Malignancies of Liver, Pancreas and Gallbladder, Gallstones and Pancreatitis
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Questions and Answers

Which type of liver neoplasm is directly linked to anabolic steroids and the oral contraceptive pill?

  • Hepatocellular carcinoma
  • Hepatic adenoma (correct)
  • Cholangiocarcinoma
  • Bile duct adenoma

    • Which of the following statements about hepatocellular carcinoma (HCC) is correct?

  • It is considered the most common primary malignancy of the liver. (correct)
  • It is often presented as intrahepatic bile duct adenocarcinoma.
  • It is commonly benign.
  • It generally has a good prognosis when diagnosed early.

    • What is one common presenting symptom of extrahepatic bile duct obstruction?

  • Weight loss
  • Elevated heart rate
  • Hemorrhage
  • Jaundice (correct)

    • What is the significance of finding gallstones in the context of liver health?

    <p>They may obstruct bile flow and cause symptoms.</p> Signup and view all the answers

    Which tumor type is classified as a malignant neoplasm of the liver?

    <p>Intrahepatic cholangiocarcinoma</p> Signup and view all the answers

    Which of the following is NOT typically a primary source for liver metastases?

    <p>Pancreas</p> Signup and view all the answers

    What diagnostic tools are utilized to distinguish between non-neoplastic lesions and neoplasms in the liver?

    <p>Ultrasound and MRI</p> Signup and view all the answers

    Which of the following immunohistochemical markers would suggest a primary lung carcinoma if found in liver metastases?

    <p>TTF1</p> Signup and view all the answers

    What is a prominent feature of the prognosis for individuals with liver metastases?

    <p>Poor prognosis due to late-stage symptoms</p> Signup and view all the answers

    Which of the following is NOT considered a cause of acute pancreatitis?

    <p>Chronic liver disease</p> Signup and view all the answers

    What is the most common cause of acute pancreatitis?

    <p>Gallstones</p> Signup and view all the answers

    Which of the following symptoms is characteristic of ascending cholangitis?

    <p>Charcot's triad</p> Signup and view all the answers

    Which complication may arise from severe acute pancreatitis?

    <p>Pseudocyst formation</p> Signup and view all the answers

    Which imaging technique is often used to visualize dilated ducts in cases of extrahepatic bile duct obstruction?

    <p>Ultrasound</p> Signup and view all the answers

    What is typically the primary treatment approach for acute pancreatitis?

    <p>Supportive care and management of complications</p> Signup and view all the answers

    What is the characteristic feature of chronic pancreatitis on imaging?

    <p>Pancreatic calcifications</p> Signup and view all the answers

    What is the expected blood amylase level in acute pancreatitis?

    <p>Higher than 3X normal</p> Signup and view all the answers

    What is a possible consequence of untreated acute cholangitis?

    <p>Sepsis and multi-organ failure</p> Signup and view all the answers

    In chronic pancreatitis, which symptom is directly associated with malabsorption?

    <p>Steatorrhoea</p> Signup and view all the answers

    What is the primary goal of ERCP in managing bile duct obstruction?

    <p>Decompression and treatment</p> Signup and view all the answers

    What is the primary association of hepatocellular carcinoma in regions such as East and Southeast Asia?

    <p>Chronic hepatitis or cirrhosis</p> Signup and view all the answers

    Which imaging technique is preferred for the diagnosis and assessment of liver nodules greater than 1 cm in hepatocellular carcinoma?

    <p>MRI with a specific contrast protocol</p> Signup and view all the answers

    What is the typical prognosis for patients diagnosed with pancreatic carcinoma?

    <p>5-year survival rate is relatively low due to late presentation and vague symptoms</p> Signup and view all the answers

    What is a common clinical presentation for cholangiocarcinoma?

    <p>Painless obstructive jaundice</p> Signup and view all the answers

    What is the most characteristic histological feature of hepatocellular carcinoma?

    <p>Pleomorphic tumor cells resembling hepatocytes</p> Signup and view all the answers

    Which of the following is NOT a recognized risk factor for pancreatic carcinoma?

    <p>Excessive physical activity</p> Signup and view all the answers

    What is a key characteristic of cholangiocarcinoma diagnosis?

    <p>Diagnosis is challenging and often made late</p> Signup and view all the answers

    What defines the staging of hepatocellular carcinoma?

    <p>Stage, liver function impairment, and co-morbidity</p> Signup and view all the answers

    Which pancreatic tumors are known for their unpredictable behavior?

    <p>Pancreatic neuroendocrine tumors</p> Signup and view all the answers

    What treatment option is typically considered for early-stage hepatocellular carcinoma?

    <p>Resection</p> Signup and view all the answers

    Which of the following is NOT a feature of a non-neoplastic lesion?

