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surgery > liver tumer -نوري حنون > Flashcards

liver tumer -نوري حنون Flashcards

1
Q

what’re the begging tumor of the liver ?

A

1- hemangioma
2- hepatic adenoma
3- folicular nodular hyperplasia

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2
Q

whats the hemangioma ?

A

its begin tumor & most common liver lesion

consist often multiple of cavernous

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3
Q

dose hemangioma appear with symptoms ?

A

no its asymptomatic but if the too large it presented as mass

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4
Q

is there is any chance that the tumer become malignant ?

A

they have little if any malignant potential

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5
Q

how to diagnosis the hemangioma ?

A

-by the U/S it show the abnormal plexus of the blood vessel (diagnostic)

-if no u/s so CT with contrast
that show peripheral nodular enhancement then central enhancement that means there is delay or slow contrast enhancement due to the the small vessels uptake in the hemangioma

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6
Q

whats the treatment of the hemangioma ?

A 
is its small --- no treatment 
if large -----contravention either 
1-embolism 
2-lobe or segmental resection
3- DXT to reduce the size
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7
Q

what’re the indications of the interventional treatment of the hemangioma ?

A

1- if there is shunting (artery venous shunt) affacting the heart
2-if miss.dignose as malignant vascular tumor

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8
Q

can we do percutaneous biopsy in the state of hemangioma ?

A

no ,there will be bleeding

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9
Q

whats the hepatic adenoma?

A

its rare tumor that have malignant potential
could occur in pt who takes contraceptive pills
but also happen with normal liver

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10
Q

how to diagnose hepatic adenoma?

A

1- by using the U/S and CT
seen as circumscribed solid tumor(رسم خطا حوله)
but couldn’t diagnose by radiology but when take pericutanoeus biopsy its will bleed

2- Angiography
tumor with well develop arterialization

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11
Q

treatment of hepatic adenoma?

A

resection lobe or a segment

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12
Q

whats focal follicular hyperplasia ?

A

its rare & unusual tumor of unknown etiology that affected mainly middle age women and may affect normal liver that means no association with the liver disease

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13
Q

whats the pathology of the focal follicular hyperplasia ?

A

it over growth of the of the functioning liver tissue (hepatocyte & kuppfer )and supported with fibers stoma

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14
Q

How to diagnose the focal follicular hyperplasia ?

A
  • US only show sold tumor
    -CT show some details as central scaring in the tumor
    and wel vessculrized tumor but this not specific

-so the most useful to dignose this condition is
Sulphur colloid liver scan

*this is positive only for the focal follicular hyperplasia
because the tumor contain both the kuppfer cell and hepatocyte

  • but negative for the adenoma ,primary and secondary tumor because they don’t have sufficient number of kuppfer cells
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15
Q

what’re the types of the of the liver malignant tumor ?

A

1- primary tumor

a) hepatocellular carcinoma
b) cholangiocarcinoma

2- secondary tumor

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16
Q

whats hepatocellular carcinoma ?

A

its the commonest tumor in the word
attack the middle age 3rd-4th
man are more female (8:1)

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17
Q

whats the main cause of the hepacellular carcinoma ?

A

its associated with chronic liver especially with HBV& HCV

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18
Q

How for the pt with chronic liver disease screen ?

A

bu US and alphafetoprotein which hight

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19
Q

what’re the clinical feature of the hepacellular carcinoma ?

A
  • either the pt present with the symptoms of chronic liver disease like
    (malaise , weakness, jaundice , ascites,
    varical bleed and encephalopathy )
  • or anorexia and weight loss of an advanced tumor
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20
Q

how to diagnosis the hepacellular carcinoma ?

A

US CT and biopsy

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21
Q

whats the treatment of the hepatocellular carcinoma ?

A 
1- lobar or segmental  resection 
2- liver transplant 
which depot on 
-stage, size, site of the tumor 
-availablity of the donor organ
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22
Q

how the hepacellular carcinoma appear in imaging ?

A
  • its appear as single or multiple mass which is hypo in dense in comparison to the normal liver
  • with calcification
  • L sign of the cirrhosis
  • may be associated with spleenomegly
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23
Q

how the hepacellular carcinoma appear when the contrast injected ?

A
  • very early arterial phase

- while in the portal phase the contrast is washout

24
Q

which age group are affected by the cholangiocarcioma ?

and how presented with ?

A
  • Elderly but pt with PSC(primary scelosing cholangitis) may have the tumor very early .
  • typical prevention is the painless obstructive jaundice
25
Q

how speed that tumor could grow and from where it could raise ?

A

it grows slowly and
arise from the right and left hepatic duct
and also could raise from the distal bile duct

26
Q

whats the type of tumor of cholangiocarcioma in the right and left hepatic duct?

