Quiz 5 Flashcards
Are 1° or 2° (metastatic) tumors of the liver more common?
2° - metastasis from other tissues
frequently GI - colon cancer
other: breast ovarian lung renal prostate
MC 1° liver tumor:
hepatic hemangioma (benign)
MC 1° liver cancer:
hepatocellular carcinoma (hepatoma)
2nd MC - cholangiocarcinoma (<10%)
Vascular tumor of the liver characterized by dilated vascular spaces filled with blood:
Cavernous hemangioma
Hepatic adenoma risk is increased in young women who use:
oral contraceptives
resolves upon discontinuation of the pill
Hepatic adenomas are (benign/malignant) and have potential to (metastasize/rupture).
Benign
Rupture
Hepatic adenoma appearance - gross:
Histologic:
Smooth, well-circumscribed
cells resemble normal hepatocytes
disorganized, crowded
loss of lobar architecture
less cytoplasm
Cancer coming from cells that line the bile ducts & create sinus passages for bile flow:
cholangiocarcinoma
Rare 1° forms of liver cancer:
hepatoblastoma
mixed tumors
sarcoma of the liver
In countries such as China, where it is endemic, _______ is the MC cause of hepatocellular carcinoma.
HBV (viral hepatitis)
MC cause in US: cirrhosis (2° to alcohol or HCV)
Histology of HCC:
nuclear atypia
loss of normal architecture
collagen fibrosis
Infants who contract HBV at birth have a _____x increased risk of developing HCC.
200x
A clue to the presence of a HCC neoplasm is an elevated:
serum alpha-fetoprotein
may also obstruct biliary tract & lead to elev serum alk phos
Is HCC MC in men or women?
M>F 8:1
Risk factors for development of cholangiocarcinoma:
longstanding inflammation
chronic injury of the biliary epithelium
classified as: intra- or extra-hepatic
intra- further classified: hilar or peripheral (MC)
Tumor markers you might use to differentiate cholangiocarcinoma from HCC:
CA 19-9
CA-50
Type of endothelial tumor that may occur in the skin & soft tissue organs, such as breast, heart:
angiosarcoma
hepatic angiosarcomas are rare
What exposure is of notable interest d/t association with hepatic angiosarcoma?
Arsenic
such as pesticides, polyvinyl chloride in plastics
Biliary atresia occurs as a (congenital/acquired) dz?
BOTH
congenital - common bile duct blocked/absent
acquired - MC in autoimmune dz, common form of chronic rejection of a transplanted liver allograft.
Features of biliary atresia in infants:
Tx:
progressive cholestasis pruritis fat-soluble vit deficiencies malabsorption eventual cirrhosis w/portal HTN => liver failure
surgical anatomoses
liver transplantation
Congenital cystic dilatations of the bile ducts:
choledochal cysts
MC - Type I (80-90%)
most dx’d during infancy/childhood, mb found at any age
60-70% <10yo
Most feared complication of choledochal cysts:
cholangiocarcinoma (9-28% incidence)
Choledochal cyst presentation - infants:
children:
adults:
Infants - jaundice, clay-colored stool, palpable mass in RUQ, hepatomegaly
Children - palpable mass in RUQ, jaundice, OR intermittent colicky abd pain (ssx like pancreatitis)
Adults - MC abd pain (vague epigastric/RUQ pain),
jaundice, cholangitis, mb palpable RUQ abd mass
Crystalline mass formed in GB by accretion of bile components:
Cholelithiasis
Risk factors for cholelithiasis:
fat, female, 40
N/S American Indian
Hispanic
Northern European
prolonged PPI use lack of melatonin low fiber/high cholesterol diet high starch diet rapid wt loss low intake of: folate, mg, ca, vit C
Gall stones that have relocated to biliary ducts:
choledocholithiasis
freq. assoc w/obstruction of biliary tree -> ascending cholangitis
obstruction of ampulla of vater -> pancreatitis