    <p>It always requires surgical excision.</p> Signup and view all the answers

    What is the key differentiating factor between benign and malignant neoplasms? A) Rate of growth. B) Presence of necrosis. C) Metastatic potential. D) All of the above.

    <p>All of the above</p> Signup and view all the answers

    Which of the following is NOT a primary malignant neoplasm of epithelial origin?

    <p>Lymphoma</p> Signup and view all the answers

    Secondary malignancies are commonly a result of:

    <p>Metastasis from a distant primary tumor.</p> Signup and view all the answers

    A hemangioma is an example of which type of lesion?

    <p>Non-neoplastic</p> Signup and view all the answers

    Which imaging modality is the most commonly used to differentiate between a neoplastic and non-neoplastic lesion?

    <p>Ultrasound (US)</p> Signup and view all the answers

    A primary neoplasm that arises from mesenchymal tissue is referred to as: A) Carcinoma. B) Sarcoma. C) Lymphoma. D) Adenoma.

    <p>Sarcoma</p> Signup and view all the answers

    Which of the following is NOT a benign liver tumor?

    <p>Hepatocellular carcinoma</p> Signup and view all the answers

    Hepatic adenoma is commonly associated with which of the following risk factors? A) Chronic alcohol use. B) Hepatitis B infection. C) Oral contraceptive pill (OCP) use. D) Autoimmune hepatitis.

    <p>Oral contraceptive pill (OCP) use.</p> Signup and view all the answers

    The most common benign liver tumor is:

    <p>Haemangioma</p> Signup and view all the answers

    Which of the following liver tumors is considered malignant?

    <p>Hepatocellular carcinoma</p> Signup and view all the answers

    A rare malignant tumor of the liver, usually associated with occupational exposure to vinyl chloride, is: A) Hepatocellular carcinoma. B) Haemangiosarcoma. C) Intrahepatic cholangiocarcinoma. D) Hepatic adenoma.

    <p>Haemangiosarcoma</p> Signup and view all the answers

    Which of the following statements about Hepatocellular carcinoma (HCC) is true?

    <p>It is often asymptomatic until late stages.</p> Signup and view all the answers

    Intrahepatic cholangiocarcinoma arises from:

    <p>Bile duct epithelium.</p> Signup and view all the answers

    Which of the following tumors is associated with the use of anabolic steroids?

    <p>Hepatic adenoma</p> Signup and view all the answers

    The most common type of liver tumor in Europe and North America is: A) Hepatocellular carcinoma. B) Haemangioma. C) Liver metastasis. D) Intrahepatic cholangiocarcinoma.

    <p>Liver metastasis</p> Signup and view all the answers

    Liver metastases most commonly originate from which of the following primary sites?

    <p>Gastrointestinal (GI) tract</p> Signup and view all the answers

    Which of the following malignancies is least likely to cause liver metastasis? A) Lymphoma B) Leukaemia C) Brain tumor D) Breast cancer

    <p>Brain tumor</p> Signup and view all the answers

    In early-stage liver metastases, which lab finding is commonly elevated?

    <p>Alkaline phosphatase (Alk Phos)</p> Signup and view all the answers

    Obstruction of bile flow due to liver metastases initially presents with:

    <p>Few symptoms but elevated Alkaline Phosphatase (Alk Phos).</p> Signup and view all the answers

    What is a characteristic late-stage clinical finding in patients with liver metastases?

    <p>Rising bilirubin and jaundice.</p> Signup and view all the answers

    The primary treatment for isolated colorectal liver metastases is: A) Chemotherapy. B) Radiation therapy. C) Surgical resection. D) Immunotherapy.

    <p>Surgical resection</p> Signup and view all the answers

    The prognosis of liver metastases is generally:

    <p>Poor, especially with widespread metastases.</p> Signup and view all the answers

    Which of the following immunohistochemical markers is commonly used to identify large intestine (colorectal) metastasis in the liver?

    <p>CK20</p> Signup and view all the answers

    CDX2 is a marker primarily associated with which type of cancer metastasis to the liver? A) Melanoma. B) Lung carcinoma. C) Colorectal carcinoma. D) Breast carcinoma.

    <p>Colorectal carcinoma</p> Signup and view all the answers

    TTF1 is an immunohistochemical marker used to identify metastasis originating from which organ?

    <p>Lung</p> Signup and view all the answers

    Which of the following immunohistochemical markers would be most useful for diagnosing melanoma metastasis to the liver?

    <p>S100</p> Signup and view all the answers

    Melan A and HMB-45 are immunohistochemical markers specifically used to identify which type of cancer metastasis?

    <p>Melanoma.</p> Signup and view all the answers

    A liver biopsy shows positive staining for CK20 and CDX2. What is the most likely primary site of the metastatic tumor?

    <p>Large intestine (colorectal)</p> Signup and view all the answers

    A biopsy from a liver lesion shows positive immunohistochemical staining for TTF1. What is the likely source of the primary tumor?

