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Clinical Pathology > Liver Tumours and Biliary > Flashcards

Liver Tumours and Biliary Flashcards

1
Q

4 reasons you can die from cirrhosis

A

Bleeding varices
Liver cell failure
Infection
Hepatocellular carcinoma

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2
Q

Risk factors for hepatocellular carcinoma

A

Cirrhosis
Male
Obesity
Alcohol

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3
Q

Cause of malignant tumour in non-cirrhotic patients

A

Metastatis

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4
Q

Cause of malignant tumour in cirrhotic patients

A

70% hepatocellular carinoma

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5
Q

Clinical features of hepatocellular carinoma

A

Worsening liver function

Weight loss

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6
Q

Treatment for cirrhosis

A

Surveillance- 6 month ultrasound scan

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7
Q

Blood test for hepatocellular carcinoma

A

Alpha feto-protein (liver cells often synthesise this) Although by the point this is detected, usually too poor a prognosis for surgical treatement

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8
Q

Macroscopic structure of HCC

A

Expansile soft nodules, often green (bile)

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9
Q

What other hepatic vessels are affected by HCC?

A

Portal vein 60%
Hepatic vein 20%
Bile duct 5%

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10
Q

Is HCC usually unifocal or multifocal in cirrhosis?

A

Multifocal

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11
Q

Microscopic structure of HCC

A

Cancer cells may produce bile

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12
Q

Prognosis of HCC

A

Very poor (

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13
Q

Treatment for HCC

A

Surgery- if non cirrhotic or small and peripheral

Transplant

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14
Q

In what circumstances would you consider liver transplant with HCC

A

If tumour is smaller than 5cm or 3 or less tumours smaller than 3cm

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15
Q

Treatment for non-resectable tumours e.g. multiple, large, metastasised

A

Ablation-radiofrequency
Embolisation
Chemotheraphy-sorafenib

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16
Q

Solitary tumour without vascular invasion

A

pT1

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17
Q

Solitary tumour with vascular invasion or multiple tumours, none more than 5 cm in greatest dimension

A

PT2

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18
Q

Multiple tumours, any more than 5cm

A

PT3a

19
Q

Single or multiple tumours of any size involving a major branch of the portal vein or hepatic vein.

A

pT3b

20
Q

Tumour(s) with direct invasion of adjacent organs other than the gall bladder or with perforation of visceral peritoneum

A

pT4

21
Q

What is more common, primary or secondary liver cancer?

A

Secondary (more common that tumour metastasise to the liver)

22
Q

Where might a tumour have metastasised from if it presents in the liver with few large nodules?

A

Large bowel

23
Q

Treatment for tumours in the liver than have metastasised from the large bowel

A

Surgery

24
Q

Where might tumours in the liver that are multinodular or infiltrative, come from?

A

Lung, pancreas, breast, stomach, melanoma

25
Q

Treament for secondary metastases to the liver which present as multinodular or infiltrative?

A

Biopsy to decide best treatment

26
Q

Primary liver cancer (adenocarcinoma)

A

Cholangiocarcinoma

27
Q

2 sites of cholangiocarcinoma

A

Intrahepatic

Perihilar

28
Q

Cholangiocarcinoma from small intrahepatic ducts, where are they found, when do they present and what are the risk factors?

A

Intrahepatic
Peripheral
Late
None or cirrhosis

29
Q

Cholangiocarcinoma from large ducts, causing obstructive jaundice early, risk factors

A

Perihilar
Bile duct disease
Primary sclerosing cholangitis
Liver flukes

30
Q

How much bile is excreted by the liver each day?

A

0.5-1 litre

31
Q

Where is bile concentrated?

A

In the gall bladder

32
Q

Constituents of bile

A

Bile salts, phospholipids, cholesterol, bilirubin and calcium salts +mucin from peribiliary glands

33
Q

What occurs when bile constituents precipitate

A

Gall stones

34
Q

How common are gallstones

A

10-20% in adults

35
Q

Risk factors for gall stones

A

Female
Obesity
Diabetes
All results in imbalance of bile constituents

36
Q

5 main types of gallstones

A

Cholesterole stones
Pigment stones
Mixed stones
10% contain calcium-visible on Xray

37
Q

When might you get pigment stones

A

Haemolytic anaemia

38
Q

Complications of gallstones

A 
Cholecystitis
Mucocele
Predisposed to carcinoma of the gallbladder
Biliary colic and jaundice
Cholangitis and liver abscesses
Gasstone ileus
Pancreatitis
39
Q

intestinal obstruction by a gallstone that has entered the gut through a fistulous connection with the gallbladder

A

Gallstone ileus

40
Q

Indications for cholecystectomy

A

Pain
Gallstones
Pancreatitis
Gall bladder polyp

41
Q

– duct blocked by stone,
Initially sterile, later infected.
Large, swollen, congested, ulcerated.
Complications – empyema, rupture

A

Acute Cholecystitis

42
Q

usually gall stones
small, fibrotic, stones,
Fibrosis, Rokitansky Aschoff sinuses

A

Chronic cholecystitis

43
Q

Macroscopic display of chronic cholecystitis

A

Fibrosis and inflammation
usually gall stones
small, fibrotic, stones,
Fibrosis, Rokitansky Aschoff sinuses

Clinical Pathology (53 decks)

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