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14 Onco > Surgery Hepatobiliary > Flashcards

Surgery Hepatobiliary Flashcards

1
Q

absolute contraindications for liver biopsy

A

significant coagulopathy, biliary dilatation, suspicion of hemangioma or echinococcal cyst

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2
Q

common primary site for metastatic liver tumors

A

colorectal

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3
Q

most common primary malignant tumor

A

hepatocellular ca

4th most common cancer in the ph

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4
Q

risk factors for hcc

A
  • viral hepatitis (b or c) !!
  • (alcoholic) cirrhosis !!
  • hemochromatosis !!
  • non-alcoholic steatosis hepatitis !!
  • schistosomiasis
  • chemicals
  • aflatoxins (a. flavusi, a fumigatus)
  • thorotrast
  • male gender
  • 50 yo
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5
Q

clinical presentation of hcc

A
  • asymptomatic when small
  • when glisson’s capsule is stretched = dull aching ruq associated with fever, malaise, and jaundice
  • hepatomegaly
  • weight loss
  • tender abdominal mass
  • cirrhosis
  • paraneoplastic syndrome
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6
Q

most common site for metastases

A

lung and diaphragm

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7
Q

laboratory tests for hcc

A

afp = elevated

liver function = abnormal but not specific

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8
Q

imaging for hcc

A
  • ct scan and mri
  • triphasic ct scan hypervascularity in arterial phase, hypodense in delayed phase
  • hepatic ultrasound (cannot asses if <2 cm)
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9
Q

management for hcc

A
  • resection (toc for no cirrhosis and child’s score A, with preserved liver function, without portal hpn)
  • transplant
  • chemo
  • chemoembolization
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10
Q

criteria for transplant

A
  • resection not possible

milan criteria

  • one nodule < 5 cm
  • 2-3 nodules all < 3 cm
  • no gross vascular invasion or extrahepatic spread
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11
Q

algorithm for hcc management

A
  • determine if resection or transplant candidate

- if non resectable: sorafenib or palliative care

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12
Q

2nd most common primary malignancy of the liver

A

cholangioca (adenoca of bile ducts)

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13
Q

presentation of cholangioca

A
  • painless jaundice !!
  • hepatomegaly and palpable mass
  • patho: hard grayish mass, metastasizes to liver and regional ln
  • uts or ct scan
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14
Q

subclassifications of cholangioca

A
  • peripheral or intrahepatic
  • central extrahepatic proximal: hilar cholangioca / klatskin tumor
  • central extrahepatic distal can be nodular, scirrhous, diffusely infiltrating, or papillary
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15
Q

what is klatskin tumor

A
  • originates in wall of bile duct at hepatic duct confluence (bifurcation)
  • obstructive jaundice
  • mgt: neo-adjuvant chemorad
  • poor prognosis
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16
Q

bismuth corlette classification for klatskin tumor

A

I common hepatic duct
II involves bifurcations
III either right or left intrahepatic duct
IV both right and left secondary intrahepatic duct

17
Q

management for klatskin tumor

A
  • surgical resection (only cure)

- intrahepatic cholangioca = hepatectomy

18
Q

t/f if primary sclerosing cholangitis is present, surgical resection is still possible

A

false, there are high recurrence rates

19
Q

prognosis for cholangioca

A
  • median survival is 32-38 mos
  • greatest risk for recurrence: presence of positive margins, ln positive tumors
  • most common cause of death: hepatic failure or cholangitis
20
Q

t/f the liver is the second most common site for all ca of abdomen, and most common site for hematogenous spread

A

true

21
Q

negative prognostic factors for hepatic metastasis

A
  • non-breast and non-colorectal origin
  • > 60 yo
  • disease free interval of <12 mos
  • (+) need major hepatectomy
  • (+) r2 resection
  • (+) extrahepatic metastasis
22
Q

predictors of poor outcoome

A
  • (+) primary node
  • tumor > 1 in location
  • > 5 cm
  • caa > 200 ng/mL
23
Q

most common primary malignant liver ca in children

A

hepatoblastoma

24
Q

presentation and tx for hepatoblastoma

A
  • abdominal distention, failure to thrive, and high afp

- tx: surgery, liver transplant

25
Q

what is angiosarcoma / malignant hemangioendothelioma

A
  • highly malignant tumor
  • metastasis to spleen and lungs
  • associated with chemical agents
  • poor prognosis
26
Q

what is ca of gallbladder

A
  • more in elderly
  • aggressive, poor prognosis
  • gallstones common
  • adenoca common
  • indistinguishable from cholecystitis and cholelithiasis
27
Q

risk factors for ca of gallbladder

A
  • polypoid lesion of the gb (> 10 mm = cholecystectomy and evaluation)
  • calcified “porcelain” gb
28
Q

diagnosis and management of ca of gallblader

A
  • uts, ct scan, mrcp
  • surgery
  • endoscopic or percutaneously placed stents
29
Q

prognosis for ca of gallbladder

A
  • 5 year survival 5%
  • t1: cholecystectomy
  • t2: extended cholecystectomy with lymphadenectomy

14 Onco (27 decks)

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