice
obstructive pain
what markers are elevated in cholangiocarcinomas?
CA 19-9
CEA
what type of surgery is performed for a perihilar cholangiocarcinoma?
roux-en-y hepatojejunostomy
what is the typical gall bladder cancer population?
elderly women
what are the features of gall bladder cancer?
metastasizes early
aggressive
poor prognosis
people with what gall bladder cancer diagnosis have the best prognosis?
limited to mucosa and lamina proprita T1a
