Tumours of the liver Flashcards
Normal structure of the liver (parenchyma)
Parenchyma is where hepatocytes are found
What are contained within the portal tracts of the liver?
Bile ducts
Blood vessels
Fibroblasts
Inflammatory cells
Primary tumours of the liver can originate from which cells?
Hepatocytes
Bile ducts
Benign tumours of the liver are called
Adenoma
multiple are called adenomatosis
What are liver adenomas driven by?
Often driven by exogenous steroids (eg OCP, anabolic steroids)
What does rupture of adenomas of the liver cause?
Haemoperitneum
Adenoma of the bile duct is
Meyenberg complex
Benign proliferation of bile duct cells
How do bile duct adenomas appear?
Tiny white nodules
Grossly appear like metastases
What is a haemangioma?
tumours of the blood vessels
found in 1% of the population
What is focal nodular hyperplasia?
Regenerative arterialised nodule found in young females (20-40y/o)
What is a malignant liver tumour called?
Hepatocellular carcinoma
Where do Hepatocellular carcinomas usually arise?
Cirrhosis
Incidence of Hepatocellular carcinoma is increasing due to which diseases?
In the East - Hep C/Hep B
West - cirrhosis due to alcoholism
What is Hepatocellular carcinoma composed of and what do they secrete?
May contain liver-origin substances eg. Bile, Antitrypsin globules
Secrete AFP which can be detected in the blood and measured
What is a cholangiocarcinoma?
Malignant tumour of the bile duct cells
What is cholangiocarcinoma due to?
Chronic inflammation e.g. PSC/liver fluke
Nature of cholangiocarcinoma
Aggressive
Difficult to resect at the hilum of the liver
What is angiosarcoma?
Aggressive tumour of blood vessels
Strongly associated with toxins like:
Vinyl chloride (records) Thorotrast (contrast agent)
Secondary tumours of the liver are caused by
metastases of liver tumour
Commonest sites of secondary liver tumours
Lung
Breast
Colon
Pancreas
What surgery is used for metastatic carcinomas?
Ultrasound, heat, tissue glue, clips – prevent haemorrhage
Intra-operative ultrasound – see where you are cutting
Gallbladder pathology is caused by…
Cholesterol, bile salts, bacterial growth + calcification
Slowly form a stone (calculus)
Risk factors of gallstone pathology
female,
middle aged,
overweight
Clinical features of gallstone pathology
Asymptomatic
Crampy pain
Complications of gallstone pathology
Obstruction at neck –
pain;
Obstruction at common bile duct – jaundice
Chronic cholecystitis
Perforation
Obstruction at pancreatic level – pancreatitis
What is Chronic cholecystitis?
Inflammation of the gallbladder
Due to chemical or bacterial causes
Over time causes fibrosis, ulceration of gallbladder
Clinical features of Chronic cholecystitis
Pain
Fever
Jaundice
Diagnosis methods of Chronic cholecystitis
Ultra sound scan (bc 25% are visible on x ray)
Treatment of chronic cholecystitis
Cholecystectomy
