Hepatopancreatobiliary System

Question 1

Prognosis of fibrolamellar HCC vs HCC?

Answer 1

Often resectable and better Px (60% 5 year survival)

HCC: 30% 5 year survival

Question 2

Most common cause of HCC?

Answer 2

Developing countries: Hep B, Hep C and aflatoxin

Western world: alcohol

Question 3

Acute fatty liver of pregnancy?

Answer 3

Spectrum from mild hepatic dysfunction to failure, coma, death

Congenital deficiency causing defect in mitochondrial fatty acid oxidation

Question 4

7 cm green tumour in liver with cirrhosis and UC?

Answer 4

HCC

Note cholangiocarcinoma is fibrous and has firm/ gritty consistency

Question 5

Which cell causes excess collagen production in cirrhosis?

Answer 5

Hepatic stellate or Ito cell

Question 6

Least likely to cause irregular bile ducts on ERCP?

Answer 6

SLE

Question 7

Caroli disease and hepatic fibrosis?

Answer 7

Involves large IHBD without fibrosis

Question 8

Fibrosis in PSC vs PBC?

Answer 8

PSC: periductal onion-skin fibrosis

PBC: portal fibrosis, nodular regeneration and cirrhosis

Question 9

Most common cause of liver disease in pregnancy?

Answer 9

Cholestasis

Viral infections

Question 10

Cholangiocarcinoma- differentiation and nodal mets?

Answer 10

Typically well to moderately differentiated

50-75 % have mets to regional nodes

Question 11

Stains for Cu and Fe on liver histology?

Answer 11

Cu: Rhodamine stain

Fe: Prussian blue (blue-black colour)

Question 12

Green tumour in non-cirrhotic liver?

Answer 12

Adenoma

Question 13

DNA virus in liver?

Answer 13

Hep B (all others RNA)

Question 14

Does acute pancreatitis cause hypocalcaemia?

Answer 14

YES

Precipitation of calcium salts in necrotic fat

Question 15

Cholesterol vs pigment stones?

Answer 15

85% cholesterol (only 15% radio-opaque)

15% pigment (from unconjugated bilirubin- black 60% radio opaque and brown radiolucent)

Both have glycoprotein matrix

Question 16

Jaundice in neonate: physiological vs biliary atresia?

Answer 16

Physiological should NOT be seen beyond 2 weeks

Otherwise, consider biliary atresia: intra and extra-hepatic fibrosis which progresses to cirrhosis within 3-6 mths if untreated

Question 17

What percentage of people with gallstones develop pancreatitis?

Answer 17

Only 5%

Note viruses (coxsakie, mumps, HSV etc) can cause acute pancreatitis

Question 18

Least likely location for ectopic pancreas?

Answer 18

Colon

Question 19

Autoimmune pancreatitis- LN? Name 3 features.

Answer 19

LN is RARE

Focal or diffuse (more common) pancreatic swelling

Irregular narrowing of MPD

Biliary tree involvement

Question 20

Name 5 genetic mutations associated with pancreatitis and adenocarcinoma

Answer 20

Peutz-Jegher, BRCA2, SPINK

CDKN2A

PRSS-1

Question 21

Peliosis hepatis- signal on MRI?

Answer 21

Multiple blood filled cysts within liver.

Low T1, high T2 , centrifugal enhancement

HIV, TB, HCC, chemoRx

Question 22

Chronic hepatitis- which virus implicated?

Answer 22

10% Hep B

80% Hep C

Question 23

Histology of autoimmune hepatitis?

Answer 23

Clusters of plasma cells in the interface of portal tracts and hepatic lobules

Question 24

Haemochromatosis more common in males or females?

Answer 24

6X more common in males

Women protected by menstruation

Question 25

Haemochromatosis and adrenals?

Answer 25

Can cause Addison's disease due to haemosiderin deposition

Question 26

FNH- contents and location?

Answer 26

Contains normal hepatocytes, kuppfer cells and bile ducts No normal PV Subcapsular location, well demarcated but not encapsulated

Question 27

Thrombocytopaenia from platelet sequestration within liver haemangioma?

Answer 27

Kasabach Merritt syndrome

Question 28

Focal GB wall thickening- 2 DDx

Answer 28

Adenomyomatosis Cholesterolosis: strawberry GB and multiple polyps

Question 29

4 stages of pancreatic adenocarcinoma

Answer 29

Stage 1: less than 2 cm Stage 2: more than 2 cm Stage 3: beyond pancreas but not coeliac axis/ SMA Stage 4: involves coeliac axis/ SMA (unresectable) Note: nodal involvement means stage 2 or greater

Question 30

Most likely to benefit from phototherapy?

Answer 30

Criggler-Najjar (AR disorder of bilirubin metabolism)