Tumours of the liver

Question 1

Normal structure of the liver (parenchyma)

Answer 1

Parenchyma is where hepatocytes are found

Question 2

What are contained within the portal tracts of the liver?

Answer 2

Bile ducts
Blood vessels
Fibroblasts
Inflammatory cells

Question 3

Primary tumours of the liver can originate from which cells?

Answer 3

Hepatocytes

Bile ducts

Question 4

Benign tumours of the liver are called

Answer 4

Adenoma

multiple are called adenomatosis

Question 5

What are liver adenomas driven by?

Answer 5

Often driven by exogenous steroids (eg OCP, anabolic steroids)

Question 6

What does rupture of adenomas of the liver cause?

Answer 6

Haemoperitneum

Question 7

Adenoma of the bile duct is

Answer 7

Meyenberg complex

Benign proliferation of bile duct cells

Question 8

How do bile duct adenomas appear?

Answer 8

Tiny white nodules

Grossly appear like metastases

Question 9

What is a haemangioma?

Answer 9

tumours of the blood vessels

found in 1% of the population

Question 10

What is focal nodular hyperplasia?

Answer 10

Regenerative arterialised nodule found in young females (20-40y/o)

Question 11

What is a malignant liver tumour called?

Answer 11

Hepatocellular carcinoma

Question 12

Where do Hepatocellular carcinomas usually arise?

Answer 12

Cirrhosis

Question 13

Incidence of Hepatocellular carcinoma is increasing due to which diseases?

Answer 13

In the East - Hep C/Hep B

West - cirrhosis due to alcoholism

Question 14

What is Hepatocellular carcinoma composed of and what do they secrete?

Answer 14

May contain liver-origin substances eg. Bile, Antitrypsin globules

Secrete AFP which can be detected in the blood and measured

Question 15

What is a cholangiocarcinoma?

Answer 15

Malignant tumour of the bile duct cells

Question 16

What is cholangiocarcinoma due to?

Answer 16

Chronic inflammation e.g. PSC/liver fluke

Question 17

Nature of cholangiocarcinoma

Answer 17

Aggressive

Difficult to resect at the hilum of the liver

Question 18

What is angiosarcoma?

Answer 18

Aggressive tumour of blood vessels

Strongly associated with toxins like:

Vinyl chloride (records)
Thorotrast (contrast agent)

Question 19

Secondary tumours of the liver are caused by

Answer 19

metastases of liver tumour

Question 20

Commonest sites of secondary liver tumours

Answer 20

Lung
Breast
Colon
Pancreas

Question 21

What surgery is used for metastatic carcinomas?

Answer 21

Ultrasound, heat, tissue glue, clips – prevent haemorrhage

Intra-operative ultrasound – see where you are cutting

Question 22

Gallbladder pathology is caused by…

Answer 22

Cholesterol, bile salts, bacterial growth + calcification

Slowly form a stone (calculus)

Question 23

Risk factors of gallstone pathology

Answer 23

female,
middle aged,
overweight

Question 24

Clinical features of gallstone pathology

Answer 24

Asymptomatic

Crampy pain

Question 25

Complications of gallstone pathology

Answer 25

Obstruction at neck – pain; Obstruction at common bile duct – jaundice Chronic cholecystitis Perforation Obstruction at pancreatic level – pancreatitis

Question 26

What is Chronic cholecystitis?

Answer 26

Inflammation of the gallbladder Due to chemical or bacterial causes Over time causes fibrosis, ulceration of gallbladder

Question 27

Clinical features of Chronic cholecystitis

Answer 27

Pain Fever Jaundice

Question 28

Diagnosis methods of Chronic cholecystitis

Answer 28

Ultra sound scan (bc 25% are visible on x ray)

Question 29

Treatment of chronic cholecystitis

Answer 29

Cholecystectomy