question

Benign Tumors

answer

Hemangioma Hepatic Cysts Hepatocellular Adenoma Focal nodular Hyperplasia Hepatobiliary Cystadenoma

question

Malignant Tumors

answer

Metastatic carcinoma Hepatocellular Carcinoma Cholangiocarcinoma Fibrolamellar Carcinoma Angiosarcoma, Lymphoma

question

Benign Tumors car arise from

answer

any cell in the liver

question

Cells that are common to forming tumors

answer

hepatocytes biliary tract blood vessels

question

Sonographical appearance

answer

cystic or solid appearance hemorrhage or fibrosis internal calcifications or capsule well-circumscribed blood-filled faint acoustic enhancement echogenicity can be variable

question

Your patient has a positive Murphy's Sign and an elevated WBC count. Which of these signs would you least likely see using ultrasound? a. air in the biliary tree from Empyema/Necrosis b. shadowing stones c. solid mass/lesion d. free fluid from a GB rupture

answer

air in the biliary tree from Empyema/Necrosis

question

Your patient has hemolytic anemia. Which of these tests is least likely to be abnormal? a. RBC b. Hep C c. Total Bilirubin d. Alkaline Phosphatase

answer

Hep C

question

Your patient presents with Charcot's Triad. Which of the following tests is least likely to be elevated? a. cholesterol b. total bilirubin c. alkaline phosphatase d. hematocrit

answer

Hematocrit

question

Of these laboratory tests, which result is the most suggestive of HCC in a patient with cirrhosis? a. positive hepatitis C b. elevated ALT, AST and ALP c. low platelets d. elevated alpha-fetoprotein

answer

elevated alpha-fetoprotein

question

You have just identified gallstones in your patient, who is 30 weeks pregnant. Each of these test will be elevated except: a. alpha-fetoprotein b. alkaline phosphatase c. alanine transaminase d. conjugated bilirubin

answer

Alkanine Transaminase

question

What test can confirm the presence of Hepatocellular Carcinoma? a. unconjugated bilirubin b. AST, ALP, and ALT c. alpha-fetoprotein d. biopsy

answer

biopsy

question

Each of these primary causes of cirrhosis, except: a. PSC b. ALT c. ETOH d. Hepatitis C

answer

ALT

question

Your patient complains of sleeplessness caused by pain and hot flashes. Mostly she hates how waxy her skin has become. Her skin is indeed yellowish, and it's not just the crappy lighting in the hospital. What test has the patient's team ordered that will confirm this finding? a. total bilirubin b. prothrombin time c. alpha-fetoprotein d. aspartate transaminase

answer

total biilirubin

question

Blood urea nitrogen is excreted by the liver so it can then be eliminated from the body by kidneys. If the liver can't convert the toxin urea into ammonia, what condition can a patient develop?

answer

hepatic encephalitis

question

Portal hypertension leads to varices in the abdominal wall and gastrointestinal system. What elevated clotting factor would lead to thrombus (blood clot) obstructing the Portal Vein?

answer

platelets

question

Clinical trials of alpha-interferon have shown some positive results eliminating this severe viral form of Hepatitis from the body, but no vaccine exists.

answer

HCV

question

You will be vaccinated for this viral form of Hepatitis several months before your first clinical rotation.

answer

HBV

question

This viral form of Hepatitis is transmitted by the fecal/oral route.

answer

HAV

question

Your patient has cirrhosis and is in clinic for a liver biopsy. Because of the depleted function of his liver, he has low levels of clotting factors. Which enzyme will be tested to make sure your patient is not at risk of bleeding out during the procedure?

answer

prothrombin

question

You have just discovered your patient has cholecystitis. You prove this by demonstrating the thickened gallbladder wall, free fluid in the gallbladder fossa, and a 7mm stone jammed into the neck of the gallbladder like a cork in a wine bottle. In addition to elevated conjugated bilirubin and white blood cells, she will also have elevated ____.

answer

alkaline phosphatase

question

In severe hepatocellular destruction the aspartate aminotransferase and alanine aminotransferase levels are ____.

answer

high

question

The live converts ___ into ___.

answer

RBCs, bilirubin

question

Elevation of serum (blood) bilirubin results in ____.

answer

jaundice

question

The most common benign tumor of the liver?

answer

hemangioma

question

Hemangiomas are more common in men or women?

answer

women

question

Hemangiomas are typically symptomatic or asymptomatic?

