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Yr 2 - Clinical Pathology > Liver Tumours and Gallbladder Disease > Flashcards

Liver Tumours and Gallbladder Disease Flashcards

1
Q

What is liver parenchyma?

A

The liver parenchyma is the functional tissue of the organ made up of around 80% of the liver volume as hepatocytes.

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2
Q

What is an adenoma of liver cells?

A

A benign proliferation of liver cells

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3
Q

What is hepatic adenomatosis?

A

Multiple (more than 10 and up to 50) hepatic adenomas

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4
Q

What are liver adenomas usually driven by?

A

Exogenous steroids; oral contraceptive pill, anabolic steroids

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5
Q

Danger of liver adenomas?

A

May rupture causing haemoperitoneum

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6
Q

What is a benign proliferation of bile duct cells called?

A

Bile duct adenoma / von Meyenberg complex

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7
Q

How does bile duct adenomas appear?

A

Tiny white nodules –> can look like metastases grossly

Do a frozen section and we can tell you if they are benign or malignant

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8
Q

What is the most common form of benign liver tumour?,

A

Hepatic haemangioma

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9
Q

What is a haemangioma?

A

A benign vascular tumour derived from blood vessel cell types.

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10
Q

How common are haemangiomas?

A

1% population

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11
Q

What is the 2nd most common form of benign liver tumour?

A

Focal nodular hyperplasia

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12
Q

Who are focal nodular hyperplasias most commonly seen in?

A

Young females (20-40)

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13
Q

Pathogenesis of focal nodular hyperplasia?

A

One of arteries in liver becomes abnormally hyperplastic and starts bringing too much oxygenated blood to liver.

Liver is a natural regenerative organ so more oxygenated blood = more proliferation of hepatocytes.

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14
Q

What is focal nodular hyperplasia?

A

A regenerative, arterialised nodule

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15
Q

What is the most common type of primary liver cancer?

A

Hepatocellular carcinoma (HCC)

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16
Q

What does hepatocellular carcinoma usually result from?

A

Existing chronic liver disease or end stage fibrosis

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17
Q

Most common cause of hepatocellular carcinoma in West vs East?

A

East –> hep C/hep B

West –> cirrhosis due to fatty liver disease or alcohol

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18
Q

What is measured as a marker for HCC?

A

AFP

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19
Q

What do HCC’s secrete?

A
  1. May contain liver-origin substances –> secrete bile and antitrypsin globules
  2. Secrete AFP
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20
Q

What is AFP?

A

Serum glyocprotein (alpha-fetoprotein)

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21
Q

What is a malignant tumour of bile duct cells called?

A

Cholangiocarcinoma

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22
Q

Where does HCC originate from?

A

Hepatocytes

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23
Q

Cholangiocarcinomas can be due to chronic inflammation.

What are the 2 major causes of this inflammation?

A
  1. Primary sclerosing cholangitis

2. Liver fluke (Clonorchis sinensis)

24
Q

What is Clonorchis sinensis? What condition does it cause?

A

A liver fluke; Trematode, Helminth. Most commonly found in Eastern Asia.

In humans, it infects the common bile duct and gall bladder, feeding on bile.

25
Q

What are the 2 major locations of cholangiocarcinoma?

A
  1. Central/hilar

2. Peripheral

26
Q

Where are hilar cholangiocarcinomas located?

A

Occurs in the bile ducts that lead out of the liver (hepatic ducts) and join with the gallbladder.

27
Q

Prognosis of cholangiocarcinomas?

A

Aggressive, difficult to resect especially at the hilum of the liver.

Can present very late.

28
Q

What is an angiosarcoma?

A

Aggressive tumour of blood vessels

29
Q

2 major symptoms of cholangiocarcinomas?

A

Painless jaundice

Weight loss

30
Q

What are angiosarcomas strongly associated with?

A

Toxins

31
Q

What 2 toxins are angiosarcomas strongly associated with?

A
  1. Vinyl chloride (records)

2. Thorotrast (contrast agent)

32
Q

What is vinyl chloride?

A

An important industrial chemical (used to make vinyl records)

33
Q

What is thorotrast?

A

A contrast agent - used to increase the contrast of structures or fluids within the body in medical imaging

34
Q

What % of liver tumours are metastases?

A

90%

35
Q

What are the commonest sites of origin of liver metastases?

A

Lung
Breast
Colon
Pancreas

36
Q

How do liver metastases appear?

A

Multiple whitish nodules

37
Q

How do liver metastases affect liver function?

A

May replace large volumes of the liver before liver function iscompromised.

38
Q

Purpose of heat, tissue glue and clips in metastatic carcinoma surgery?

A

Prevent haemorrhage

39
Q

Purpose of intra-operative ultrasound?

A

see where you are cutting

40
Q

What are gallstones?

A

Small stones that form in the gallbladder

41
Q

Most common cause of gallstones?

A

CHOLESTEROL - high levels in the bile

42
Q

How are gallstones formed?

A

Formed from stuff in bile that crystallises out to form stones (calculus)

43
Q

Other causes of gallstones?

A
  1. Cholesterol (most common)
  2. Bile salts
  3. Bacterial growth
  4. Calcification
44
Q

Risk factors for gallstones?

A

Female, middle aged, overweight

45
Q

Clinical features of gallstones?

A
  • Asymptomatic (80%)

- Crampy pain (”biliary colic”)

46
Q

Complications of gallstones?

A
  • Obstruction at neck – pain
  • Obstruction at common bile duct – jaundice
  • Chronic cholecystitis
  • Perforation
  • Obstruction at pancreatic level – pancreatitis
47
Q

If a gallstone causes obstruction at the neck of the gallbladder, what can this cause?

A

Pain

48
Q

If a gallstone causes obstruction at the common bile duct, what can this cause?

A

Jaundice

49
Q

If a gallstone causes obstruction at the pancreatic level, what can this cause?

A

Pancreatitis

50
Q

What is chronic cholecystitis?

A

Inflammation of the gallbladder

51
Q

Over time, how can chronic cholecystitis affect the gallbladder?

A

Can cause fibrosis and ulceration of gallbladder

52
Q

Clinical features of chronic cholecystitis?

A

pain (RUQ), fever, jaundice

53
Q

How is chronic cholecystitis diagnosed?

A

USS (only 25% are visible on xray)

54
Q

Treatment of chronic cholecystitis?

A

Cholecystectomy

55
Q

How can chronic pancreatits cause diabetes?

A

Damage to insulin-producing cells in your pancreas from chronic pancreatitis can lead to diabetes.

Yr 2 - Clinical Pathology (80 decks)

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