T11-L3: Hepatobillary System and Pancreas II

Question 1

Give benign lesions of the liver.

Answer 1

• Adenomas - driven often by exogenous steroids e.g. OCP, oestrogen and anabolic steroids
• Adenomas of the bile duct
• Haemangioma - very common, often an incidental finding and are not specific to the liver

Question 2

What is Focal Nodular Hyperplasia?

Answer 2

It is a mass in the liver but not neoplastic. It is seen in young women (20-40). One of the arteries in the liver becomes abnormally hyperplastic and overgrows bringing too much oxygenated blood to that area causing the hepatocytes there to proliferate much quicker than normally. It looks like a tumour on imaging.

Question 3

What is the most common malignant neoplasm of the liver?

Answer 3

Hepatocellular carcinoma. It uses arises due to end stage cirrhosis.

Question 4

How can you detect hepatocellulr carcinoma?

Answer 4

They secret AFP (alpha-foetal protein - embryonic protein) which can be detected which can be detected in the blood and measures. The more malignant cells you have, the higher the AFP.

Question 5

Though often unknown, what can we include in the causes of cholangiocarcinoma?

Answer 5

• Primary Sclerosing Cholangitis (PSC) - autoimmune chronic inflammatory condition of the bile duct
• Liver flukes

Question 6

What are associated with angiosarcoma?

Answer 6

Toxins inc. vinyl chloride and thorotrasts. It is a very aggressive tumour.

Question 7

What are the commonests sites of origin of metastatic liver tumours?

Answer 7

• Lung
• Breast
• Colon
• Pancreases

They may replace large volumes of the liver before the liver function is compromised (it can replace up to 90% before compromise) - this is as the liver has a large capacity to regenerate. Paitents do not get jaundice until very end stage disease.

Question 8

What is the aetiology and risk factors for gall stones?

Answer 8

Cholesterol, bile salts, bacterial growth and calcification slowly from a stone (calculus) - months or even many years.

Risk factors include being female, middle aged and overweight.

Question 9

Give complications of gallstones.

Answer 9

They often present asymptomatic in 80% and with billary colic.

Complications include:

- Obstruction at neck, especially cystic duct, causes pain; obstruct usually occurs at common bile duct leads to jaundice 
- Chronic cholecystitis 
- Perforation 
- Obstruction at pancreatic level - pancreatitis as it 	- stopes the pancreatic secretions. The secretions contain toxic enzymes and so they can cause inflammation of the pancreas. Chronic pancreatitis and obstruction over many years can cause diabetes.