answer

asymptomatic

question

As a result of compression of adjacent structures, ruptures, hemorrhage or thrombosis it is possible for hemangiomas to present with symptoms such as:

answer

abdominal pain, nausea, vomiting

question

In hemangiomas malignant change does or does not occur?

answer

does not

question

Hemangiomas are usually _____cm. If they are greater than ___-___cm they are referred to as "Giant Hemangiomas"

answer

6-10cm

question

It is important to distinguish ______ from other potentially more serious lesions.

answer

simple cysts

question

The prevalence of simple hepatic cysts increases with ____.

answer

age

question

Multiple hepatic cysts also occur in association with adult ____ ____ disease.

answer

adult polycystic kidney disease

question

A history of use of oral contraceptive for over 5 years is present in cases of this benign tumor?

answer

Hepatocellular Adenoma (HCA)

question

A small minority of HCA cases involve men and women using _____.

answer

anabolic steroids

question

This benign tumor has a potential for spontaneous rupture and bleeding that can lead to hemperitoneum and shock.

answer

Hepatocellular Adenoma

question

Most common physical finding for HCA is

answer

enlarged liver or palpable mass young or middle-aged woman

question

HCA's arise on a non-______ liver.

answer

non-cirrhotic liver

question

HCA's occur predominantly in the ____ lobe and are often quite large >___cm

answer

right 10cm

question

The absence of a _______ differentiates HCA from FNH.

answer

central scar

question

The high ____ content of the hepatocytes within HCA results in a hyperechoic mass.

answer

lipid

question

What is the preferred treatment of HCA?

answer

surgery

question

This benign tumor is small and are characterized by a central stellate (star-shaped) scar with radiating septae and with areas of nodularity in between fibrous bands.

answer

Focal Nodular Hyperplasia (FNH)

question

This may be a hyperplastic response of the hepatic tissue to an abnormality of a large blood vessel in the location of the lesion.

answer

FNH

question

Hormonal effects of pregnancy and oral contraceptives cause an increase in the size of this benign tumor but does not initiate it. Name that tumor.

answer

Focal Nodular Hyperplasia

question

What is the second most common benign liver tumor after hemangioma?

answer

FNH

question

FNH is seen mostly in _____ during the ___ and ___ decades of life.

answer

women 3rd and 5th

question

Focal Nodular Hyperplasia is less than ___cm.

answer

5cm

question

Sonographically FNH appear:

answer

sharply circumscribed lack true capsule globular/lobulated central scar homogeneous hyperechoic or isoechoic

question

In a _____ tumor all the components of normal liver are present, but in an abnormally organized manner.

answer

FNH

question

Once FNH is discovered it is important to consider other lesions such as the rare _____ variant of hepatocellular carcinoma.

answer

fibrolamellar

question

This lesion occurs almost exclusively in middle-aged women and has an appearance of a cyst that is lined by mucus-secreting epithelium.

answer

Hepatobiliary cystadenoma

question

Hepatobiliary cystadenoma most commonly presents with ____.

answer

abdominal discomfort

question

Sonographically hepatobiliary cystadenoma demonstrates:

answer

cystic lesion thick walls septations

question

Hepatobiliary cystadenomas can be as large as ___cm.

answer

25cm

question

Hepatobiliary cystadenomas have the potential to undergo malignant change to adenocarcinoma. T/F

answer

true

question

The most common malignant tumor in the liver is _______.

answer

metastatic

question

The incidence of metastatic carcinoma is ___ times greater than that of primary hepatic carcinoma.

answer

20

question

The liver is the ___ most common site of metastases behind the _____.

answer

2nd lymph nodes

question

Virtually all types of cancers except those primary to the ____ can metastasize to the liver.

answer

brain

question

The most common cancers to metastasize to the liver are those from the _____, _____, _____, and _____.

answer

gastrointestinal tract lung breast melanomas

question

The less common cancers to metastasize to the liver are tumors of the _____, _____, and _____.

answer

prostate, skin thyroid

question

Patients with widespread metastatic liver involvement usually have suggestive signs of ____ and _______.

answer

cancer hepatic enlargement

question

These three factors are responsible for the liver being the 2nd most common site of metastases.

answer

high rate of blood flow size double perfusion by the hepatic artery and portal vein

question

Hepatocellular carcinoma accounts for approximately ____% of primary liver tumors.

