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HEPATOLOGY > SURGERY: LIVER CANCER > Flashcards

SURGERY: LIVER CANCER Flashcards

1
Q

⚡⚡ MOST COMMON MALIGNANCY in LIVER
⚡⚡ MOST COMMON 1° MALIGNANCY in LIVER
⚡⚡ MOST COMMON 1° MALIGNANCY in LIVER in CHILDREN

A

⚡⚡ MOST COMMON MALIGNANCY in LIVER
🎯 METASTASIS

⚡⚡ MOST COMMON 1° MALIGNANCY in LIVER
🎯 HCC

⚡⚡ MOST COMMON 1° MALIGNANCY in LIVER in CHILDREN
🎯 HEPATOBLASTOMA

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2
Q

⚡⚡ MOST COMMON BENIGN Tumor of LIVER

⚡⚡ 2nd MOST COMMON BENIGN Tumor of LIVER

A

⚡⚡ MOST COMMON BENIGN Tumor of LIVER
🎯 HEMANGIOMA

⚡⚡ 2nd MOST COMMON BENIGN Tumor of LIVER
🎯 FOCAL NODULAR HYPERPLASIA (FNH)

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3
Q

⚡⚡ MOST COMMON age group of HEMANGIOMA

A

♀️ ≥ 45 yrs

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4
Q

🧑🏻‍⚕️ Clinical Features HEMANGIOMA

A
  1. Asymptomatic
  2. Large Hemangiomas ➡️ Kasabach Merritt syndrome ➡️ Bleeding
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5
Q

Types of HEMANGIOMA

A
  1. Capillary HEMANGIOMA
  2. Cavernous HEMANGIOMA
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6
Q

Kasabach Merritt Syndrome

🧠⚡HTC⚡

A
  1. Hemangioma
  2. Thrombocytopenia
  3. Coagulopathy
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7
Q

🩺 IOC for HEMANGIOMA
🩺 IOC for FOCAL NODULAR HYPERPLASIA
🩺 IOC for Hepatic Adenoma
🩺 IOC for Von Mayenburg Disease
🩺 IOC for Peliosis Hepatis

A

CECT

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8
Q

CECT Findings of HEMANGIOMA

A

Arterial phase: Peripheral Nodular Enhancement

Washout phase: Homogenous Enhancement

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9
Q

Giant Live Hemangioma is >

A

5 cm

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10
Q

LIGHT BULB Sign is seen in MRI in

A

Liver HEMANGIOMA
⬇️
Hypointense on T1
Hyperintense on T2

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11
Q

BEST INVESTIGATION to Diagnose HEMANGIOMA if CT & MRI unavailable

A

99m Technitium labelled RBC

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12
Q

Liver HEMANGIOMA

A
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13
Q

Large HEMANGIOMA in children leads to

A

CONGESTIVE HEART FAILURE
⬇️
2° to ARTERIOVENOUS SHUNTING

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14
Q

💊💉 MANAGEMENT of LIVER HEMANGIOMA

A

✨ Observation
✨ Angioembolization ➡️ Large & symptomatic
✨ TOC: Enucleation with INFLOW CONTROL

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15
Q

TOC for HEMANGIOMA

A

Enucleation with INFLOW CONTROL

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16
Q

Etiology of FNH

A
  1. Unknown
  2. 2° to VASCULAR INSULT to Liver
  3. OCP use
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17
Q

Difference BETWEEN Focal Nodular Hyperplasia & Adenoma

A

Focal Nodular Hyperplasia
✨ Bile Duct structure ➕
✨ Hepatocytes ➕
✨ Kupffur cells ➕
✨ Necrosis & Hemorrhage ⛔
✨ Capsule ⛔

HEPATIC ADENOMA
✨ Bile Duct structure ⛔
✨ Hepatocytes ➕
✨ Kupffur cells ⛔
✨ Necrosis & Hemorrhage ➕
✨ Capsule ➕

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18
Q

🧑🏻‍⚕️ Clinical Features of Focal Nodular Hyperplasia

A

Asymptomatic

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19
Q

Central Stellate Scar

🧠⚡SOF CR⚡

A
  1. Serous Cystadenoma of Pancreas
  2. ONCOCYTOMA
  3. Focal NODULAR HYPERPLASIA of Liver
  4. Chromophobe RCC
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20
Q

INVESTIGATION to distinguish BETWEEN Hepatic Adenoma & FNH

A

MRI with GADOBENATE DIMEGLUMINE

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21
Q

⭐ Spoke wheel Pattern on ANGIOGRAPHY

⭐ Spoke wheel Pattern on MRI

A

⭐ Spoke wheel Pattern on ANGIOGRAPHY
🎯 FOCAL NODULAR HYPERPLASIA

⭐ Spoke wheel Pattern on MRI
🎯 MENINGIOMA

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22
Q

💊💉 MANAGEMENT of FOCAL NODULAR HYPERPLASIA

A

Observation
✨ Persistent Symptomatic: RESECTION

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23
Q

F > M

A
  1. Liver Hemangioma
  2. Focal Nodular Hyperplasia
  3. Hepatic Adenoma
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24
Q

