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GI Nelson > Liver part three...cancer > Flashcards

Liver part three...cancer Flashcards

1
Q

What is HELLP syndrome?

A

Something to do with preeclampsia/eclampsia

Hemolysis
Elevated Liver enzymes
Low Platelets

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2
Q

What is acute fatty liver of pregnancy?

A

Something to do with preeclampsia/eclampsia

Acute onset of liver dysfunction during pregnancy… can lead to death

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3
Q

What is intrahepatic cholestasis of pregnancy?

A

Something to do with preeclampsia/eclampsia

Estrogenic hormones with biliary secretory defects –> mild increase conjugated bilirubin

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4
Q

What liver abnormalities cay occur int bone marrow transplant patients?

A

Drug toxicity
Sinusoidal obstruction syndrome
Acute/chronic graft-vs-host disease

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5
Q

What liver abnormalities can occur post liver transplant?

A

Preservation injury (oxygen radicals)
Anastomotic problems
Acute/chronic rejection

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6
Q

What is hemangioma?

A

MOST COMMON benign neoplasm of the liver

Discrete red-blue hemorrhagic nodules

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7
Q

What are simple cysts?

A

Single/small cluster

Rarely associated with polycystic kidney disease

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8
Q

Polycystic liver disease?

A

Multiple cysts
Often associated with autosomal dominant polycystic kidney disease

Do NOT communicate with biliary system

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9
Q

What is a choledochal cyst? What are some possible complications?

A

Congenital dilatation of the common bile duct

Biliary obstruction, stones, bile duct carcinoma

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10
Q

What is Caroli’s disease?

A

Autosomal recessive cause of intrahepatic biliary dilatations that communicate with biliary tree

Associated with congenital hepatic fibrosis
Risk of cholangiocarcinoma

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11
Q

What is Alagille syndrome?

A

Autosomal dominant cause of absence of bile ducts in portal tracts

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12
Q

What is congenital hepatic fibrosis?

A

Autosomal recessive non-cirrhotic fibrotic liver disease of kids

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13
Q

What is focal nodular hyperplasia?

A

Well-demarcated lesion composed of a proliferation of all liver parenchymal elements (central veins, hepatocytes, portal triads)

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14
Q

What is seen with imaging of focal nodular hyperplasia?

A

Mass with a central fibrous scar of stellate configuration

Angiography shows a distinctive peripheral filling pattern

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15
Q

What is nodular regenerative hyperplasia?

A

Diffuse non-fibrosing nodular hyperplasia of the liver

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16
Q

What is a complication of nodular regenerative hyperplasia?

A

May develop portal hypertension

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17
Q

What is hepatic adenoma?

A

Well-circumscribed benign neoplasm composed of well differentiated hepatocytes

NO portal triads or central veins

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18
Q

Who is most likely to get hepatic adenoma?

A

Women of reproductive age on oral contraceptives

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19
Q

What is the gross appearance of bile duct hamartoma?

A

Single…more commonly multiple…small white nodules

Mimics metastatic carcinoma

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20
Q

What is the gross appearance of bile duct adenoma?

A

Usually solitary proliferation of bile ducts

Mimics metastatic carcinoma

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21
Q

How are metastatic tumors diagnosed?

A

Obtain microscopic confirmation of lesions felt grossly to be liver metastases

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22
Q

What are the risk factors for Hepatocellular Carcinoma (HCC)?

A

Hepatotrophic viruses
Cirrhosis
Hepatocarcinogens (toxin of aspergillus flavus)
Metabolic conditions (hereditary tyrosinemia; glycogen storage disease)

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23
Q

What is the gross appearance of HCC?

A

Solitary mass…or with multiple nodules
Soft and hemorrhagic
Can metastasize to regional lymph nodes, diaphragm, lung, and/or bone

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24
Q

Who gets HCC in the US? China?

A

US: men over 60yo
China: men at 40yo (high endemic HBV –> malignancy)

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25
Q

How is HCC screened for?

A

Alpha-fetoprotein

26
Q

What form of HCC has polygonal oncocytic tumor cells in nests and cords separated by lamellar fibrous stroma?

A

Fibrolamellar variant of HCC

27
Q

What age group typically develops Fibrolamellar variant HCC? What is the 5 year survival?

A

Fibrolamellar affects people < 35yo

Better 5 year survival than other HCC, but late recurrences are common

28
Q

What is cholangiocarcinoma?

A

Bile duct carcinoma

Virtually always adenocarcinomas

29
Q

What are 5 risk factors for intrahepatic cholangiocarcinoma?

A 
Thorotrast and liver flukes
PSC
Caroli's disease
Congenital hepatic fibrosis
Choledochal cysts
30
Q

What is NOT associated with intrahepatic cholangiocarcinoma?

