Quiz 5

Question 1

Are 1° or 2° (metastatic) tumors of the liver more common?

Answer 1

2° - metastasis from other tissues
frequently GI - colon cancer

other:
breast
ovarian
lung
renal
prostate

Question 2

MC 1° liver tumor:

Answer 2

hepatic hemangioma (benign)

Question 3

MC 1° liver cancer:

Answer 3

hepatocellular carcinoma (hepatoma)

2nd MC - cholangiocarcinoma (<10%)

Question 4

Vascular tumor of the liver characterized by dilated vascular spaces filled with blood:

Answer 4

Cavernous hemangioma

Question 5

Hepatic adenoma risk is increased in young women who use:

Answer 5

oral contraceptives

resolves upon discontinuation of the pill

Question 6

Hepatic adenomas are (benign/malignant) and have potential to (metastasize/rupture).

Answer 6

Benign

Rupture

Question 7

Hepatic adenoma appearance - gross:

Histologic:

Answer 7

Smooth, well-circumscribed

cells resemble normal hepatocytes
disorganized, crowded
loss of lobar architecture
less cytoplasm

Question 8

Cancer coming from cells that line the bile ducts & create sinus passages for bile flow:

Answer 8

cholangiocarcinoma

Question 9

Rare 1° forms of liver cancer:

Answer 9

hepatoblastoma
mixed tumors
sarcoma of the liver

Question 10

In countries such as China, where it is endemic, _______ is the MC cause of hepatocellular carcinoma.

Answer 10

HBV (viral hepatitis)

MC cause in US: cirrhosis (2° to alcohol or HCV)

Question 11

Histology of HCC:

Answer 11

nuclear atypia
loss of normal architecture
collagen fibrosis

Question 12

Infants who contract HBV at birth have a _____x increased risk of developing HCC.

Answer 12

200x

Question 13

A clue to the presence of a HCC neoplasm is an elevated:

Answer 13

serum alpha-fetoprotein

may also obstruct biliary tract & lead to elev serum alk phos

Question 14

Is HCC MC in men or women?

Answer 14

M>F 8:1

Question 15

Risk factors for development of cholangiocarcinoma:

Answer 15

longstanding inflammation
chronic injury of the biliary epithelium

classified as: intra- or extra-hepatic
intra- further classified: hilar or peripheral (MC)

Question 16

Tumor markers you might use to differentiate cholangiocarcinoma from HCC:

Answer 16

CA 19-9

CA-50

Question 17

Type of endothelial tumor that may occur in the skin & soft tissue organs, such as breast, heart:

Answer 17

angiosarcoma

hepatic angiosarcomas are rare

Question 18

What exposure is of notable interest d/t association with hepatic angiosarcoma?

Answer 18

Arsenic

such as pesticides, polyvinyl chloride in plastics

Question 19

Biliary atresia occurs as a (congenital/acquired) dz?

Answer 19

BOTH

congenital - common bile duct blocked/absent
acquired - MC in autoimmune dz, common form of chronic rejection of a transplanted liver allograft.

Question 20

Features of biliary atresia in infants:

Tx:

Answer 20

progressive cholestasis
pruritis
fat-soluble vit deficiencies
malabsorption
eventual cirrhosis w/portal HTN
=> liver failure

surgical anatomoses
liver transplantation

Question 21

Congenital cystic dilatations of the bile ducts:

Answer 21

choledochal cysts

MC - Type I (80-90%)

most dx’d during infancy/childhood, mb found at any age
60-70% <10yo

Question 22

Most feared complication of choledochal cysts:

Answer 22

cholangiocarcinoma (9-28% incidence)

Question 23

Choledochal cyst presentation - infants:
children:
adults:

Answer 23

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

Question 24

Crystalline mass formed in GB by accretion of bile components:

Answer 24

Cholelithiasis

Question 25

Risk factors for cholelithiasis:

Answer 25

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

Question 26

Gall stones that have relocated to biliary ducts:

Answer 26

choledocholithiasis

freq. assoc w/obstruction of biliary tree -> ascending cholangitis

obstruction of ampulla of vater -> pancreatitis