    <p>Lung</p> Signup and view all the answers

    SOX10 is an important marker for diagnosing metastasis from which cancer type?

    <p>Melanoma</p> Signup and view all the answers

    HMB-45 is primarily used to identify which type of cancer? A) Colorectal cancer. B) Lung cancer. C) Melanoma. D) Liver cancer.

    <p>Melanoma</p> Signup and view all the answers

    What is the typical gross appearance of liver metastases?

    <p>Multiple pale deposits.</p> Signup and view all the answers

    Hepatocellular carcinoma (HCC) is most commonly associated with which of the following conditions?

    <p>Cirrhosis and chronic hepatitis</p> Signup and view all the answers

    In regions with high incidence of HCC (e.g., East and Southeast Asia), the tumor typically presents:

    <p>In young patients and may co-present with cirrhosis.</p> Signup and view all the answers

    In low-incidence areas (e.g., Europe and North America), hepatocellular carcinoma is typically diagnosed when:

    <p>There is decompensation of cirrhosis.</p> Signup and view all the answers

    Which of the following statements is true regarding hepatocellular carcinoma (HCC) in non-cirrhotic livers?

    <p>It can occur in fibrotic livers infected with HBV.</p> Signup and view all the answers

    What is the annual risk of developing HCC in patients with cirrhosis in low-incidence areas?

    <p>3%</p> Signup and view all the answers

    Vascular invasion is a common feature in which type of liver cancer?

    <p>Hepatocellular carcinoma (HCC).</p> Signup and view all the answers

    Hepatocellular carcinoma (HCC) can occur in:

    <p>Non-cirrhotic fibrotic livers infected with HBV.</p> Signup and view all the answers

    The typical presentation of hepatocellular carcinoma includes:

    <p>A single mass or multifocal lesions.</p> Signup and view all the answers

    In hepatocellular carcinoma, vascular invasion is:

    <p>Possible and indicates a more aggressive tumor.</p> Signup and view all the answers

    Compared to other tumor types, the frequency of metastases in hepatocellular carcinoma is:

    <p>Lower than in many other solid tumors.</p> Signup and view all the answers

    Which of the following is a common risk factor for developing hepatocellular carcinoma?

    <p>Chronic hepatitis B virus (HBV) infection.</p> Signup and view all the answers

    The primary imaging modalities used for diagnosing hepatocellular carcinoma include: A) X-ray and PET scan. B) Ultrasound, CT, and MRI with specific contrast-enhanced protocols. C) MRI alone. D) Only CT scan.

    <p>Ultrasound, CT, and MRI with specific contrast-enhanced protocols.</p> Signup and view all the answers

    In the assessment of liver nodules in patients with cirrhosis, a size greater than 1 cm is significant because:

    <p>Nodules larger than 1 cm are at increased risk for malignancy.</p> Signup and view all the answers

    Alpha-fetoprotein (AFP) is used in the diagnosis of hepatocellular carcinoma as:

    <p>A tumor marker that is often elevated in HCC.</p> Signup and view all the answers

    Biopsy for hepatocellular carcinoma is:

    <p>Rarely necessary due to the reliability of imaging and AFP.</p> Signup and view all the answers

    Screening for hepatocellular carcinoma is recommended every 6 months for:

    <p>High-risk patients with compensated cirrhosis.</p> Signup and view all the answers

    Which of the following is NOT a component of the screening process for hepatocellular carcinoma?

    <p>Routine liver biopsy</p> Signup and view all the answers

    The prevention of hepatocellular carcinoma can include:

    <p>Treatment of the underlying cause of chronic liver disease.</p> Signup and view all the answers

    Vaccination against hepatitis B virus (HBV) is important for:

    <p>Reducing the incidence of hepatocellular carcinoma.</p> Signup and view all the answers

    The first-line treatment for early-stage hepatocellular carcinoma is: A) Systemic chemotherapy. B) Resection (surgical removal of the tumor). C) Radiation therapy. D) Palliative care only.

    <p>Resection (surgical removal of the tumor).</p> Signup and view all the answers

    Orthotopic liver transplantation (OLT) is considered in hepatocellular carcinoma treatment for: A) Patients with advanced metastatic disease. B) Patients with very early-stage HCC and cirrhosis. C) All patients diagnosed with HCC. D) Patients who refuse surgery.

    <p>Patients with very early-stage HCC and cirrhosis.</p> Signup and view all the answers

    Local ablative treatments for hepatocellular carcinoma include:

    <p>Radiofrequency ablation and arterial chemoembolization.</p> Signup and view all the answers

    The prognosis of hepatocellular carcinoma depends on:

    <p>Stage, degree of liver function impairment, and co-morbidity.</p> Signup and view all the answers

    In selected cases of hepatocellular carcinoma, the 5-year survival rate can reach up to:

    <p>50%</p> Signup and view all the answers

    The most common etiology for hepatocellular carcinoma is: A) Alcoholic liver disease. B) Cirrhosis due to HBV and HCV infection. C) Non-alcoholic fatty liver disease (NAFLD). D) Autoimmune hepatitis.

