LIVER TUMOURS and BILIARY PATHOLOGY

Question 1

Primary liver tumour: benign

Answer 1

Definition:

1) Benign Adenoma of liver cells: benign proliferation of liver cells often caused by excess steriods
2) Benign adenoma of bile ducts- tiny white nodules
3) tumours of blood vessels: haemangioma 1% pop
4) Focal nodular hypoplasia: regenrated arterialised nodule

Question 2

Metastatic Liver tumour (secondary)

Answer 2

Definition: commonest site of origin is lung, breats, colon & pancreas
Epidemiology:
Aetiology: may replace large volumes of liver before liver function is compromised.
Pathogenesis: multiple whitish nodules
Key clinical features: use ultrasound and heat for surhery to prevent haemorrhage.

Question 3

Gallstones

Answer 3

Definition: when cholesterol and Ca salts precipitate in green liquid in gallbladder.
Epidemiology: female, obeisity, diabetes, imbalance of bile constituents.
Aetiology/ Pathogenesis: complications: cholecystits, obstructionof the biliary system resulting in biliary colic and jaundice.
Key clinical features: 80% asymptomatic, some have crampy pain

Question 4

Cholecystitis

Answer 4

Definition:inflammation of gallbladder due to chemical/ bacterial cause
Epidemiology: 1,2000 per year in leeds
Aetiology: ACUTE –> duct blocked by stone, initially sterile then later affected.
Pathogenesis: –> fibrosis and ulceration of gallbladder
Key clinical features: right upper Q pain, pancreatits, fever, jaundice.

Question 5

Primary liver tumour: malignant

Answer 5

Usually arise in cirrhosis
Increasing incidence worldwide east due to hep c/b and west due to fatty liver disease and alchohol.
composed of malignant liver cells: may contain bile, antitrypsin globules.
Secrete AFP which can be detected in the blood & measured.
1) Cholangiocarcinoma –> malignant tumour of bile duct cells due to chronic inflammation. aggressive and difficult to resect.
2) Angiosarcoma –> agressive tumour of blood vessels. associated with toxins.

Question 6

Hepatocellular carcinoma

Answer 6

Complications due to cirrhosis
Epidemiology: more common in males, increasing in west due to obesity, alcohol. and viral hep
Aetiology: Risk factors–> cirrhosis. (70% cases)
Pathogenesis: poorly differentiated
Key clinical features: worsening liver function, weight loss, blood loss (raised alpha feto protein in serum 75% of time)
Prognosis: very poor less than a year unless treated.
Treatment: non cirrhotic or small = surgery.
Cirrhotic/ large = radiofrequency/ chemo