answer

80%

question

Cholangiocarcinoma accounts for approximately ___-___% of primary liver tumors.

answer

10-20%

question

What is HCC?

answer

Hepatocellular Carcinoma

question

What is the most common primary malignant tumor?

answer

Hepatocellular Carcinoma

question

In the United States and Europe the incidence of HCC is ___-___ per ______ people. The incidence seen in Asia and Africa may be ___x greater.

answer

3-7 per 100,000 50x

question

In high incidence areas HCC is diagnosed in the ___ and ___ decades of life. In the low incidence areas HCC is diagnosed in the ___ and ___ decades of life.

answer

3rd and 4th 7th and 8th

question

In high incidence areas HCC occurs more frequently in ____.

answer

men

question

Though not as common in the United States ____ is actually one of the most common carcinomas in the world.

answer

HCC

question

HCC is predominantly associated with ____ and _____ with HepB or HepC.

answer

cirrhosis chronic infection

question

Any patient with chronic liver disease is at increased risk for developing ____.

answer

HCC

question

In Africa and southern China, aflatoxin B1 (fungal toxin) may lead to ____.

answer

HCC

question

Aflatoxin is a fungal toxin from a fungal organism that grows on improperly stored ____, ____, and ____.

answer

corn grain peanuts

question

In the United States only ___% of patients with cirrhosis develop HCC. However, ____-related cirrhosis patients in the US with has a ___%-___% chance of developing HCC

answer

5% alcohol-related 40%-50%

question

HCC will most commonly present as _____.

answer

solitary tumor

question

HCC has a better prognosis when____.

answer

it is encapsulated because it does not invade the portal vein and is more readily resectable

question

With HCC, ___ ___ ___ occurs in 44% of cases and ____ and ___ ___ invasion occurs in 4% of cases.

answer

portal vein thrombosis IVC and hepatic vein

question

Elevated ___ levels are found in about 70%-80% of patients with HCC.

answer

alpha-fetoprotein (AFP)

question

The presence and persistence of high levels of serum AFP without evidence of a GI tumor strongly suggests ___.

answer

HCC

question

If HCC is untreated most patients will die within ___ to ___ months of diagnosis.

answer

3 to 6 months

question

Common sites for distant metastases for patients with HCC are ___, ___, ___, and ____.

answer

lung brain bone adrenal gland

question

_____ accounts for 10%-20% of primary malignant liver tumors.

answer

cholangiocarcinoma

question

Cholangiocarcinoma is an _____ that arises from the ___ ____ducts.

answer

adenocarcinoma intrahepatic bile ducts

question

Cholangiocarcinoma typically presents in adults in their ___ to ___, and is usually quite large and advanced prior to detection.

answer

50's to 60's

question

_____ is not associated with cirrhosis or chronic hepatitis.

answer

Cholangiocarcinoma

question

Cholangiocarcinoma can be present as a ____, ____, or ____.

answer

singular nodule multiple nodules diffusely-infiltrative manner

question

This rare neoplasm of hepatocellular origin and is distinct from HCC.

answer

Fibrolamellar carcinoma (FLC)

question

FLC only accounts for ___% of all hepatocellular malignancies.

answer

2%

question

This malignant tumor is seen in younger patients, ___ to ___ years of age, mean age of ___.

answer

5 to 35 23

question

Why does FLC have a more favorable prognosis than HCC?

answer

because FLC is often resectable for potential cure

question

The 5 year survival rate is ___% for FLC

answer

60%

question

Serum ___ is not elevated with FLC.

answer

AFP

question

FLC usually presents with:

answer

large mass 4-17cm lobulated central fibrous scar (may be calcified) satellite nodules may be present

question

FLC is usually much larger than this other tumor with a central scar?

answer

FNH

question

This rare malignant hepatic tumor arises from endothelial cells lining blood vessels.

answer

Angiosarcoma

question

For every 30 HCCs diagnoses there is ___ angiosarcoma.

answer

1

question

Grossly, angiosarcoma is an _____ lesion or a ____ micronodular lesion.

answer

unencapsulated multinodular diffusely infiltrative

question

This is a disease of lymphocytes (WBCs).

answer

lymphoma

question

Lymphoma occurs more commonly in middle aged ____.

answer

men

question

Large solitary mass with central fibrosis or necrosis, multiple smaller nodular lesions or hepatomegaly without discrete lesion. What is it?

