Liver Tumours and Biliary Flashcards
4 reasons you can die from cirrhosis
Bleeding varices
Liver cell failure
Infection
Hepatocellular carcinoma
Risk factors for hepatocellular carcinoma
Cirrhosis
Male
Obesity
Alcohol
Cause of malignant tumour in non-cirrhotic patients
Metastatis
Cause of malignant tumour in cirrhotic patients
70% hepatocellular carinoma
Clinical features of hepatocellular carinoma
Worsening liver function
Weight loss
Treatment for cirrhosis
Surveillance- 6 month ultrasound scan
Blood test for hepatocellular carcinoma
Alpha feto-protein (liver cells often synthesise this) Although by the point this is detected, usually too poor a prognosis for surgical treatement
Macroscopic structure of HCC
Expansile soft nodules, often green (bile)
What other hepatic vessels are affected by HCC?
Portal vein 60%
Hepatic vein 20%
Bile duct 5%
Is HCC usually unifocal or multifocal in cirrhosis?
Multifocal
Microscopic structure of HCC
Cancer cells may produce bile
Prognosis of HCC
Very poor (
Treatment for HCC
Surgery- if non cirrhotic or small and peripheral
Transplant
In what circumstances would you consider liver transplant with HCC
If tumour is smaller than 5cm or 3 or less tumours smaller than 3cm
Treatment for non-resectable tumours e.g. multiple, large, metastasised
Ablation-radiofrequency
Embolisation
Chemotheraphy-sorafenib
Solitary tumour without vascular invasion
pT1
Solitary tumour with vascular invasion or multiple tumours, none more than 5 cm in greatest dimension
PT2
Multiple tumours, any more than 5cm
PT3a
Single or multiple tumours of any size involving a major branch of the portal vein or hepatic vein.
pT3b
Tumour(s) with direct invasion of adjacent organs other than the gall bladder or with perforation of visceral peritoneum
pT4
What is more common, primary or secondary liver cancer?
Secondary (more common that tumour metastasise to the liver)
Where might a tumour have metastasised from if it presents in the liver with few large nodules?
Large bowel
Treatment for tumours in the liver than have metastasised from the large bowel
Surgery
Where might tumours in the liver that are multinodular or infiltrative, come from?
Lung, pancreas, breast, stomach, melanoma
Treament for secondary metastases to the liver which present as multinodular or infiltrative?
Biopsy to decide best treatment
Primary liver cancer (adenocarcinoma)
Cholangiocarcinoma
2 sites of cholangiocarcinoma
Intrahepatic
Perihilar
Cholangiocarcinoma from small intrahepatic ducts, where are they found, when do they present and what are the risk factors?
Intrahepatic
Peripheral
Late
None or cirrhosis
Cholangiocarcinoma from large ducts, causing obstructive jaundice early, risk factors
Perihilar
Bile duct disease
Primary sclerosing cholangitis
Liver flukes
How much bile is excreted by the liver each day?
0.5-1 litre
Where is bile concentrated?
In the gall bladder
Constituents of bile
Bile salts, phospholipids, cholesterol, bilirubin and calcium salts +mucin from peribiliary glands
What occurs when bile constituents precipitate
Gall stones
How common are gallstones
10-20% in adults
Risk factors for gall stones
Female
Obesity
Diabetes
All results in imbalance of bile constituents
5 main types of gallstones
Cholesterole stones
Pigment stones
Mixed stones
10% contain calcium-visible on Xray
When might you get pigment stones
Haemolytic anaemia
Complications of gallstones
Cholecystitis Mucocele Predisposed to carcinoma of the gallbladder Biliary colic and jaundice Cholangitis and liver abscesses Gasstone ileus Pancreatitis
intestinal obstruction by a gallstone that has entered the gut through a fistulous connection with the gallbladder
Gallstone ileus
Indications for cholecystectomy
Pain
Gallstones
Pancreatitis
Gall bladder polyp
– duct blocked by stone,
Initially sterile, later infected.
Large, swollen, congested, ulcerated.
Complications – empyema, rupture
Acute Cholecystitis
usually gall stones
small, fibrotic, stones,
Fibrosis, Rokitansky Aschoff sinuses
Chronic cholecystitis
Macroscopic display of chronic cholecystitis
Fibrosis and inflammation
usually gall stones
small, fibrotic, stones,
Fibrosis, Rokitansky Aschoff sinuses
