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86 Cards in this Set
- Front
- Back
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What are the benign tumors of the liver?
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focal nodular hyperplasia, hepatic adenoma, bile duct adenoma, hemangioma
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What are the malignant tumors of the liver?
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hepatocellular carcinoma, cholangiocarcinoma, hepatoblastoma, angiosarcoma, mets
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What is focal nodular hyperplasia?
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nodular overgrowth of hepatocytes around AV malformation
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Who gets focal nodular hyperplasia?
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any age group
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What does focal nodular hyperplasia look like?
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central stellate scar, contains bile ducts
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Who gets hepatic adenomas?
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young women on oral contraceptives
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What is the problem with hepatic adenomas?
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can rupture and bleed
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What does a hepatic adenoma look like microscopically?
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hepatocytes in cords, looksl ike liver, no bile ducts in portal triads
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How do hepatic adenomas present?
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hemorrhage in or around adenoma, can cause pain, massive bleeding
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What are the most common liver cancers in the US?
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mets
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What is the most common liver cancer in trans-Saharan Africa and Asia?
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hepatocellular carcinoma
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Why is hepatocellular carcinoma popular in Asia and Africa?
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prevalence of Hep B
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What diseases are associated with hepatocellular carcinoma?
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HBV, HCV, aflatoxin
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What epi things are associated with hepatocellular carcinoma?
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older age, male
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What substances are associated with hepatocellular caricoma?
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alcohol, iron accumulation, nutrition
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What are the symptoms of hepatocellular carcinoma?
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non-specific: abdominal pain, weight loss, fatigue
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What blood test is associated with hepatocellular carcinoma?
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elevated serum alpha-fetoprotein
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Where do hepatocellular carcinomas spread?
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lungs, bone, regional lymph nodes
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What do HCCs look like grossly?
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large masses with smaller satellite tumors
can have multiple smaller nodules or diffuse carcinoma areas of necrosis, green color due to bile |
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What are the microscopic changes with HCC?
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form irregular, disorderly trabeculae, can have moderately dysplastic cells that resembles active cirrhosis
can retain canaliculi |
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What is the prognosis of HCC?
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7 month median survival
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What determines prognosis of HCC?
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stage
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What causes death with HCC?
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liver failure, cachexia, tumor rupture with hemorrhage
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What is a fibrolamellar carcinoma?
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subtype of hepatocellular carcinoma in young adults, not associated with other risk factors
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What does a fibrolamellar carcinoma look like?
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large oncocytic tumor cells separated by bundles of collagen
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What is special about a fibrolamellar carcinoma?
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better overall prognosis
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What is a cholangiocarcinoma?
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primary adenocarcinoma that resembles the bile duct epithelium, second most common liver tumor
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What etiologies are associated with cholangiocarcinomas?
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primary sclerosing cholangitis, infection with Clonorchis sinensis, thorotrast, anabolic steroids
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What is the clinical presentation of cholangiocarcinoma?
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non-specific symptoms: ab pain, weight loss, fatigue
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What is the prognosis of cholangiocarcinoma?
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about 7 months
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What is the gross presentation of cholangiocarcinoma?
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large solitary mass, can be mroe diffuse
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What is a Klatskin tumor?
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cholangiocarcionma involving hepatic ducts in porta hepatitis
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How does a Klatskin tumor present?
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biliary obstruction, secondary biliary cirrhosis
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What is a hemangioma?
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most common liver vascular tumor, usually incidental
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With what are angiosarcomas associated?
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exposure to vinyl chloride, thortrast, arsenic
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What is a hepatoblastoma?
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hepatic analog of Wilms' tumor
looks like fetal liver tissue, very aggressive and grows rapidly |
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What groups have high rates of biliary calculi?
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Navajo Native Americans, older age, obese patients, middle aged females
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What % of patients with biliary calculi have symptoms?
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half
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What is in bile?
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bile salts, lecithin, cholesterol, bilirubin, electrolytes, protein
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What causes biliary calculi?
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solids of cholesterol, bilirubin, calcium, mixes
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Who gets symptomatic bilirubin calculi as kids?
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people with chronic hemolytic anemias
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When do you see calcium salts?
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with cholesterol calculi
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How do you see calcium calculi?
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on X-Ray plain films
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What are the symptoms of calculi?
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right upper quadrant pain that radiates to right scapula (biliary colic)
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What causes biliary colic?
