Liver and gall bladder

Question 1

Liver epidemiology and aetiology?

Answer 1

• 5th most common cancer in the world
• More frequent in Asia than in Europe and USA
• Associated with chronic viral hepatitis
• Ageing population
• Obesity
• High prevalence in indigenous Australians

Question 2

Liver signs and symptoms?

Answer 2

Abdominal pain, weight loss

Hepatic failure/Ascites

Question 3

Liver staging?

Answer 3

TNM
unifocal expansive,
Infiltrating
Multifocal (50 per cent).

Question 4

Liver clinical management?

Answer 4

Surgery Main curative procedure (Hepatectomy and transplantation)
RT Not commonly used due to whole liver irradiation (limit 30Gy)
Complex therapies or stereotactic
CT Not very responsive to Chemo
Best response is to Doxorubicin

Question 5

Liver patient care?

Answer 5

• Anti-emetics (Ondansetron, Zofran)
• Monitor proteins (Bilirubin, prothrombin time and albumin)
• Whole liver irradiation doses - not exceed 30 Gy avoid radiation induced liver disease (radiation hepatitis)

Question 6

Gall bladder aetiology and epidemiology?

Answer 6

• Equal incidence in male and female
• After age 65
• Gallbladder lethal – 10% 5 year survival rate
• Chile, Japan & Northern India
• Gallstones , liver flukes

Question 7

Gall bladder pathology?

Answer 7

Primary biliary tumours
Cholangiocarcinoma
Adenocarcinomas (85%)
Anaplastic (6%)
Squamous (5%)
Distant mets

Question 8

Gall bladder clinical management?

Answer 8

Surgery only cure
Chemo-radiation shown to extend survival
Combination of cisplatin & gemcitabine
Biliary stenting-Palliative

Question 9

Gall bladder patient care?

Answer 9

Anti-emetics (Ondansetron, Zofran)

Steroids