    <p>Cirrhosis due to HBV and HCV infection.</p> Signup and view all the answers

    Chronic hepatitis B virus (HBV) infection is considered directly oncogenic because it:

    <p>Leads to cirrhosis and creates a microenvironment for cancer development.</p> Signup and view all the answers

    Aflatoxins, which are fungal contaminants of food stores, are associated with hepatocellular carcinoma due to their:

    <p>Ability to cause DNA damage and mutations.</p> Signup and view all the answers

    Arterial chemoembolization is primarily used in the treatment of:

    <p>Advanced hepatocellular carcinoma.</p> Signup and view all the answers

    The main goal of arterial chemoembolization in treating hepatocellular carcinoma is to:

    <p>Reduce the blood supply to the tumor and deliver chemotherapy directly.</p> Signup and view all the answers

    Among the following, which is considered a common cause of cirrhosis in adults?

    <p>Hemochromatosis (HFE)</p> Signup and view all the answers

    The gross appearance of hepatocellular carcinoma (HCC) typically presents as:

    <p>Multiple nodules with a variable appearance.</p> Signup and view all the answers

    Under microscopic examination, hepatocellular carcinoma (HCC) is characterized by:

    <p>Tumor cells that resemble hepatocytes but display pleomorphism and atypical nuclei.</p> Signup and view all the answers

    The pleomorphism observed in tumor cells of hepatocellular carcinoma indicates which of the following?

    <p>Variation in cell size, shape, and nuclear characteristics.</p> Signup and view all the answers

    Which of the following is NOT a characteristic feature of hepatocellular carcinoma on histological examination?

    <p>Presence of well-formed granulomas.</p> Signup and view all the answers

    The staining characteristics of HCC cells on histology typically include:

    <p>Positive staining for alpha-fetoprotein (AFP).</p> Signup and view all the answers

    Cholangiocarcinoma arises from which type of epithelial cells?

    <p>Bile duct epithelium</p> Signup and view all the answers

    What is the most common site for cholangiocarcinoma?

    <p>Hilum of the liver</p> Signup and view all the answers

    Which type of cholangiocarcinoma is specifically associated with the bifurcation of the common hepatic duct?

    <p>Klatskin tumor</p> Signup and view all the answers

    What percentage of primary liver malignancies is accounted for by intrahepatic cholangiocarcinoma?

    <p>10%</p> Signup and view all the answers

    Which condition is commonly associated with cholangiocarcinoma?

    <p>Primary sclerosing cholangitis (PSC)</p> Signup and view all the answers

    What is a rare cause of cholangiocarcinoma?

    <p>Chronic fluke infestation</p> Signup and view all the answers

    What is the typical outcome for patients diagnosed with cholangiocarcinoma?

    <p>Poor prognosis</p> Signup and view all the answers

    What is a common palliative treatment for cholangiocarcinoma?

    <p>Stent placement to relieve obstruction</p> Signup and view all the answers

    What percentage of the pancreas is composed of exocrine tissue?

    <p>98%</p> Signup and view all the answers

    The endocrine function of the pancreas is primarily associated with which structures?

    <p>Islets of Langerhans</p> Signup and view all the answers

    Which of the following best describes the location of the pancreas?

    <p>Retroperitoneal</p> Signup and view all the answers

    The exocrine pancreas is composed of what type of tissue?

    <p>Glandular acini grouped into lobules</p> Signup and view all the answers

    Where do the exocrine secretions of the pancreas ultimately drain into?

    <p>The pancreatic duct</p> Signup and view all the answers

    In pancreatic histology, what structure surrounds the small pancreatic duct?

    <p>Exocrine pancreatic glandular acini</p> Signup and view all the answers

    The islets of Langerhans in the pancreas are primarily responsible for what function?

    <p>Hormone secretion</p> Signup and view all the answers

    Which cells are found in the exocrine portion of the pancreas?

    <p>Glandular acini</p> Signup and view all the answers

    In pancreatic histology, the pale collection of cells is referred to as:

    <p>Islet of Langerhans</p> Signup and view all the answers

    What is the primary function of the exocrine pancreas?

    <p>Production of digestive enzymes</p> Signup and view all the answers

    Which of the following is the most common malignant tumor of the exocrine pancreas?

    <p>Pancreatic (ductal) adenocarcinoma</p> Signup and view all the answers

    Which of the following types of tumors is rare and originates from the endocrine pancreas?

    <p>Pancreatic neuroendocrine tumors</p> Signup and view all the answers

    Which of the following conditions is associated with pancreatic neuroendocrine tumors in MEN type 1 syndrome?

