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Gastro > neoplasms of biliary tract & liver > Flashcards

neoplasms of biliary tract & liver Flashcards

1
Q

what is cholestasis

A
  • systemic retention of bilirubin/ other solutes eliminated in bile, caused by impaired bile formation and bile flow
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2
Q

presentation of cholestasis

A

jaundice
- yellow discolouration of skin

icterus
- yellow discolouration of sclera

other symptoms
- pruritus, skin xanthomas, intestinal malabsorption / vit ADEK deficiencies

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3
Q

types of jaundice

A

Pre-hepatic:
* excess production of bilirubin e.g. haemolysis, ineffective erythropoiesis

Hepatic:
* reduced hepatic uptake e.g. drugs
* impaired bilirubin conjugation e.g. physiologic / neonatal jaundice, genetic deficiency, diffuse hepatocellular disease
* impaired bile flow e.g. AI cholangiopathies

Post-hepatic:
* impaired bile flow / large duct obstruction

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4
Q

what does post hepatic jaundice commonly present with

A
  • hyperbilirubinaemia
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5
Q

unconjugated vs conjugated hyperbilirubinaemia

A

unconjugated
- before conjugation, pre hepatic
- excess cannot be excreted in urine

conjugated
- after conjugation in liver
- water soluble -> excess CAN be excreted in urine

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6
Q

Biliary tract diseases

A
  • large bile duct obstruction
  • primary heptolithiasis
  • neonatal cholestasis & biliary atresia
  • structural anomalies of biliary tree
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7
Q

what is large bile duct obstruction associated with (2)

A
  • GALLSTONES
  • MALIGNANCIES of biliary tree

others:
- inflammation of bile duct strictures
- porta hepatis lymphadenopathy
- bile duct malformations in children

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8
Q

large bile duct obstruction symptoms

A
  • acute: reversible with correction of obstruction
  • subtotal/ intermittent obstruction: increase risk of ascending cholangitis -> abscess & sepsis
  • chronic: biliary cirrhosis
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9
Q

what is primary hepatolithiasis

A
  • intrahepatic biliary stone formation
  • lead to repeated bouts of ascending cholangitis, progressive inflammatory destruction -> collapse & scarring of hepatic parenchyma
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10
Q

what does primary hepatolithiasis predispose pt to

A
  • Biliary Intraepithelial Neoplasia (BilIN) and cholangiocarcinoma
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11
Q

neonatal cholestasis

A
  • prolonged conjugated hyperbilirubinaemia in neonate BEYOND 14 DAYS after birth
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12
Q

most common cause of neonatal cholestasis

A
  • cholangiopathies (extrahepatic biliary atresia)
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13
Q

what is extrahepatic biliary atresia

A
  • complete/ partial obstruction of lumen of extrahepatic biliary tree within FIRST 3 MONTHS of life -> can extend to involve intrahepatic ducts
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14
Q

types of structural anomaly of biliary tree

A
  • choledochal cyst
  • fibropolycystic disease
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15
Q

choledochal cyst

A
  • developmental malformation of biliary tree, usually CBD -> predispose to stones, stenosis, strictures, pancreatitis and risk of bile duct cancer
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16
Q

fibropolycystic disease

A
  • Heterogeneous group of lesions in which the primary abnormalities are congenital malformations of the biliary tree (ductal plate malformations)
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17
Q

diseases of gallbladder

A
  • cholelithiasis
  • cholecystitis (acute & chronic)
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18
Q

clinical features of cholelithiasis

A
  • usually asymptomatic
  • RUQ/ epigastric pain ->
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19
Q

complications of gallstones

A
  • obstruction, pancreatitis
  • gallbladder carcinoma
  • perforation
20
Q

acute cholecystitis (gall bladder inflammation) presentation

A
  • progressive pain >6 hrs
  • fever, sweating, N&V
  • NO JAUNDICE (if present -> suggest CBD obstruction)
21
Q

calculous acute cholecystitis (90%)

