Liver tumours, biliary tract, pancreas Flashcards
What are risk factors & clinical features for hepatocellular carcinoma?
- Cirrhosis: 70% malignant tumours, male, obesity & alcohol, western life
- Worsening of cirrhosis, weight loss
What is the pathology & involvement of hepatocellular carcinoma? What is the prognosis?
- Expansile soft nodules often green
- Multifocal : portal vein, bile duct, hepatic vein
- Very poor unless diagnosed early: treatment & transplant
- Early: pT1/2
List the tumours that commonly metastasise to the liver
- Large nodules: L.bowel
- Multifocal: lung, pancreas, breast, stomach, melanoma
What are the types of primary liver cancer?
- Hepatocellular carcinoma
- Cholangiocarcinoma (adenocarcinoma of bile ducts)
- Intrahepatic-peripheral small ducts
- Perihilar-liver flukes, sclerosing cholangitis, large ducts
list the common types of gallstones
- cholesterol stones=yellow, opalescent,
- pigment stones=small black in haemolytic anaemia
- Mixed stones=most common
- 10% contain calcium
How are gallstones formed?
- constituents precipitate
- imbalance of bile constituents
What are the complications of gallstones?
- cholecystitis
- mucocele
- predispose to carcinoma
- obstruction of the biliary system=biliary colic&jaundice
- infection of static bile= cholangitis & liver abscesses
- gallstone ileus due to intestinal obstruction by a gallstone & fistula
- pancreatitis
What are the causes of acute & chronic cholecystitis?
-A=duct blocked, sterile then infected, Large, swollen, congested, ulcerated.
Complications – empyema, rupture
-C=gall stones small, fibrotic, stones, Fibrosis, Rokitansky, Aschoff sinuses
What are the clinical features of acute & chronic pancreatitis?
- A=emergency, acute severe abdo pain, radiates to back, nausea/vomiting
- C=
What are the blood markers of pancreatitis?
- A=Raised serum amylase/ lipase
- C=
What is the aetiology of acute pancreatitis?
- Gallstones
- Idiopathic
- Alcohol
- RARE=Vascular insufficiency, hypercalcaemia, viral infection
What is the pathogenesis of acute pancreatitis?
- Leakage and activation of pancreatic enzymes
- Amylase released into blood
- Mild=swollen gland with fat necrosis
- Severe=swollen, necrotic gland with fat necrosis and haemorrhage(Grey Turner’s sign – haemorrhage into the subcut tissues flank, Cullen’s sign
How does chronic pancreatitis occur?
- Progressive inflammatory disorder
- parenchyma of pancreas is destroyed and replaced by fibrous tissue.
- Irreversible destruction of the exocrine tissue, followed by destruction of the endocrine tissue
- Dilated and distorted ducts
- Calculi=alcohol induced
- Fatty replacement
- early localised, irregular involvement of the gland, later global atrophy
Describe islet cell tumours
Pancreatic neuroendocrine tumours
- uncommon
- MEN1, von hippel genetics
- well differentiated: single tumour in children
- poorly differentiated: poor prognosis
- well circumscribed, solid, encapsulated
What are the causes of chronic pancreatitis?
- Toxic=alcohol, smoking, drugs, hypercalcaemia, hyperparatyroidism, infections
- Genetic CFTR, PRSS1, SPINK 1 mutations
- Obstruction of main duct – cancer, scarring
- Recurrent AP
- Autoimmune
- Idiopathic
