Liver Lecture 3 Flashcards

1
Q

budd chiari syndrome

A

hepatic vein obstruction/ thrombosis

  • hepatic ascites, abdominal pain and hepatic dysfunction
  • centrilobular congestion
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2
Q

sinusoidal obstructive syndrome or veno-occlusive disease

A
  • **`1.bone marrow transplants
  • first 3 weeks
  • 25% of recipients of allogeneic BMT
    2. chemotherapy patients
    3. drugs-azathioprine
  • toxic injury to the sinusoidal endothelium with resulting fibrotic occlusion of small hepatic veins
  • Classic triad: Acute RUQ tenderness, hepatomegaly, ascites, weight gain, and jaundice

Histology:
fibrous obliteration of central vein

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3
Q

Acute fatty liver of pregnancy

A

sudden catastrophic illness occurring exclusively in the 3rd trimester

Microvesicular fatty infiltration

  • acute liver failure and encephalopathy
  • significant perinatal and maternal mortality
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4
Q

Focal Nodular hyperplasia

A
  • solitary
  • central stellate scar
  • 20-40
  • no malignant potential
  • doesnt need to be removed?
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5
Q

Nodular regenerative hyperplasia

A

widespread transformation of the hepatic parenchyma into small regenerative nodule in the ABSENCE OF FIBROSIS

  • partial or diffuse
  • non cirrhotic portal hypertension
  • associated with solid organ transplant, bone marrow transplant, vasculitis, and HIV
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6
Q

Hepatic adenoma

A
  • young women
  • associated with hormones and oral contraceptives
  • usually solitary lesion
  • cord of normal hepatocytes with absent portal tracts
  • prominent solitary arterial vessels

-risk of:
rupture, transform to hepatocellular carcinoma,
-resection indicated if >5cm as risk of malignant
transformation increases

associated with rare metabolic disorder and glycogen diseases

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7
Q

Hemangioma

A
  • most common benign tumor
  • discrete red-blue nodules
  • microscopically: benign vascular changes and fibrotic tissue
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8
Q

Angiosarcoma

A

most common primary sarcoma of liver

  • malignant vascular tumor
  • associated with exposure to vinyl chloride, arsenic

lots of nuclei and deformed vessels

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9
Q

HEpatoblastoma

A

-most common malignant liver tumor of CHILDHOOD
-male>female
-RUQ mass found on physical exam
-elevated alpha fetoprotein (AFP)
-primary hepatocellular malignancy
epithelial type: fetal and embryonal hepatocytes
mixed epithelial and mesenchymal: fetal and embryonal hepatocytes with foci of mesenchymal differentiation

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10
Q

Hepatocellular carcinoma

A

third most common cancer death

  • incidence rising due to HCV endemic
  • vague symptoms
  • 95% occur in patients with cirrhosis
  • HCC can occur independent of cirrhosis in hepB
  • 50% elevated AFP
Treatment: 
surgery
radiofrequency ablation 
transarterial chemoembolization 
(TACE)
radioembolization
liver transplant
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11
Q

What can cause hepatocellular carcinoma?

A

1.Cirhosis:
NASH
Alcohol
Hep C-repeated cycles on cell death and regeneration
Hemochromatosis
2. chronic hep b-integration of viral dna
3. aflatoxin
4. hereditary tyrosinemia (highest risk-40%)

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12
Q

How does hepatocellular carcinoma look grossly and microscopically?

A

gross

  • single lesion
  • multifocal
  • diffusely infiltrative

microscopically

  • trabecular, acinar/pseudoglandular and undifferentiated
  • bile production
  • well different (resembling hepatocytes) to poorly differentiated forms
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13
Q

Fibrolamellar variant of HCC

A

younger person

  • not associated with cirrhosis or HBV
  • characterized by areas of dense collagenous fibrosis and large polygonal tumor cells
  • thought to have better prognosis
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14
Q

Cholangiocarcinoma

A
malignancy of bile ducts 
10% intrahepatic 
extrahepatic arising from bile ducts outside the liver
-perihilar (50-60%)
-distal bile duct (20-30%)
-periampullary
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15
Q

What are the risk factors for cholangiocarcinoma?

A
  1. primary sclerosing cholangitis
  2. congenital fibropolycystic disease of the biliary system
    -caroli’s disease
    3 cirrhosis
  3. exposure to thorotrast
  4. liver fluke: opisthorchis sinensis
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16
Q

What are the clinical findings of cholangiocarcinoma intrahepatic and extrahepatic?

A

Intrahepatic

  • not detectable until late; massive lesion of tree like tumor along the portal system
  • bile flow obstruction

adenocarcinoma
dense fibrous stroma
sometimes combined with HCC

Extrahepatic

  • small lesion at the time of diagnosis
  • biliary obstruction, cholangitis, RUQ pain
  • obstructive jaundice

adenocarcinoma
special variant-klatskin tumor—>perihilar/hilar

17
Q

metastatic to liver from where most commonly

A

Adult: breast, lung, colon, pancreas
Children: neuroblastoma, wilms tumor, rhabdomyosarcoma