Liver Tumours and Gallbladder Disease Flashcards
What is liver parenchyma?
The liver parenchyma is the functional tissue of the organ made up of around 80% of the liver volume as hepatocytes.
What is an adenoma of liver cells?
A benign proliferation of liver cells
What is hepatic adenomatosis?
Multiple (more than 10 and up to 50) hepatic adenomas
What are liver adenomas usually driven by?
Exogenous steroids; oral contraceptive pill, anabolic steroids
Danger of liver adenomas?
May rupture causing haemoperitoneum
What is a benign proliferation of bile duct cells called?
Bile duct adenoma / von Meyenberg complex
How does bile duct adenomas appear?
Tiny white nodules –> can look like metastases grossly
Do a frozen section and we can tell you if they are benign or malignant
What is the most common form of benign liver tumour?,
Hepatic haemangioma
What is a haemangioma?
A benign vascular tumour derived from blood vessel cell types.
How common are haemangiomas?
1% population
What is the 2nd most common form of benign liver tumour?
Focal nodular hyperplasia
Who are focal nodular hyperplasias most commonly seen in?
Young females (20-40)
Pathogenesis of focal nodular hyperplasia?
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.
What is focal nodular hyperplasia?
A regenerative, arterialised nodule
What is the most common type of primary liver cancer?
Hepatocellular carcinoma (HCC)
What does hepatocellular carcinoma usually result from?
Existing chronic liver disease or end stage fibrosis
Most common cause of hepatocellular carcinoma in West vs East?
East –> hep C/hep B
West –> cirrhosis due to fatty liver disease or alcohol
What is measured as a marker for HCC?
AFP
What do HCC’s secrete?
- May contain liver-origin substances –> secrete bile and antitrypsin globules
- Secrete AFP
What is AFP?
Serum glyocprotein (alpha-fetoprotein)
What is a malignant tumour of bile duct cells called?
Cholangiocarcinoma
Where does HCC originate from?
Hepatocytes
Cholangiocarcinomas can be due to chronic inflammation.
What are the 2 major causes of this inflammation?
- Primary sclerosing cholangitis
2. Liver fluke (Clonorchis sinensis)
What is Clonorchis sinensis? What condition does it cause?
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.
What are the 2 major locations of cholangiocarcinoma?
- Central/hilar
2. Peripheral
Where are hilar cholangiocarcinomas located?
Occurs in the bile ducts that lead out of the liver (hepatic ducts) and join with the gallbladder.
Prognosis of cholangiocarcinomas?
Aggressive, difficult to resect especially at the hilum of the liver.
Can present very late.
What is an angiosarcoma?
Aggressive tumour of blood vessels
2 major symptoms of cholangiocarcinomas?
Painless jaundice
Weight loss
What are angiosarcomas strongly associated with?
Toxins
What 2 toxins are angiosarcomas strongly associated with?
- Vinyl chloride (records)
2. Thorotrast (contrast agent)
What is vinyl chloride?
An important industrial chemical (used to make vinyl records)
What is thorotrast?
A contrast agent - used to increase the contrast of structures or fluids within the body in medical imaging
What % of liver tumours are metastases?
90%
What are the commonest sites of origin of liver metastases?
Lung
Breast
Colon
Pancreas
How do liver metastases appear?
Multiple whitish nodules
How do liver metastases affect liver function?
May replace large volumes of the liver before liver function iscompromised.
Purpose of heat, tissue glue and clips in metastatic carcinoma surgery?
Prevent haemorrhage
Purpose of intra-operative ultrasound?
see where you are cutting
What are gallstones?
Small stones that form in the gallbladder
Most common cause of gallstones?
CHOLESTEROL - high levels in the bile
How are gallstones formed?
Formed from stuff in bile that crystallises out to form stones (calculus)
Other causes of gallstones?
- Cholesterol (most common)
- Bile salts
- Bacterial growth
- Calcification
Risk factors for gallstones?
Female, middle aged, overweight
Clinical features of gallstones?
- Asymptomatic (80%)
- Crampy pain (”biliary colic”)
Complications of gallstones?
- Obstruction at neck – pain
- Obstruction at common bile duct – jaundice
- Chronic cholecystitis
- Perforation
- Obstruction at pancreatic level – pancreatitis
If a gallstone causes obstruction at the neck of the gallbladder, what can this cause?
Pain
If a gallstone causes obstruction at the common bile duct, what can this cause?
Jaundice
If a gallstone causes obstruction at the pancreatic level, what can this cause?
Pancreatitis
What is chronic cholecystitis?
Inflammation of the gallbladder
Over time, how can chronic cholecystitis affect the gallbladder?
Can cause fibrosis and ulceration of gallbladder
Clinical features of chronic cholecystitis?
pain (RUQ), fever, jaundice
How is chronic cholecystitis diagnosed?
USS (only 25% are visible on xray)
Treatment of chronic cholecystitis?
Cholecystectomy
How can chronic pancreatits cause diabetes?
Damage to insulin-producing cells in your pancreas from chronic pancreatitis can lead to diabetes.