A

Cirrhosis or HBV

31
Q

What is important when diagnosing intrahepatic cholangiocarcinoma

A

Adenocarcinoma metastatic to the liver HAS to be excluded

32
Q

What is hepatoblastoma of the liver?

A

Malignancy composed immature hepatic elements (epithelial or mixed epithelial-immature stroma)

Almost always occurs in infants

Blastoma…like young/immature

33
Q

What is angiosarcoma of the liver?

A

Malignancy of endothelial cells –> tumor composed of anastomosing vascular channels lined by atypical (malignant) endothelial cells

34
Q

What is phyrgrian cap?

A

Folded fundus (phyrgrian cap. holy alliteration!)

35
Q

What are the risk factors for developing cholesterol stones?

A 
Four F's:
Fat
Female (from northern Europe, North/South America)
Fertile (oral contraceptives)
Forty
36
Q

What are the risk factors for developing pigment stones?

A

From eastern Asia (bacterial and parasitic biliary infections)
Hemolysis (increased unconjugated bilirubin)

37
Q

What is used to look for gallstones?

A

Ultrasound

38
Q

What percentage of people with gallstones have complications?

A

20-30%

39
Q

What are 5 potential complications of gallstones?

A 
Biliary "colic"
Acute cholecystitis
Chronic cholecystitis
Choledocholithiasis (stones in common bile duct)
Ascending cholangitis
40
Q

What are 6 potential complications of acute cholecystitis?

A 
Gallbladder perforation
Bile peritonitis
Acute cholangitis
Sepsis
Biliary-enteric fistula
Gallstone ileus (stone gets trapped at ileocecal valve)
41
Q

What is the most common cause of extra hepatic biliary obstruction?

A

Choledocholthiasis

42
Q

What is chronic cholecystitis?

A

Gallbladder exhibits varying degrees of chronic lymphocytic inflammation and fibrosis

43
Q

Porcelain gallbladder is associated with chronic cholecystitis, what is it?

A

Dystrophic calcification of the gallbladder wall

44
Q

What is the gross appearance of cholesterolosis?

A

Yellow mucosal flecks

45
Q

What is the gross appearance of a cholesterol polyp?

A

Yellow small polyps

46
Q

What is the gross appearance of mucocele of the bladder?

A

Distended gallbladder with atrophic wall

Mucosa secretes a mucinous water fluid

47
Q

What is adenoma of the gallbladder?

A

May have papillary appearance

BENIGN NEOPLASM

48
Q

What is adenomyoma of the gallbladder?

A

Diverticulae with focal muscular hypertrophy of the gallbladder muscle wall at the fundus

NOT a true neoplasm

49
Q

What is a risk factor for developing gallbladder carcinoma?

A

Cholelithiasis

50
Q

Why is the 5 year survival rate of gallbladder carcinoma so low?

A

Usually metastasizes to regional lymph nodes by onset of symptoms

51
Q

What is the most common gallbladder carcinoma?

A

Adenocarcinoma

52
Q

What are the three types (regions) of cholangiocarcinomas?

A

Intrahepatic
Perihilar
Distal extrahepatic

53
Q

What is another name given to perihilar cholangiocarcinoma?

A

Klatskin tumor

54
Q

What are periampullary carcinomas?

A

Tumors of the ampulla of Vater…include tumors arising from duodenal mucosa, pancreatic duct, and bile duct

55
Q

What are 5 potential risk factors for extrahepatic cholangiocarcinomas?

A 
Chronic ductal inflammation
Bile stasis
Parasitic infections
PSC
UC (often associated with PSC...pANCA...just another reminder)
56
Q

What is the clinical presentation of extrahepatic cholangiocarcinomas?

A

Painless jaundice…secondary to obstruction

57
Q

What previously talked about carcinoma also caused obstructive jaundice?

A

Pancreatic head carcinomas

58
Q

What lab findings are seen with extrahepatic cholangiocarcinoma?

A

Cholestatic injury pattern with increase in ALP

59
Q

What imaging studies can be done to see extrahepatic cholangiocarcinoma?

A

CT scan
Endoscopy with EUS and FNA
ERCP with cytology brushing

60
Q

What is needed to diagnose extrahepatic cholangiocarcinoma?

A

Liver biopsy

61
Q

Why does extrahepatic cholangiocarcinoma have such a poor prognosis?

A

Diffuse infiltrative tumor

Presents late??

62
Q

Why is prognosis of periampullary carcinoma better than the prognosis for extrahepatic cholangiocarcinoma?

A

Periampullary presents sooner (per Kasey)

GI Nelson (11 decks)

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