answer

Lymphoma

question

Organ transplant recipients or AIDS patients are at increased risk for ______.

answer

Lymphoma

question

The ____ is a pear-shaped sac located under the right lobe of the liver, lateral to the quadrate lobe.

answer

gallbladder

question

In adults, gallbladders measure up to ___ cm long and __ to __ cm wide and a volume of about ___ ml.

answer

10cm 3 to 4cm 50ml

question

The gallbladder consists of three parts:

answer

neck body fundu

question

The gallbladder neck connects to the ____.

answer

cystic duct

question

The biliary tract itself has four structural and functional components:

answer

1. hepatic canaliculus 2. the ductal system from the liver to the duodenum 3. the gallbladder 4. the sphincter of Oddi

question

___ ___ are secreted by the liver then stored in the gallbladder for variable periods of time during the interdigestive period before they enter the duodenum.

answer

Bile salts

question

Absorption is passive in jejunum and colon but active in the ____ ____.

answer

terminal ileum

question

Bile salts are synthesized from ____, this is done only in the liver.

answer

cholesterol

question

____ rate of synthesis is determined by the availability of cholesterol and more importantly, by the returning ___ ___ pool.

answer

Bile salts bile salt

question

Only about ___% of bile salts are lost from the intestine to the feces with each circuit.

answer

5%

question

Approximately ___-___ million people in the United States have gallstones. About ___ million new cases of cholelithiasis develop each year.

answer

16-20 million 1 million

question

At least ___% of women and ___% of men over 40 years old have gallstones.

answer

20% 8%

question

There are three types of stones: ____, ____, and ____.

answer

cholesterol mixed pigment

question

____ and ____ account for 80% of stones while ____ accounts for 20% of stones.

answer

cholesterol and mixed pigment

question

Cholesterol is water _____.

answer

insoluble

question

Cholesterol is solubilized by ____.

answer

bile salts

question

Conditions that increase the conditions of ____, increase the formation of stones while conditions that decrease the concentration of ____ also lead to formation of stones.

answer

cholesterol bile salts

question

____, ____, or ____ can affect cholesterol synthesis. ____ can increase biliary sludge, which is a thick mucous material that predisposes to gallstone formation.

answer

obesity high-caloric diets drugs Pregnancy

question

____ stones are more common in Asian countries than western usually due to increased amounts of ___ ___ ___ in the bile.

answer

Pigment unconjugated insoluble bilirubin

question

Any condition that results in hemolysis will flood the blood with ____. Over time this will result in _____ stone formation.

answer

bilirubin pigment

question

____ stones are far more common in the United States.

answer

Cholesterol

question

Predisposing factors for cholesterol and mixed stones are ____, ____, ____, ____, and ____.

answer

demographics (N. Europe, both Americas) obesity weight loss female sex hormone increasing age

question

A helpful pneumonic to remember the risk factors for cholesterol stone formation is the Four F's:

answer

Fat Fertile Forty Female

question

Patients classically develop ___ ___ pain in the ___, which can radiate to the ___ ___. Regardless of the type of gallstone on has.

answer

sharp episodic pain RUQ right shoulder

question

Approximately ___% of patients with acute cholecystitis will need surgical removal of the gallbladder.

answer

25%

question

If a patient has acute cholecystitis the gallbladder becomes filled with ___ and the clinical situation reflects with ___, ___, and elevated ____

answer

pus fever chills WBC

question

African Americans are at high risk for ____ since they have a greater incidence of sickle cell disease.

answer

pigment stones

question

Caucasian women are at higher risk for _____ because high estrogen levels decrease ____ concentrations and because people of N. European descent have genetically higher levels of ______.

answer

cholesterol stones bile salt cholesterol

question

An inflamed gallbladder is tender to palpation, especially during inspiration. This is called?

answer

Murphy's Sign

question

What is empyema?

answer

pus accumulation

question

Complications of Acute Cholecystitis:

answer

necrosis/gangrene perforation/rupture infection abcess (due to WBS creating pus inside gallbladder) peritonitis shock fistula formation choledocholithiasis

question

The most frequently encountered common duct disease are those that result from a gallstone entering the common duct and becoming impacted at the ____.

answer

Sphincter of Oddi

question

If the Sphincter of Oddi is obstructed then there can be a back-pressure to the ____ resulting in ____.

answer

pancreas pancreatitis

question

Gallstones can affect the CBD, a condition called?

