Hepatocellular carcinoma

Question 1

Causes

Answer 1

Mostly arises on a background of cirrhosis liver disease

Viral hepatitis (b or c)

Alcohol
Autoimmune
Genetic e.g. haemochromatosis

Question 2

Features

Answer 2

Jaundice

Pain RUQ
Abdominal swelling
Red flags: weight loss, lymphadenopathy

Question 3

Clinical and blood features of obstructive jaundice

Answer 3

Pale stools
Dark urine
Pruritus

Very high ALP
With raised ALT, bilirubin

Question 4

Complication

Answer 4

Metastases to liver

Haemorrhage

Liver failure

Mortality

Question 5

Investigations

Answer 5

Bloods: AFP, LFTs and liver screen

Imaging: CT or MRI

Interventional: percutaneous USS guided liver biopsy

Question 6

Liver screen

What involved?

Answer 6

Viral serology: hepatitis, EBV, CMV

Antibodies:

• Antimitochondrial antibody for primary biliary Cholangitis
• Anti- smooth muscle / LKM1/ ANA for autoimmune hepatitis
• p-ANCA for primary biliary Cholangitis

Genetic: caeruloplasmin
Ferritin or total iron binding capacity
Alpha 1 antitrypsin

Cancer markers: AFP, Ca199

Immunoglobulins:

• igG for autoimmune hepatitis
• IgM for primary biliary Cholangitis

Question 7

Management

Answer 7

Find slide from phone 13/10/19