A
  • obstruction of neck/ cystic duct by GALLSTONES -> chemical irritation & inflammation
  • primary complication of gallstones
22
Q

acalculous acute cholecystitis (10%)

A
  • found in severely ill pts (sepsis, DM, infection, immunosuppressed)
  • due to ISCHAEMIA (cystic artery is end artery)
  • presence of inflammation & edema of wall -> further compromise blood flow -> gallbladder stasis, biliary sludge & gallbladder mucus cause obstruction WITHOUT stones (acalculous)
23
Q

chronic cholecystitis

A
  • contracted thickened wall due to chronic inflammatory infiltrates
  • fibromuscular hypertrophy
24
Q

types of non neoplastic mass

A
  • focal nodular hyperplasia
25
Q

focal nodular hyperplasia

A
  • due to focal alterations in hepatic blood supply
26
Q

most common benign liver tumour

A
  • cavernous haemangioma
  • hepatocellular adenoma
27
Q

gross feature cavernous haemangioma

A
  • subcapsular, soft, red blue

complications: rupture -> intraperitoneal bleeding

28
Q

hepatocellular adenoma presentation

A
  • benign tumour arising from hepatocytes
  • incidental, abdo pain from rapid growth or haemorrhage, intraabdominal bleeding due to rupture (surgical emergency)
29
Q

hepatocellular adenoma risk factor

A
  • oral contraceptives
  • anabolic steroids
30
Q

rank most commonly found malignant tumour of liver

A
  • # 1 - hepatocellular carcinoma (HCC)
  • # 2 - cholangiocarcinoma
31
Q

hepatocellular carcinoma etiology

A
  • countries with high rates of CHRONIC HBV (hep B) infection -> china, kr, taiwan
  • increasing in west due to Hep C epidemic

**major cause - viral infection (HBV, HCV)

32
Q

pathogenesis of hepatocellular carcinoma

A
  • beta-catenin activation -> demonstrate genetic instability, unrelated to HBV
  • p53 inactivation
33
Q

features of hepatocellular carcinoma

A
  • hepatomegaly
  • upper abdo pain, fatigue
34
Q

cholangiocarcinoma pathogenesis

A
  • carcinoma of bile duct origin
  • sporadic; usually chronic inflammation & cholestasis -> promote somatic mutation & epigenetic alterations

*POOR PROGNOSIS

35
Q

cholangiocarcinoma presentations

A

affected by location
- extrahepatic -> present earlier & smaller with biliary obstruction, cholangitis, RUQ pain
- intrahepatic tumours -> usually undetected till late

36
Q

most common liver tumour of EARLY CHILDHOOD (<3yo)

A

hepatoblastoma

37
Q

what is hepatoblastoma associated with

A
  • FAP
  • Beckwith Wiedemann syndrome
38
Q

are primary hepatic neoplasms are secondary hepatic neoplasms more common

A
  • SECONDARY METASTASES&raquo_space;> primary
39
Q

common primary sites for secondary hepatic metastases

A
  • colon, breast, lung, pancreas
40
Q

secondary hepatic metastases presentations

A
  • usually asymptomatic, liver function retained
41
Q

gross imaging of secondary hepatic metastases

A
  • hepatomegaly
  • multiple pale nodules in non-cirrhotic liver
  • central tumour necrosis causing subcapsular umbilication of nodules
42
Q

most common malignancy of EXTRAHEPATIC BILIARY TRACT

A
  • gallbladder carcinoma
43
Q

which gender is gallbladder carcinoma more common in

A

female (2:1 F:M)

44
Q

risk factors of gallbladder carcinoma

A
  • gallstones (95%); though little people (1%) with gallstones develop the carcinoma
  • chronic bacterial & parasitic infection
45
Q

how can gallbladder carcinoma metastases

A

direct invasion
- liver, stomach, duodenum

metastases
- liver, regional lymph nodes, lungs

**POOR PROGNOSIS

46
Q
A

Gastro (20 decks)

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