    <p>Parathyroid hyperplasia and pituitary adenomas</p> Signup and view all the answers

    Some less common pancreatic tumors may be cystic and have what kind of behavior?

    <p>May be benign or have intermediate behavior</p> Signup and view all the answers

    Pancreatic neuroendocrine tumors (pNETs) are associated with which of the following conditions?

    <p>Parathyroid hyperplasia and pituitary adenomas</p> Signup and view all the answers

    Pancreatic adenocarcinoma most commonly arises from which part of the pancreas?

    <p>Head</p> Signup and view all the answers

    What percentage of pancreatic carcinoma cases are metastatic at diagnosis?

    <p>50%</p> Signup and view all the answers

    Pancreatic carcinoma has the highest rate of spread to which organ?

    <p>Liver</p> Signup and view all the answers

    Which of the following is a common clinical feature of locally advanced pancreatic carcinoma?

    <p>Jaundice</p> Signup and view all the answers

    Pancreatic carcinoma most commonly spreads directly to which structure in locally advanced cases?

    <p>Duodenum</p> Signup and view all the answers

    Which of the following is a common presentation of pancreatic carcinoma located in the head of the pancreas?

    <p>Painless obstructive jaundice</p> Signup and view all the answers

    A patient with pancreatic carcinoma might experience which of the following symptoms, particularly in advanced disease?

    <p>Weight loss and anorexia</p> Signup and view all the answers

    Trousseau's sign, associated with pancreatic carcinoma, refers to:

    <p>Migratory thrombophlebitis</p> Signup and view all the answers

    Which serum marker is often used to monitor the response to treatment or relapse in pancreatic carcinoma?

    <p>CA 19-9</p> Signup and view all the answers

    Which diagnostic approach is commonly used to obtain tissue for cytology in suspected pancreatic carcinoma?

    <p>FNA cytology via endoscopic ultrasound (EUS)</p> Signup and view all the answers

    The CA 19-9 serum marker in pancreatic carcinoma is primarily used for:

    <p>Monitoring response to therapy and relapse</p> Signup and view all the answers

    Which imaging modality is commonly used first in the evaluation of suspected pancreatic carcinoma?

    <p>Ultrasound (US)</p> Signup and view all the answers

    In pancreatic carcinoma, what does vague abdominal pain that radiates to the back typically indicate?

    <p>A common presentation in advanced stages</p> Signup and view all the answers

    What is the 5-year survival rate for patients diagnosed with pancreatic adenocarcinoma?

    <p>&lt;3%</p> Signup and view all the answers

    What is a common presenting symptom of pancreatic carcinoma in the head of the pancreas?

    <p>Painless obstructive jaundice</p> Signup and view all the answers

    What is the primary treatment modality for a resectable pancreatic adenocarcinoma?

    <p>Pancreatico-duodenectomy (Whipple's procedure)</p> Signup and view all the answers

    What is a typical feature of pancreatic adenocarcinoma on microscopy?

    <p>Fibrosis (desmoplastic reaction)</p> Signup and view all the answers

    Which of the following is a palliative measure commonly used for advanced pancreatic cancer?

    <p>Pancreatic stenting</p> Signup and view all the answers

    What is the role of chemotherapy in the treatment of pancreatic adenocarcinoma?

    <p>Adjuvant therapy with modest benefit</p> Signup and view all the answers

    What is the primary goal of treatment in most patients with advanced pancreatic adenocarcinoma?

    <p>Palliation</p> Signup and view all the answers

    What is the primary function of the gallbladder?

    <p>Store and concentrate bile</p> Signup and view all the answers

    Which of the following is a primary component of bile?

    <p>Bilirubin</p> Signup and view all the answers

    What percentage of gallstones are predominantly cholesterol?

    <p>90%</p> Signup and view all the answers

    What term describes stones located in the gallbladder?

    <p>Cholelithiasis</p> Signup and view all the answers

    Cholecystitis is commonly associated with which of the following conditions?

    <p>Obstruction of the gallbladder</p> Signup and view all the answers

    Which demographic group is most likely to develop gallstones?

    <p>Elderly females</p> Signup and view all the answers

    Which of the following is a known dietary factor that increases the risk of gallstones?

    <p>High fat and low fiber diet</p> Signup and view all the answers

    Which of the following conditions is associated with an increased risk of bilirubin stones?

    <p>Crohn's ileitis</p> Signup and view all the answers

    Rapid weight loss can lead to gallstone formation due to: A) Increased bile salt production, B) Gallbladder hypomotility and stasis, C) Decreased estrogen levels, D) Increased dietary fiber

    <p>Gallbladder hypomotility and stasis</p> Signup and view all the answers

    Which of the following factors is NOT a risk factor for gallstone formation?

