L10: Liver, Pancreas and Biliary Tract Flashcards
List 3 primary benign liver tumours
- Hepatic Adenoma (Hepatocellular Adenoma)
- Bile Duct Adenoma
- Haemangioma
List 1 risk factor for a hepatic adenoma
anabolic steroids (e.g. oral contraceptive pill - OCP)
List 3 primary malignant tumours
- Hepatocellular Carcinoma
- Intrahepatic Cholangiocarcinoma
- Haemangiosarcoma
What is another term for an intrahepatic cholangiocarcinoma?
intrahepatic bile duct adenocarcinoma
Are primary or secondary tumours of the liver more common?
secondary tumours (liver mets)
List 3 of the most common cancers that metastasize to the liver
Carcinoma of the…
- GIT
- Lung
- Breast
What is a hepatocellular carcinoma?
primary, malignant liver tumour
List some of the risk factors/aetiology for hepatocellular carcinoma
- cirrhosis
- chronic hepatitis
- HBV
- Aflatotoxins
What tumour marker is a/w hepatocellular carcinoma?
Alpha-Fetoprotein (AFP)
What are aflatotoxins? What are they a/w?
- fungal contaminants of food stores
- a/w the risk of developing HCC
List 3 possible treatments for HCC
- resection (if early)
- OLT
- local ablative treatments (radiofrequency, arterial chemo-embolisation)
List 2 cancers of the biliary tract
- Cholangiocarcinoma
2. Gall Bladder Adenocarcinoma
What is a cholangiocarcinoma?
- carcinoma of the bile duct
- mainly extrahepatic (but can be intrahepatic)
- commonest site: hilum of liver
- a/w PSC
What is the commonest site for a cholangiocarcinoma?
hilum of the liver
What is a Klatskin tumour?
- a cholangiocarcinoma
- obstructing tumour at bifurcation of the common hepatic duct
What is the principal cause of gall bladder adenocarcinoma?
long standing gallstones
What would an ultrasound of gall bladder adenocarcinoma show?
“polyps” of the gall bladder
Is the pancrine mainly exocrine or endocrine?
exocrine
Where does the pancreatic duct enter the duodenum?
- at the Ampulla of Vater
- surrounded by the Sphincter of Oddi
Pancreatic enzymes are secreted in their inactive form. How do they become activated?
require activation by gut enzymes
What cancer is common in the exocrine pancreas?
malignant: pancreatic (ductal) adenocarcinoma
What cancers may be present in the endocrine pancreas?
pancreatic neuroendocrine tumours
What is a pancreatic carcinoma?
- malignant
- adenocarcinoma
- ductal (arises in ducts)
- usually affects the head of the pancreas
MEN Type 1 is associated with cancer of which 3 organs?
- parathyroid gland
- islet cells of pancreas
- pituitary gland
List some of the risk factors for pancreatic carcinoma
- smoking
- diabetes mellitus
- chronic pancreatitis
- family history
Which part of the pancreas do pancreatic carcinomas normally affect?
head of the pancreas
Pancreatic carcinomas are typically only symptomatic with advanced disease. List some of the possible symptoms of pancreatic cancer.
- anorexia
- weight loss
- painless obstructive jaundice*
- vague abdominal pain (may radiate to the back)
- Trousseau’s Sign*
What is Trousseau’s Sign and what type of cancer is it a/w?
Trousseau’s Sign = migratory thrombophlebitis (moving inflammation of superficial veins)
– a/w pancreatic carcinoma
The serum marker CA 19-9 is a/w which type of cancer?
pancreatico-biliary cancer
Which tumour serum marker is associated with pancreatico-biliary cancer?
CA 19-9
What is the MAIN treatment of a pancreatic carcinoma?
Palliation (stenting, analgesia)
If a patient has an extrahepatic cholestasis/obstructive jaundice and weight loss, what should be suspected?
pancreatico-biliary malignancy
The liver has a central role in drug metabolism. What are conjugation enzymes?
the liver takes insoluble compounds and stick it to something to make it soluble (so that it can be excreted)
What are the 2 types of drug-induced liver injury? Explain them
Type 1: predictable, dose-related injury
Type 2: not dose-related; hypersensitivity rxn or metabolic defect
Give an example of a type 2 drug-induced liver injury
Halothane
- causes acute hepatic necrosis on repeat exposure in sensitized individuals
What is halothane and what does it cause?
- causes type 2 drug-induced liver injury
- causes acute hepatic necrosis on repeat exposure in sensitized individuals
List some of the possible consequences of drug induced liver injury [6]
- hepatocellular injury
- acute liver failure
- chronic hepatitis
- cholestatic reactions
- fatty change/steatohepatitis
- fibrosis
List some of the drugs that may cause hepatocellular drug-induced liver injury
- antibiotics
- NSAIDs
- statins
- anti-epileptics
- isoniazid
List 2 drugs that may cause chronic hepatitis
- methyldopa
- nitrofurantoin
List 3 drugs that may cause cholestatic reactions (drug-induced liver injury)
- erythromycin
- chlorpromazine
- augmentin
List 1 drug that may lead to fatty change in the liver/steatohepatitis
amiodarone
List 1 drug that may cause fibrosis in the liver
methotrexate
Lower doses of paracetamol can be toxic if the patient has…
glutathione depletion (e.g. fasting, alcohol, anti-convulsants)
NAPQI is a toxic by-product of the metabolism of paracetamol. How is it gotten rid of?
rendered inactive by -SH portion of glutathione (which is stored in hepatocytes)
If NAPQI accumulates due to overdose of paracetamol, where would acute liver necrosis occur in the liver?
in zone 3 - closest to central vein
What are the 2 possible treatment for paracetamol toxicity?
if < 2 hours = oral activated charcoal
if up to 8-10 hours: N-Acetylcysteine effective
What is N-Acetylcysteine and what is it used to treat?
- treats paracetamol toxicity up to 8-10 hours
- is an -SH group donor
- replenishes glutathione stores (reduces NAPQI)
What is another name for acetaminophen?
paracetamol
List some of the causes of acute liver failure
- drugs (paracetamol, anticonvulsants, isoniazid, rare antibiotics, rare NSAIDs)
- acute hepatitis A or E
- mushroom poisoning
- Budd-Chiari Syndrome
- Wilson’s Syndrome
- pregnancy-associated
What is biliary atresia and what may be required to treat this condition?
- congenital condition
- occurs when the bile ducts inside or outside the liver do not develop normally
- so there is a blockage in the ducts
Liver Transplant may be required
List some of the indications of an orthotopic liver transplant
- decompensated cirrhosis
- acute liver failure
- biliary atresia (in childhood)
- metabolic disorders (in childhood)
