liver tumer -نوري حنون Flashcards
what’re the begging tumor of the liver ?
1- hemangioma
2- hepatic adenoma
3- folicular nodular hyperplasia
whats the hemangioma ?
its begin tumor & most common liver lesion
consist often multiple of cavernous
dose hemangioma appear with symptoms ?
no its asymptomatic but if the too large it presented as mass
is there is any chance that the tumer become malignant ?
they have little if any malignant potential
how to diagnosis the hemangioma ?
-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
whats the treatment of the hemangioma ?
is its small --- no treatment if large -----contravention either 1-embolism 2-lobe or segmental resection 3- DXT to reduce the size
what’re the indications of the interventional treatment of the hemangioma ?
1- if there is shunting (artery venous shunt) affacting the heart
2-if miss.dignose as malignant vascular tumor
can we do percutaneous biopsy in the state of hemangioma ?
no ,there will be bleeding
whats the hepatic adenoma?
its rare tumor that have malignant potential
could occur in pt who takes contraceptive pills
but also happen with normal liver
how to diagnose hepatic adenoma?
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
treatment of hepatic adenoma?
resection lobe or a segment
whats focal follicular hyperplasia ?
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
whats the pathology of the focal follicular hyperplasia ?
it over growth of the of the functioning liver tissue (hepatocyte & kuppfer )and supported with fibers stoma
How to diagnose the focal follicular hyperplasia ?
- 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
what’re the types of the of the liver malignant tumor ?
1- primary tumor
a) hepatocellular carcinoma
b) cholangiocarcinoma
2- secondary tumor
whats hepatocellular carcinoma ?
its the commonest tumor in the word
attack the middle age 3rd-4th
man are more female (8:1)
whats the main cause of the hepacellular carcinoma ?
its associated with chronic liver especially with HBV& HCV
How for the pt with chronic liver disease screen ?
bu US and alphafetoprotein which hight
what’re the clinical feature of the hepacellular carcinoma ?
- 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
how to diagnosis the hepacellular carcinoma ?
US CT and biopsy
whats the treatment of the hepatocellular carcinoma ?
1- lobar or segmental resection 2- liver transplant which depot on -stage, size, site of the tumor -availablity of the donor organ
how the hepacellular carcinoma appear in imaging ?
- 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
how the hepacellular carcinoma appear when the contrast injected ?
- very early arterial phase
- while in the portal phase the contrast is washout
which age group are affected by the cholangiocarcioma ?
and how presented with ?
- Elderly but pt with PSC(primary scelosing cholangitis) may have the tumor very early .
- typical prevention is the painless obstructive jaundice
how speed that tumor could grow and from where it could raise ?
it grows slowly and
arise from the right and left hepatic duct
and also could raise from the distal bile duct
whats the type of tumor of cholangiocarcioma in the right and left hepatic duct?
its fibrous and produce tight duct stricture
whats the type of tumor of cholangiocarcioma in the distal bile duct ?
polypoidal and obstruct the lumen of the duct
what’re the clinical feature of cholangiocarcioma ?
- painless obstructive jaundice
- enlarge liver ,weight loss ,anorexia , fever, asthenia(lack of energy)
how to diagnosis the cholangiocarcioma ?
- 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
what’re the treatment of the cholangiocarcioma ?
- surgical resection
- chemotherpy
- radiotherpy but the prognosis is very poor
secondary liver tumors , how they’re common ?
the most common tumor and the’ re multiple usually
what’re the source of the secondary tumer of the liver ?
1_INTRA- ABDOMINAL : GIT, pancreas , uterus and overy
2_EXTRA-ABDOMINAL :breast tumor , Carcinoid ,Sarcoma ,Melanoma.
how to diagnosis the the secondary tumer of the liver ?
1-US & CT
2- Clinical examination , chest CT, bone scan , colonoscopy
whats the treatment of the secondary tumer of the liver ??
1- resection surgically
2-if can’t recited so using the chemotherapy
5’ flurouracil and folinic acid
whats the hepatic deposits ?
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
when the liver transplantation start ?
its start in the USA in 1963
and then in UK in 1968
which groups indicate the liver transplantation ?
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
give example about liver cirrhosis and chorine liver failure ?
1- alcoholic liver disease 2- viral liver disease (b&c) 3-non alcoholic liver disease 4-primary biliiary cirrhosis 5-biliary atresia in children
give example about acute liver failure ?
acute fulminant liver failure caused by the virus and drug as paracetamol overdose
give example about metabolic liver disease ?
1-wilson disease (genetic disorder in which excess copper builds up in the body)
2- familial amyloid polyneuropathy
3-oxalosis
what’re the complications of the liver transplantation ?
1- haemorrhage
2- vascular problem
3- billiard problem
how to treat the hemorrhage from the liver transplantation ?
- by pack(تكوم) peritansplant area of 2-3 days
- correction of the coagulopathy
why the vascular complication happen and how to treat it?
- it happen spontaneously or because the cute rejection
- in pediatric recipient represented by the primary sclerosis cholangitis PSC
how to diagnosis the vascular complication ?
by doppler US or angiography
what the most common billiay complication and how to treat it ?
its billiary stenosis , billiary leakage
treat by endoscopic dilation or surgical correction
whats the outcome o the liver transplantation ?
its depend on the liver disease
the outcome of the chronic liver disease transplantation ?
its the best outcome
the outcome of the acute liver disease transplantation ?
its high morality rate early after the transplantation because it associated with multiple organ failure
the outcome of the liver tumor transplantation ?
- have very good early outcome
but ultimately fare much less because tumor malignancies
the outcome of the viral hepatitis B&C?
ithe outcome is graft failure due to recurrent viral infection
whats the primary sclerosis cholangitis ?
its attack the adult by fibrous stricture and obliteration of both the intrahepatic and extra hepatic bile duct
what the cause of the PSC ?
its unknown but its genetic may associated with ulcerative colitis
whats the outcome of PSC ?
- its the jaundice and liver failure
- choalngiocarcinoma seen in ERCP as biliary brush cytology
How to diagnosis the PSC ?
1- cholangiography (ERCP OR MRCP)
its show irregular narrow duct
2- liver biopsy – shoe fibrous liberation of the biliary duct
whats the treatment of the PSC ?
1- flow up
2- stent by ERCP – to relive the obstructive jaundice
3- transplantation the only useful treatment