Malignant conversion is possible in which Benign Liver Tumour

A

Hepatic Adenoma

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25
Q

Hemorrhage & Necrosis is seen in Hepatic Adenoma DUE TO:

A

Lack Portal Venous Supply

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26
Q

PHACES Syndrome

A
  1. Posterior Fossa malformation
  2. Hemangioma
  3. Arterial abnormalities
  4. Cardiac abnormalities
  5. Eye abnormalities
  6. Eternal Cleft
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27
Q

🧑🏻‍⚕️ Clinical Features of HEPATIC ADENOMA

A

Asymptomatic
Abdominal Pain
Non traumatic Hemoperitoneum ➡️ Hypovolemia

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28
Q

Liver Specific MRI Contrast Agents

A

Gadobenate Dimenglumine

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29
Q

Which Benign Tumour of Liver has HIGH RISK OF SPONTANEOUS RUPTURE

A

Hepatic Adenoma

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30
Q

CECT Finding of HEPATIC ADENOMA

A

Peripheral arterialization of tumour

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31
Q

Liver Adenoma is more common in which gynecological patient

32
Q

💊💉 MANAGEMENT of HEPATIC ADENOMA

A

✨ Acute Hemorrhage: Hepatic Artery Embolization
✨ Resection

33
Q

Hypervascular well circumscribed tumour supplied bye Peripheral arteries

A

Hepatic Adenoma

34
Q

Bordeaux Classification is used for

A

Hepatic Adenoma

35
Q

Bordeaux Classification
🧠⚡BHI⚡

A
  1. Beta catenin mutated
    ✨ Beta catenin Exon 7/8 mutated
    ✨ Beta catenin Exon 3 mutated
  2. HNF 1 alpha mutated
  3. Inflammatory
  4. Sonic Hedgehog activated
  5. Unclassified
36
Q

MAXIMUM RISK OF MALIGNANT CONVERSION WITH WHICH BORDEAUX TYPE HEPATIC ADENOMA

A

Beta catenin mutated

37
Q

MAXIMUM RISK OF BLEEDING WITH WHICH TYPE HEPATIC ADENOMA

A

Inflammatory

38
Q

MAXIMUM RISK OF MULTIPLE ADENOMA WITH WHICH TYPE HEPATIC ADENOMA

A

HNF 1 ALPHA MUTATED

39
Q

WHICH TYPE HEPATIC ADENOMA develops in MALE on ANABOLIC STEROIDS

A

Beta catenin mutated

40
Q

HEPATIC ADENOMA HAS HIGH RISK OF MALIGNANT CONVERSION in Male or Female?

41
Q

💊💉 MANAGEMENT of HEPATIC ADENOMA in ♀️
✨ Size < 5cm
✨ Size > 5cm

A

✨ Size < 5cm
🎯 DISCONTINUE OCPs
🎯 MRI Surveillance (atleast 5 yearly)
⚡ Annual in NON-INFLAMMATORY
⚡ Biannual in INFLAMMATORY

✨ Size > 5cm
🎯 RESECTION

42
Q

Von Mayenburg Disease

A

Multiple Cystic Liver Hamartoma

43
Q

Cause of Von Mayenburg Disease

A

Failure of Regression of Embryonic Biliary Duct

44
Q

ASSOCIATED DISORDER WITH VON MAYENBURG DISEASE

A

PCKD
CHOLANGIOCARCINOMA

45
Q

Peliosis Hepatis

A

Multiple Cavernous HEMANGIOMAS of the liver

46
Q

Causes of Peliosis HEPATIC
🧠⚡EA³T ⚡

A
  1. Estrogen
  2. Androgens
  3. A Vitamin
  4. Azathioprine
  5. Tamoxifen
  6. Immunocompromised
  7. AIDS
  8. POST TRANSPLANT
47
Q

💊💉 MANAGEMENT of VON MAYENBURG DISEASE & PELIOSIS HEPATIS

A

Observation
✨ Bleeding ➕: Angioembolization

48
Q

LIRADS
0-5

A

Liver Imaging Reporting & Data Systems

49
Q

LRM: LIRADS

A

Definitive MALIGNANCY: Not HCC Specific

50
Q

LR-TIV: LIRADS
Meaning?