answer

choledocholithiasis

question

The most common complication of choledocholithiasis are secondary ___ and ___.

answer

secondary infection pancreatitis

question

Triad of clinical symptoms for cholangitis:

answer

Charcot's Triad: biliary colic jaundice spiking fevers with chills

question

Most pancreatic carcinomas occur where?

answer

in the head of the pancreas

question

The CBD can also be obstructed by ____ or ____.

answer

pancreatic carcinoma massive lymph node enlargement

question

Three clinical stages of cholelithiasis:

answer

asymptomatic, symptomatic and complicated

question

Asymptomatic cholelithiasis is very common and of those ____-____% remain asymptomatic.

answer

75%-80%

question

The preferred management of asymptomatic cholelithiasis is ____.

answer

watchful waiting

question

The gold standard treatment for symptomatic cholelithiasis is _____.

answer

laparoscopic cholecystectomy

question

A chronic progressive cholestatic liver disease characterized by progressive inflammatory destruction of the extrahepatic biliary tree, leading eventually to bile duct fibrosis and cirrhosis is called ____.

answer

Primary Sclerosing Cholangitis

question

Due to its strong association with inflammatory bowel disease, the contention is that there is an underlying immunological disturbance that may be the cause of ____.

answer

PSC

question

About ____ of PSC patients are ____. The median age at diagnosis is ___ to ___ years old.

answer

2/3 36 to 39

question

PSC is strongly correlated with two types of inflammatory bowel disease: _____ and _____.

answer

ulcerative colitis Crohn's disease

question

Diagnosis of PSC is usually made by ____.

answer

cholangiography

question

The classical picture of a beading appearance of the bile ducts, together with several strictures of different length and decreased branching is ____.

answer

PSC

question

As PSC progresses fibrosis increases and the ducts are converted to nodular scars called ___.

answer

tombstones

question

Symptoms of PSC include:

answer

fatigue pruritus (itching) intermittent RUQ pain bouts of cholangitis with transient jaundice

question

Terminal liver failure from PSC can be averted only by ________.

answer

liver transplant

question

Bacterial infection, suppurative cholangitis, is also a well know complication of ___.

answer

PSC

question

____ may occur in up to 10% of patients with PSC. After diagnosis, the overall median survival is reported to be only 5 months.

answer

Cholangiocarcinoma

question

Tumors of the extrahepatic biliary tree down to the level of the ampulla of Vater is called ____.

answer

Carcinoma of Extrahepatic Bile Ducts

question

____ presents as jaundice due to obstruction, preceded by decolorization of the stools, nausea and vomiting, and weight loss.

answer

Carcinoma of Extrahepatic Bile Ducts

question

Mean survival times are ___ to ___ months, regardless if aggressive resection or palliation is performed for Carcinoma of Extrahepatic Bile Duct.

answer

6 to 18 months

question

______ is the fifth most common cancer of the GI tract and occurs more often in ___ and in the ___ decade.

answer

Carcinoma of the Gallbladder women 7th decade

question

In Carcinoma of the Gallbladder gallstones are present in ___% - ___%.

answer

60-90%

question

Risks for gallbladder cancer include: ___, ___, ___, ___, ___, ___, ___, and ___.

answer

gallstones choledochal cysts anomalous duct junction carcinogens estrogens typhoid carriers porcelain bladder gallbladder polys

question

Common sites for seeding are: ___, ___, and ___.

answer

peritoneum gastrointestinal tract lungs

question

Carcinoma of the gallbladder presents with symptoms typically associated with _____.

answer

Cholelithiasis abdominal pain jaundice anorexia nausea and vomiting

question

Why are the following gallstones formed: -cholesterol -mixed -pigment

answer

cholesterol- increased uptake of cholesterol (at least 80%) and decreased bile salts mixed- must contain at least 20-80% cholesterol, calcium, bilirubin, bile pigments pigment- increased amounts of unconjugated insoluble bilirubin in bile, leading to precipitation of bilirubin

question

Definition of cholangitis, how its diagnosed and treated?

answer

Cholangitis is the inflammation of the Common Bile Duct. Most often caused by bacterial infection from a blockage in the duct. Endoscopic retrograde cholangiopancreatography (ERCP) used to diagnose, and may need a stent. Antibiotic is given for the infection.

Pathophysiology – Liver Tumors & Gallbladder – Flashcards

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