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transient obstruction of gallbladder by calculi, causes spasm of muscularis of gallbladder and cystic duct
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What are the changes to the gallbladder wall in symptomatic calculi patients?
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thickened gallbladder wall due to hypertrophy, fibrosis, edema of serosa
microscopic diverticula of mucosa through hypertrophic muscularis can see infiltration by lymphocytes and plasma cells |
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What are Rokitansky-Aschoff sinuses?
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microscopic diverticula of the mucosa through the hypertrophic muscularis
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What are the complications of calculi?
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acute cholecystitis, extrahepatic bile duct obstruction, gallstone ileus, adenocarcinoma
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What causes acute cholecystitis?
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persistent obstruction of cystic duct by calculus with chemical irritation by the bile
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What are the symptoms of acute cholecystitis?
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severe, persistent, debilitating pain, tenderness, fever
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What are the complications of acute cholecystitis?
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necrosis, perforation with bile peritonitis
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What causes acalculus acute cholecystitis?
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bacterial infection, regurgitation of pancreatic juice, or ischemia
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What causes extrahepatic bile duct obstruction?
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small calculi pass into cystic duct, causes obstruction of cystic duct, common bile duct, sphincter
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What are the symptoms of extrahepatic bile duct obstruction?
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pain, biliary colic
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What are the complications of extrahepatic bile duct obstruction?
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cholestasis, ascending cholangitis, secondary biliary cirrhosis, form more calculi in ducts
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What is gallstone ileus?
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obstruction of the intestine by biliary claculus
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What causes gallstone ileus?
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passage of stone from gallbladder to duodenum through extrahepatic duct or through fistula between gallbladder and intestine
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What cancer is linked to calculi?
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carcinoma of gallbladder and carcinoma of extrahepatic ducts
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Who gets adenocarcinomas of the gallbladder?
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elderly women
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What is the prognosis of adenocarcinomas of the gallbladder?
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very poor
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What causes cholesterolosis?
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precipitated cholesterol is phagocytized by macrophages in lamina propria of gallbladder mucosa
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What does cholesterolosis look like grossly?
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delicate yellow streaks in gallbladder mucosa
can have polyps protruding from surface |
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What does cholesterolosis look like microscopically?
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foamy, lipid filled macrophages in lamina propria
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Who gets cholesterolosis?
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patients with symptomatic calculi
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What are most carcinomas of the gallbladder?
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moderately differentiated adenocarcinomas
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Which is more common carcinoma of the GI tract or of the biliary system?
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carcinoma of the GI tract
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Where do carcinomas of the biliary system metastasize to?
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regional lymph nodes, liver
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What is the prognosis of carcionmas of the biliary tract?
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poor
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What is linked to carcinoma of the gallbladder?
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calculi
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When is carcinoma of the gallbladder usually diagnosed?
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at cholecystectomy for concurrent symptomatic calculus disease
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What causes cholesterolosis?
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precipitated cholesterol is phagocytized by macrophages in lamina propria of gallbladder mucosa
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What does cholesterolosis look like grossly?
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delicate yellow streaks in gallbladder mucosa
can have polyps protruding from surface |
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What does cholesterolosis look like microscopically?
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foamy, lipid filled macrophages in lamina propria
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Who gets cholesterolosis?
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patients with symptomatic calculi
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What are most carcinomas of the gallbladder?
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moderately differentiated adenocarcinomas
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Which is more common carcinoma of the GI tract or of the biliary system?
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carcinoma of the GI tract
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Where do carcinomas of the biliary system metastasize to?
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regional lymph nodes, liver
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What is the prognosis of carcionmas of the biliary tract?
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poor
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What is linked to carcinoma of the gallbladder?
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calculi
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When is carcinoma of the gallbladder usually diagnosed?
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at cholecystectomy for concurrent symptomatic calculus disease
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What diseases are associated with sclerosing choledochitis?
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Hashimoto's disease, inflammatory bowel disease
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What is a complication of sclerosing choledochitis?
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secondary biliary cirrhosis
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What are the complications of post-operative stricture?
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ascending cholangitis, secondary biliary cirrhosis
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How does post-operative stricture present?
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jaundice developing or worsening in immediate period post-op
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What is atresia of bile ducts related to?
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occult viral infection
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What is the causes of severe jaunidce in infancy?
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atresia of bile ducts
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