Diseases of the Hepatobiliary System 2 Flashcards Preview

Year 2 Clinical Pathology > Diseases of the Hepatobiliary System 2 > Flashcards

Flashcards in Diseases of the Hepatobiliary System 2 Deck (41)
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1
Q

Cirrhosis is a major risk factor for what cancer?

A

hepatocellular carcinoma

2
Q

Is hepatocellular carcinoma (HCC) more common in males or females?

A

males

3
Q

Why is the incidence of HCC thought to be rising in the UK?

A

Obesity and alcohol

4
Q

HCC can show geographical variantion based on the prevelance of which infection?

A

Viral hepatitis

5
Q

what are the 2 clinical features of HCC, when in the disease course do they arise?

A

Worsening liver function

Weight loss

6
Q

What are the 2 possible surveillance methods for patients with cirrhosis?

A

1) 6 monthly USS
2) Blood test possibly - raised alpha feto-protein in serum in 75% (less than 50% in non cirrhotic patients and small HCC less than 3cm)

7
Q

What is the macroscopic appearance in HCC, is there just one lesion?

A

Expansile soft nodule which are often green (bile), this is often multifocal in cirrhosis

8
Q

Well differentiated HCC is likely to produce what?

A

Bile

9
Q

What are the 2 main differential diagnosis in liver biopsy investigation when unclear diagnosis?

A

1) benign liver v well differentiated HCC

2) Metastatic carcinoma v poorly differentiated HCC

10
Q

What is the prognosis of HCC?

A

very poor (less than 1 year) unless diagnosed early - hence surveillance of cirrhosis is v important

11
Q

What are the 2 treatments for confined HCC?

A

1) surgery is non cirrhotic, small and peripheral

2) Transplant is 1 tumour less than 5 cm or less than 3 less than 3cm

12
Q

What is the 3 treatment options for non resectable (multiple, large, metastasised) HCC?

A

1) Ablation - radiofrequency
2) Embolisation
3) Chemo - sorafenib

13
Q

What is considered diagnosis HCC early in terms of TMN staging?

A

pT1 (solitary tumour, no vascular invasion) and pT2 (solitary tumour with vascular invasion or multiple tumours, none more than 5cm in greatest diameter)

14
Q

What is more common, primary liver cancer or metastasis to liver?

A

Metastasis to liver

15
Q

What metastasis results in few large nodules in liver?

A

Large bowel

16
Q

What 5 metasases result in multinodular or infiltrative?

A

1) Lung
2) Pancreas
3) Breast
4) Stomach
5) Melanoma

17
Q

In addition to HCC what is the other primary liver cancer?

A

Cholangiocarcinoma - and adenocarcinoma arising in the bile ducts

18
Q

What are the 2 classifications of cholangiocarcinoma?

A

1) intrahepatic - from small intrahepatic ducts

2) perihilar - from large ducts

19
Q

Does intrahepatic cholangiocarcinoma present early or later?

A

Later - is it mass forming

20
Q

What is the 1 risk factor for intrahepatic cholangiocarcinoma?

A

Cirrhosis

21
Q

Does perihilar cholangiocarcinoma present early or late?

A

Early as it causes obstructive jaundice early

22
Q

What are the 2 risk factors for perihilar cholangiocarcinoma?

A

Bile duct disease:

1) Primary sclerosing cholangitis
2) Liver flukes

23
Q

What are gall stones caused by?

A

Precipitation of the constituents of bile when it is concentrated in the gall bladder

24
Q

What is the prevelance of gall stones amongst UK adults?

A

10-20%

25
Q

What are the 3 risk factors for gall stones?

A

1) Female
2) Obesity
3) Diabetes
ie an imbalance of bile constituents

26
Q

What are the 4 main types of gall stones?

A

1) Cholesterol stones - yellow/opaque
2) Pigments stones - small, black - in haemolytic anaemia
3) Mixed stones - most comon
4) 10% contain calcium - visible on plain x ray

27
Q

Gallstones predispose to what cancer?

A

Cancer of the gall bladder

28
Q

Give the 3 inflammatory complications of gall stones?

A

1) Cholecystitis (inflammation of gall bladder)
2) Pancreatitis
3) Cholangitis (inflammation of bile duct)

29
Q

Why do gall stones lead to biliary colic and jaundice?

A

Due to obstruction of the bile system

30
Q

Gall stones can cause mucocele, what does this refer to?

A

Mucous retention cyst in the gall bladder

31
Q

Why can gall stones lead to cholangitis and liver abscesses?

A

Due to infection of the static bile

32
Q

How can gall stones lead to gall stone ileus?

A

Due to intestinal obstruction by a gall stone that has entered the gut through a fistulous connection with bladder

33
Q

How common is cholecystectyomy?

A

1200 per year in leeds

34
Q

What are the 4 indications for cholecystectomy?

A

1) Pain
2) gall stones
3) Pancreatitis
4) Gall stone polyp - rarely

35
Q

What is acute cholecystisis caused by?

A

Duct blocked by a stone, initially sterile then becomes infected

36
Q

What are the 2 complications of acute cholecystitis?

A

1) Empyema

2) Rupture

37
Q

What is the cause of chronic cholecystitis?

A

Usually caused by small fibrotic stones

38
Q

How do the macroscopic appearances of acute and chronic cholecystitis differ?

A

Acute - large, swollen, congested, ulcerated

Chronic - fibrosis, rokitansky aschoff sinuses

39
Q

Why are all removed gall bladders examined histologically?

A

To detect bladder cancer

40
Q

What percentage of gall bladder cancers are known about before surgery?

A

50%, the other 50% found in routine cholecystectomy

41
Q

What is the associated pre malignant lesion in gall bladder cancer?

A

Polyp showing dysplasia

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