TUMOURS OF THE BILIARY TRACT Flashcards
Who is predominantly affected by carcinoma of the gall bladder?
Elderly
What increases the risk of carcinoma of the gall bladder?
Chronic inflammation as a result of gallstones
What are the clinical features of carcinoma of the gall bladder?
Jaundice
Right upper quadrant mass
Malaise
Weight loss
How is carcinoma of the gall bladder diagnosed?
Diagnosis is usually made at cholecystectomy for gallstone symptoms.
Is ultrasound useful in the diagnosis of carcinoma of the gall bladder?
Ultrasound in poor at detecting gall bladder carcinomas but may detect local liver metastasis.
What is the prognosis for someone with carcinoma of the gall bladder?
Usually poor due to its late presentation and early local metastasis. But if caught incidentally radical resection may offer cure.
What is cholangiocarcinoma?
Adenocarcinoma of the bile duct
Are cholangiocarcinomas intra- or extra- hepatic?
Can be either
What are the clinical features of intra-hepatic cholangiocarcinoma?
Tend to invade liver parenchyma and present in a similar fashion to primary liver tumours, with jaundice being rare. Weight loss Malaise Nausea Vomiting
What are the clinical features of extra-hepatic cholangiocarcinoma?
Progressive jaundice similar to sclerosing cholangitis Weight loss Malaise Nausea Vomiting
What will LFTs of someone with extra-hepatic cholangiocarcinoma show?
Cholestatic jaundice - Raised ALP and raised bilirubin
Is ultrasound useful in the diagnosis of cholangiocarcinoma?
Yes. If it is extra-hepatic it will show dilated bile ducts. If it is intra-hepatic it will show non-specific lesions within liver parenchyma. MRCP or ERCP are needed. ERCP for biopsy.
What autoimmune disease is associated with cholangiocarcinoma?
20% of patients with chronic primary sclerosing cholangitis will develop cholangiocarcinoma. Hard to differentiate between the two without biopsy from ERCP.