A

its fibrous and produce tight duct stricture

27
Q

whats the type of tumor of cholangiocarcioma in the distal bile duct ?

A

polypoidal and obstruct the lumen of the duct

28
Q

what’re the clinical feature of cholangiocarcioma ?

A
  • painless obstructive jaundice

- enlarge liver ,weight loss ,anorexia , fever, asthenia(lack of energy)

29
Q

how to diagnosis the cholangiocarcioma ?

A
  • U/S – show dilated intrahepatic bile duct dilation but not the extra-hepatic bile duct
  • CT — only show the mass if there is infiltration in the liver parenchyma
  • Cholangiography—–show hilarious stricture
  • Angiography —-if there is local spread to the portal vein or the hepatic artery
  • brush cytology 2/3
30
Q

what’re the treatment of the cholangiocarcioma ?

A
  • surgical resection
  • chemotherpy
  • radiotherpy but the prognosis is very poor
31
Q

secondary liver tumors , how they’re common ?

A

the most common tumor and the’ re multiple usually

32
Q

what’re the source of the secondary tumer of the liver ?

A

1_INTRA- ABDOMINAL : GIT, pancreas , uterus and overy

2_EXTRA-ABDOMINAL :breast tumor , Carcinoid ,Sarcoma ,Melanoma.

33
Q

how to diagnosis the the secondary tumer of the liver ?

A

1-US & CT

2- Clinical examination , chest CT, bone scan , colonoscopy

34
Q

whats the treatment of the secondary tumer of the liver ??

A

1- resection surgically
2-if can’t recited so using the chemotherapy
5’ flurouracil and folinic acid

35
Q

whats the hepatic deposits ?

A

the liver is the 2nd common site for the deposits after the nodes
and most of the pt with tumors dies from the hepatic deposits

36
Q

when the liver transplantation start ?

A

its start in the USA in 1963

and then in UK in 1968

37
Q

which groups indicate the liver transplantation ?

A

1- cirrhosis and chronic liver failure
2-acute liver failure
3-metabolic liver disease
4- primary hepatic malignancy which is caused by the cirrhosis especially which is caused by the virus

38
Q

give example about liver cirrhosis and chorine liver failure ?

A 
1- alcoholic liver disease 
2- viral liver disease (b&c)
3-non alcoholic liver disease
4-primary biliiary cirrhosis  
5-biliary atresia in children
39
Q

give example about acute liver failure ?

A

acute fulminant liver failure caused by the virus and drug as paracetamol overdose

40
Q

give example about metabolic liver disease ?

A

1-wilson disease (genetic disorder in which excess copper builds up in the body)
2- familial amyloid polyneuropathy
3-oxalosis

41
Q

what’re the complications of the liver transplantation ?

A

1- haemorrhage
2- vascular problem
3- billiard problem

42
Q

how to treat the hemorrhage from the liver transplantation ?

A
  • by pack(تكوم) peritansplant area of 2-3 days

- correction of the coagulopathy

43
Q

why the vascular complication happen and how to treat it?

A
  • it happen spontaneously or because the cute rejection

- in pediatric recipient represented by the primary sclerosis cholangitis PSC

44
Q

how to diagnosis the vascular complication ?

A

by doppler US or angiography

45
Q

what the most common billiay complication and how to treat it ?

A

its billiary stenosis , billiary leakage

treat by endoscopic dilation or surgical correction

46
Q

whats the outcome o the liver transplantation ?

A

its depend on the liver disease

47
Q

the outcome of the chronic liver disease transplantation ?

A

its the best outcome

48
Q

the outcome of the acute liver disease transplantation ?

A

its high morality rate early after the transplantation because it associated with multiple organ failure

49
Q

the outcome of the liver tumor transplantation ?

A
  • have very good early outcome

but ultimately fare much less because tumor malignancies

50
Q

the outcome of the viral hepatitis B&C?

A

ithe outcome is graft failure due to recurrent viral infection

51
Q

whats the primary sclerosis cholangitis ?

A

its attack the adult by fibrous stricture and obliteration of both the intrahepatic and extra hepatic bile duct

52
Q

what the cause of the PSC ?

A

its unknown but its genetic may associated with ulcerative colitis

53
Q

whats the outcome of PSC ?

A
  • its the jaundice and liver failure

- choalngiocarcinoma seen in ERCP as biliary brush cytology

54
Q

How to diagnosis the PSC ?

A

1- cholangiography (ERCP OR MRCP)
its show irregular narrow duct
2- liver biopsy – shoe fibrous liberation of the biliary duct

55
Q

whats the treatment of the PSC ?

A

1- flow up
2- stent by ERCP – to relive the obstructive jaundice
3- transplantation the only useful treatment

surgery (28 decks)

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