    <p>Low cholesterol diet</p> Signup and view all the answers

    Geographic and racial predispositions to gallstones are notably higher in:

    <p>Native Americans and Hispanics</p> Signup and view all the answers

    Hormonal factors, such as high doses of estrogen, may increase gallstone risk during which of the following periods?

    <p>Pregnancy and use of oral contraceptives</p> Signup and view all the answers

    Which of the following is a potential consequence of bile salt depletion?

    <p>Increased risk of pigment stones</p> Signup and view all the answers

    What is the primary mechanism believed to contribute to the formation of cholesterol gallstones?

    <p>Cholesterol supersaturation in bile</p> Signup and view all the answers

    What is the most common symptom of gallstones?

    <p>Biliary colic</p> Signup and view all the answers

    Biliary colic is characterized by which of the following features? A) Sharp pain lasting less than 30 minutes B) Steady RUQ or epigastric pain lasting >30 minutes and <4 hours C) Constant pain with fever and jaundice D) Intermittent sharp pain in the left lower quadrant

    <p>Steady RUQ or epigastric pain lasting &gt;30 minutes and &lt;4 hours</p> Signup and view all the answers

    Which complication is NOT directly associated with gallstones?

    <p>Gastric ulcer</p> Signup and view all the answers

    Acute cholecystitis is most commonly associated with which of the following?

    <p>Cystic duct obstruction by a gallstone</p> Signup and view all the answers

    Which is a rare complication of gallstones that can present with obstructive jaundice?

    <p>Mirizzi syndrome</p> Signup and view all the answers

    When is surgical treatment for gallstones typically NOT indicated?

    <p>In patients with asymptomatic gallstones</p> Signup and view all the answers

    Which of the following statements is true regarding the prognosis of gallstones?

    <p>Asymptomatic gallstones are more common and typically do not require treatment.</p> Signup and view all the answers

    Which of the following is a typical physical exam finding in acute cholecystitis?

    <p>Murphy's sign</p> Signup and view all the answers

    Which of the following is NOT typically associated with acute cholecystitis?

    <p>Jaundice</p> Signup and view all the answers

    Which of the following complications occurs in 10-20% of patients with acute cholecystitis?

    <p>Empyema</p> Signup and view all the answers

    Which antibiotic therapy is recommended in the management of acute cholecystitis?

    <p>Ceftriaxone and metronidazole</p> Signup and view all the answers

    Mirizzi syndrome, a rare complication of acute cholecystitis, is characterized by:

    <p>Obstructive jaundice</p> Signup and view all the answers

    In a patient with acute cholecystitis, which of the following would most likely be elevated in blood tests?

    <p>White blood cell count (WBC)</p> Signup and view all the answers

    Which of the following is the definitive treatment for acute cholecystitis?

    <p>Cholecystectomy</p> Signup and view all the answers

    Which of the following is a rare but potentially fatal complication of acute cholecystitis?

    <p>Pericholecystic abscess or biliary peritonitis</p> Signup and view all the answers

    A cholecysto-duodenal fistula can lead to which serious complication?

    <p>Gallstone ileus</p> Signup and view all the answers

    Ascending cholangitis, a complication of CBD obstruction, presents with which triad of symptoms?

    <p>Abdominal pain, fever, jaundice</p> Signup and view all the answers

    Which of the following complications can result from CBD obstruction and secondary infection?

    <p>Hepatic abscess</p> Signup and view all the answers

    What is the most likely cause of acute pancreatitis in the setting of CBD obstruction?

    <p>Gallstones migrating from the gallbladder to the CBD</p> Signup and view all the answers

    What is the treatment for ascending cholangitis caused by CBD obstruction?

    <p>Urgent biliary decompression (ERCP) and antibiotics</p> Signup and view all the answers

    What is the hallmark histopathological finding in chronic cholecystitis?

    <p>Thickened muscle, atrophied mucosa, and diverticula</p> Signup and view all the answers

    Chronic cholecystitis is most commonly associated with:

    <p>Gallstones</p> Signup and view all the answers

    Which of the following is true regarding the symptoms of chronic cholecystitis?

    <p>It may or may not have clear symptom correlation</p> Signup and view all the answers

    Diverticula found in the gallbladder during chronic cholecystitis are called:

    <p>Rokitansky-Aschoff sinuses</p> Signup and view all the answers

    Which of the following is not a characteristic feature of chronic cholecystitis?

    <p>Acute bacterial infection</p> Signup and view all the answers

    The development of chronic cholecystitis is primarily related to:

    <p>Gallstone formation and recurrent cystic duct obstruction</p> Signup and view all the answers

    Which of the following is the most common cause of extrahepatic bile duct obstruction?

