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GI > Liver Tumours + Benign + Genetic Disease > Flashcards

Liver Tumours + Benign + Genetic Disease Flashcards

1
Q

What is most common tumour in liver

A

Metastases from lung breast/ GI
Primary = cholangiocarcinoma / HCC
Hepatoblastoma / sarcoma = very rare

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2
Q

What are symptoms of liver mets

A 
Fever 
Weight loss
RUQ pain due to stretch 
Jaundice late except cholangiocarcinoma
Hepatomegaly 
CLD signs inc decompensation 
Intraperitoneal haemorrhage if rupture
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3
Q

How do you investigate mets

A 
FBC, LFT, hepatitis serology, AFP
USS or CT
MRI to distinguish benign / malignanct
ERCP for cholangiocarcinoma 
Liver biopsy 
Find primary
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4
Q

How do you treat mets

A

Chemo
Resection
Radiofrequency ablation
Prognosis <6 months

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5
Q

What is carcinoid syndrome

A

Release of serotonin due to lung or liver mets (from GI)

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6
Q

What are symptoms of carcinoid syndrome

A 
Abdo pain 
FLushing
Palpitations
DIarrhoea - proceeds Dx by 2 years
Bronchospasm / wheeze
Hypotension

Other effects
R valve stenosis and triscupid insufficiency
ACTH / GnRH = CUshing’s

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7
Q

What is the Ddx for carcinoid

A

Phaeochromocytoma

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8
Q

How do you Dx and treat carcinoid

A 
Urinary 5-HIAA 
Somatostatin analogue (octeoride)
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9
Q

What causes HCC

A

Cirrhosis - secondary to any cause

HBV or HCV= most common

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10
Q

What are the symptoms of HCC

A 
Cirrhosis + mass on screening 
Fatigue
Anorexia
Weight loss
RUQ pain 
Jaundice
Ascites
HSM
Pruritus
Haemorrhage 
Decompensated CKD
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11
Q

How do you Dx HCC

A

AFP + USS for surveillance if cirrhotic
CT / MRI
AVOID biopsy as risk of seeding
Examine testis as AFP raised in testicular tumour

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12
Q

How do you treat

A

Resection or transplant
Radiofrequency ablation
Chemo or RT as palliative - generally resistance

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13
Q

What is Wilson’s disease

A

Excess deposition of copper in the liver
Autosomal recessive
Onset usually between 10-25 where as Haemochromatosis is older

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14
Q

What are symptoms in children

A

LIver hepatitis / cirrhosis / failure

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15
Q

How do adults with Wilsons present

A 
CNS Signs
Basal ganglia degeneration 
Dysarthria
Dysphagia
Dystonia 
Dementia
Parkinsonism - tremor, Brady, rigid
Ataxia
Speech and behaviour 
Chorea - jerky + myoclonus

Psych
- Depression / psychosis / mania

Hepatic

  • Cirrhosis
  • Astrexia - liver flap
Other 
Dark ring round eyes due to copper 
Blue nails 
Decreased libido 
Fatigue 
Renal tubular acidosis
Haemolystic anaemia 
Osteopenia
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16
Q

How do you Dx Wilson

A

Serum cereoplasmin = 1st line = decreased (carries copper in the blood) as all in liver
Serum copper = decreased
Urine copper excretion increased

Biopsy = gold standard
LFT
Genetic test to confirm

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17
Q

How do you treat Wilson’s

A

DIet
Penicillamine - chelator= 1st line
Liver transplant

18
Q

What is most common liver disease in children

A

Anti-trypsin deficiency
Leads to an excess of protease that attacks liver and lung
More likely to cause emphysema in adult

19
Q

What are signs of A1 anti-trypsin deficiency

A

SOB due to emphysema
CIrrhosis
Cholestatic jaudnice

20
Q

How do you Dx A1 and how is it inherited

A 
Autosomal recessive 
A1AT level low = screening 
Genetic test 
Obstructive lung disease on spirometry 
Liver biopsy 
Dx pre-natal
21
Q

How do you treat A1AT deficienct

A

Smoking cessation
Liver transplant if decompensate
Lung transplat
Monitor for complications

22
Q

What is haemochromotosis

A

AR

Increased iron absorption whcih deposited in joints / liver / heart / pancreas / pituitary / adrenal and skin

23
Q

What are symtpoms

A 
Fatigue
Arthralgia - X-ray shows chondrocalcinosis 
Decreased libido and erectile dysfunction 
Bronzed skin 
Type 2 DM
Hypogonadism 
Amenorrhoea 
Cognitive - mood / memory 
CLD / hepatomegaly / cirrhosis / HCC 
Dilated cardiomyopathy -> IHD
Hypothyroid if deposited there 
Pseudogout
Diabetes insidious
24
Q

What are the reversible symptoms

A

Cardiomyopathy

Skin - pigmentation

25
Q

What are irreversible

A

Cirrhosis
DM
Hypogonadism
Arthropathy

26
Q

How do you Dx

A

Increased LFT, transferrin sat and ferritin - do these if any abnormal
Transferrin = most accurate >50%
Low total iron binding capacity as used up
Genetic test - HFE genotype = make Dx
MRI / liver biopsy to make Dx
Joint X-Ray for arthralgia - chonedrocalcinosis

27
Q

How do you treat

A 
Venesection for life
Monitor LFT and glucose 
Avoid alcohol 
HCC if cirrhotic
Iron chelation if can't do venesection (desoferoxiamine)
28
Q

What is the chance of inheriting haemochromatosis if one parent affects

29
Q

What are common causes of liver access

A

S.Aureus in children

E.coli in adults

30
Q

What are the symptoms of absces

A 
RUQ pain
Fever
N+V
Rigors
Reduced E+D
Jaundice 
Sepsis
31
Q

What puts you at high risk of abscess

A

Biliary sepsis

32
Q

How do you Dx abscess

33
Q

How do you treat

A

IV Ax
Amox + cipro + met + gent
Percutaneous needle drainage - don’t delay
Surgery if fails to resolve

34
Q

What are benign liver tumour

A

Liver haemangioma - hyperchoiec USS

Liver cell adenoma - linked to OCP

35
Q

What is hydatid liver cyst

A

Caused by tapeworm
Common in the liver and lung
Type 1 hypersensiitivy

36
Q

What are the symptoms of hydatid

A 
RUQ pain
Unwell
Jaundice
Colic
Urticarial lesion
37
Q

How do you Dx

A

CT

Differentiate from amoebiasis

38
Q

How do you treat

39
Q

What causes amoebiasis

A

Entamoeba Histolytica

40
Q

What are the symptoms of amoebiasis

A 
Mild diarrhoea - severe
Liver and colonic abscess
Bloody diarrhoea
Single mass filled with anchovy puss
Fever
Jaundice 
RUQ pain
41
Q

How do you Dx

A

Serology +Ve

42
Q

How do you Rx

A

Metronidazole

Amoebicide for cyst carriage

GI (29 decks)

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