A

Definitive Tumour in Vein

51
Q

LIRADS vs BIRADS

A

BIRADS 0-6

52
Q

⚒️ RISK FACTOR for HEPATOCELLULAR CANCER HCC
🧠⚡H³A³T³A² NO²C²⚡

A
  1. Hepatitis B & Hepatitis C CHRONIC Infection
  2. Hemochromatosis
  3. Hereditary Hemorrhagic Telengiectasia
  4. Alcohol
  5. Autoimmune Chronic hepatitis
  6. Alpha 1 antitrypsin deficiency
  7. Thorotrast Exposure
  8. Tyrosinemia
  9. Type 1 & 3 Glycogen Storage Disorder
  10. Alagille Syndrome
  11. Aflatoxin
  12. NASH
  13. Obesity
  14. Orotic aciduria
  15. Cirrhosis
  16. Cigarette smoking
  17. 1° Biliary Cirrhosis
  18. Wilson’s disease
53
Q

Thorotrast Exposure leads to
🧠⚡RCH⚡

A
  1. Renal Cell Cancer RCC
  2. Cholangiocarcinoma
  3. HEPATOCELLULAR cancer HCC
54
Q

Vinyl Chloride Exposure leads to

A

Angiosarcoma

55
Q

Angiosarcoma develops on EXPOSURE with
🧠⚡VAT⚡

A
  1. Vinyl Chloride
  2. Arsenic
  3. Thorotrast
56
Q

MALE Predominant Liver Condition

57
Q

⚡⚡ MOST COMMON & EARLIEST SYMPTOM OF HCC

A

Hepatosplenomegaly

Others:
Pain
Jaundice ( Late Sign )

58
Q

Preneoplastic condition leading to HCC
🧠⚡HDr⚡

A
  1. Hepatic Adenoma
  2. Dysplastic Nodule
59
Q

Paraneoplastic Syndrome ASSOCIATED with HCC
🧠⚡Only 1 HYPO, Others HYPER ⚡

A
  1. Hypoglycemia
  2. Hypercalcemia
  3. Hypercholestrolemia
  4. Hypererythrocytosis ( Polycythemia)
  5. Hyperfeminization
  6. Hypertension
60
Q

⚡⚡ MOST COMMON Paraneoplastic Syndrome ASSOCIATED with HCC

A

Hypoglycemia

61
Q

⚡⚡ MOST COMMON BIOCHEMICAL Paraneoplastic Syndrome ASSOCIATED with HCC

A

Hypercholestrolemia

62
Q

Angioinvasive Tumours

63
Q

🩺 IOC of HCC

A

Triple Phase CT
✨ Hyperdense in Arterial Phase
✨ Early Washout

64
Q

Gold STANDARD INVESTIGATION FOR HCC

A

Trucut Biopsy

65
Q

🩺 IOC for STAGING FOR HCC

66
Q

Tumour Markers of HCC

🧠⚡ HAG FAD N⚡

A
  1. HepPar-1
  2. Alpha Feto Protein AFP
  3. Glypican 3
  4. alpha L FUCOSIDE
  5. Des Gamma Carboxy Prothrombin (OR) PIVKA2
  6. Neurotensin B
67
Q

⭐ NORMAL AFP VALUES
⭐ ELEVATED AFP VALUES
⭐ AFP VALUE DIAGNOSTIC FOR HCC

A

⭐ NORMAL AFP VALUES
🎯 < 20 ng/ml

⭐ ELEVATED AFP VALUES
🎯 20-200 ng/ml

⭐ AFP VALUE DIAGNOSTIC FOR HCC
🎯 > 200 ng/ml

68
Q

Which marker is used to monitor RESPONSE to Therapy in HCC

69
Q

AFP Elevated in

A
  1. HCC
  2. HEPATOBLASTOMA
  3. CHOLANGIOCARCINOMA
  4. COLORECTAL metastasis
  5. NSGCT of Ovary & Tumour
    ✨ Yolk Sac
    ✨ Embryonal Carcinoma
70
Q

AFP > 400 ng/ml ➕ Typical Radiological Findings of Cancer

71
Q

Cause of DEATH IN HCC

A

60% ➡️ Cancer
40% ➡️ Liver Failure

72
Q

Functional Status of Liver is assessed by

A
  1. Child Pugh Score
  2. MELD Score
  3. MELD Sodium Score
73
Q

Child Pugh Score
🧠⚡ABCDE ⚡
🧠⚡Ek BAAP⚡

A
  1. Albumin
  2. Bilirubin
  3. Coagulation
    ✨ PT
    ✨ INR
  4. Distension: Ascites
    Mild to Moderate = Diuretic Responsive
    Severe = Diuretic Resistance
  5. Encephalopathy
    Mild to Moderate = G1 or G2
    Severe = G3 or G4
74
Q

Child Pugh Turcott Score

A

Calculated by adding All parameters of Child Pugh Score
5-6: Least Severe Liver Disease
7-9: Moderately Severe Liver Disease
10-15: Most Severe Liver Disease

75
Q

MELD SCORE
Model for End Stage Liver Disease
🧠 ⚡CBI⚡
🧠⚡ MELD SODIUM Score : Just add Special CBI⚡

A
  1. Creatinine Serum
  2. Bilirubin
  3. INR
76
Q

PELD Score used for

A

Liver TRANSPLANT

77
Q

PELD Score
🧠⚡BANIA⚡

A
  1. Bilirubin
  2. Albumin
  3. Nutrition
  4. INR
  5. Age (< 1yr)

HEPATOLOGY (16 decks)

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