    <p>Gallstones in the common bile duct</p> Signup and view all the answers

    Which of the following conditions can lead to external compression of the common bile duct, causing obstruction? A) Hepatic abscess B) Mirizzi syndrome C) Peptic ulcer disease D) Crohn’s disease

    <p>Mirizzi syndrome</p> Signup and view all the answers

    Which of the following tumors is a common cause of extrahepatic bile duct obstruction?

    <p>Adenocarcinoma of the pancreas</p> Signup and view all the answers

    Benign strictures causing extrahepatic bile duct obstruction may occur due to:

    <p>Post-operative complications or primary sclerosing cholangitis</p> Signup and view all the answers

    Primary tumors or metastases in lymph nodes can cause extrahepatic bile duct obstruction through: A) Direct invasion of the bile duct epithelium B) Compression of the common bile duct or common hepatic duct C) Formation of intrahepatic biliary cysts D) Ascending infection from the intestines

    <p>Compression of the common bile duct or common hepatic duct</p> Signup and view all the answers

    Which of the following is a complication of extrahepatic bile duct obstruction?

    <p>Obstructive jaundice</p> Signup and view all the answers

    What does Courvoisier’s law state in the context of extrahepatic bile duct obstruction?

    <p>The gallbladder is typically distended when the common bile duct is obstructed due to a tumor.</p> Signup and view all the answers

    Which imaging modality is first-line for identifying dilated ducts in suspected extrahepatic bile duct obstruction?

    <p>Ultrasound (US)</p> Signup and view all the answers

    For extrahepatic bile duct obstruction due to tumors, what is the most common treatment option?

    <p>Placement of a stent</p> Signup and view all the answers

    What is the primary goal of treatment for extrahepatic bile duct obstruction?

    <p>To relieve obstruction and prevent complications</p> Signup and view all the answers

    What is the most common cause of a hepatic abscess?

    <p>Ascending infection from biliary tract disease</p> Signup and view all the answers

    What is a potential source of seeding for a hepatic abscess?

    <p>Systemic sepsis</p> Signup and view all the answers

    What is the mainstay of treatment for a hepatic abscess?

    <p>Drainage and antibiotics</p> Signup and view all the answers

    What is a common pathway leading to the development of acute pancreatitis?

    <p>Accumulation of pancreatic enzymes within the pancreas</p> Signup and view all the answers

    Which type of hepatic abscess is specifically associated with Entamoeba histolytica?

    <p>Amoebic abscess</p> Signup and view all the answers

    What triggers the irreversible cascade of auto-digestion in acute pancreatitis?

    <p>Activation of pancreatic enzymes outside the pancreas</p> Signup and view all the answers

    What condition can acute pancreatitis potentially trigger if it becomes severe?

    <p>Systemic inflammatory response syndrome (SIRS)</p> Signup and view all the answers

    What is one of the effects of alcohol on the pancreas that can lead to acute pancreatitis?

    <p>Direct toxic effect on pancreatic cells</p> Signup and view all the answers

    What initiates the process of acute pancreatitis?

    <p>Activation of pancreatic enzymes within the pancreas</p> Signup and view all the answers

    Which of the following mechanisms contributes to the premature activation of pancreatic enzymes in acute pancreatitis?

    <p>Obstruction of the pancreatic duct</p> Signup and view all the answers

    What is the consequence of the premature activation of trypsinogen to trypsin in the pancreas?

    <p>Activation of other pancreatic enzymes</p> Signup and view all the answers

    In acute pancreatitis, which of the following can lead to the systemic inflammatory response syndrome (SIRS)?

    <p>Secretion of pro-inflammatory cytokines</p> Signup and view all the answers

    Which of the following conditions is most commonly associated with the development of acute pancreatitis?

    <p>Hyperlipidemia</p> Signup and view all the answers

    What effect does alcohol consumption have on the pancreas that may lead to acute pancreatitis?

    <p>It increases the viscosity of pancreatic secretions.</p> Signup and view all the answers

    How does biliary obstruction contribute to the pathogenesis of acute pancreatitis?

    <p>By causing reflux of bile into the pancreatic duct</p> Signup and view all the answers

    What is the primary consequence of the autodigestion of pancreatic tissue during acute pancreatitis?

    <p>Formation of pancreatic pseudocysts</p> Signup and view all the answers

    Which of the following is NOT a common mechanism of acute pancreatitis?

    <p>Chronic pancreatitis</p> Signup and view all the answers

    Which of the following inflammatory mediators is typically elevated in the setting of acute pancreatitis?

    <p>Both B and C</p> Signup and view all the answers

    Which enzyme is directly responsible for the activation of trypsinogen into trypsin during acute pancreatitis?

    <p>Cathepsin B</p> Signup and view all the answers

    Which of the following cellular processes plays a central role in the activation of pancreatic enzymes in pancreatitis?

    <p>Co-localization of zymogen granules and lysosomes</p> Signup and view all the answers

    What intracellular event is triggered by a sustained rise in intracellular calcium (Ca²⁺) in acinar cells during pancreatitis?

    <p>Activation of NF-κB</p> Signup and view all the answers

    What role does protein kinase C (PKC) play in the pathogenesis of acute pancreatitis?

    <p>It increases the activation of digestive enzymes.</p> Signup and view all the answers

    Which of the following occurs in the early stages of acute pancreatitis due to lysosomal and zymogen granule co-localization?

    <p>Activation of digestive enzymes</p> Signup and view all the answers

    In the mechanism of pancreatitis, what happens when active trypsin accumulates in the pancreas?

    <p>It leads to autodigestion of pancreatic tissue.</p> Signup and view all the answers

    In the later stages of acute pancreatitis, what happens to the co-localized organelles within acinar cells?

    <p>They become leaky, allowing enzyme activation.</p> Signup and view all the answers

    Which of the following is NOT involved in the pathogenesis of enzyme activation in acute pancreatitis?

    <p>Decreased intracellular calcium levels</p> Signup and view all the answers

    What percentage of cases of mild acute pancreatitis are reported?

    <p>80%</p> Signup and view all the answers

    Which of the following is true about mild acute pancreatitis?

    A) It involves necrosis of the pancreatic tissue. B) It is associated with a self-limiting course. C) It is commonly fatal. D) It typically requires surgical intervention.

    <p>It is associated with a self-limiting course.</p> Signup and view all the answers

    Which imaging finding is characteristic of mild acute pancreatitis?

    <p>Interstitial oedematous acute pancreatitis</p> Signup and view all the answers

    What percentage represents the correct answer?

    <p>20%</p> Signup and view all the answers

    Severe acute pancreatitis is characterized by which of the following?

    <p>Necrotizing inflammation of pancreas and peri-pancreatic fat</p> Signup and view all the answers

    Which of the following is most likely to be seen in severe acute pancreatitis?

    <p>Necrosis of pancreatic tissue and surrounding fat</p> Signup and view all the answers

    Which of the following is associated with severe acute pancreatitis? A) High blood pressure B) Hyperglycaemia C) Hypocalcaemia D) Both B and C

    <p>Both B and C</p> Signup and view all the answers

    In severe acute pancreatitis, what percentage of mortality occurs during the first week due to systemic inflammatory response syndrome (SIRS) and complications?

    <p>50%</p> Signup and view all the answers

    What is the most common cause of acute pancreatitis in both men and women?

    <p>Gallstones</p> Signup and view all the answers

    What complication is commonly associated with post-ERCP? (Select one)

    <p>Acute pancreatitis</p> Signup and view all the answers

    Which of the following blood tests is typically elevated more than three times the normal level in acute pancreatitis?

    <p>Blood amylase</p> Signup and view all the answers

    Chronic pancreatitis primarily leads to which of the following functional impairments?

    A) Increased insulin production B) Exocrine and endocrine dysfunction C) Hypersecretion of pancreatic enzymes D) Malignant transformation of pancreatic tissue

    <p>Exocrine and endocrine dysfunction</p> Signup and view all the answers

    Chronic pancreatitis primarily leads to which of the following functional impairments?

    <p>Exocrine and endocrine dysfunction</p> Signup and view all the answers

    What symptom is commonly associated with both acute and chronic pancreatitis?

    <p>Epigastric pain radiating to the back</p> Signup and view all the answers

    Which of the following is NOT a common complication of chronic pancreatitis?

    <p>Hypercalcaemia</p> Signup and view all the answers

    Which of the following diagnostic tools is most commonly used for imaging advanced chronic pancreatitis?

    <p>Imaging techniques like CT or MRI</p> Signup and view all the answers

    Which of the following best describes a pancreatic pseudocyst?

    <p>A collection of pancreatic fluid without an epithelial lining</p> Signup and view all the answers

    Pancreatic pseudocysts are most commonly associated with which of the following conditions?

    <p>All of the above</p> Signup and view all the answers

    Which of the following is a potential treatment for a pancreatic pseudocyst?

    <p>Endoscopic drainage or surgical drainage</p> Signup and view all the answers

    Which of the following is not a complication of pancreatic pseudocyst?

    <p>Hypertension</p> Signup and view all the answers

    Which of the following is not a complication of pancreatic pseudocyst?

    <p>Hypertension</p> Signup and view all the answers

    Study Notes

    Liver Tumours

    • Non-neoplastic lesions can mimic neoplasms, such as cysts, haemangiomas, regenerative tumour-like lesions, and abscesses.
    • Depending on the tissue type of origin, malignant tumours in the liver can include carcinomas, sarcomas, and lymphomas.
    • Primary liver tumours are classified as benign and malignant.
      • Benign tumours include:
        • Hepatic adenoma (associated with anabolic steroids and oral contraceptive pills)
        • Bile duct adenoma
        • Haemangioma
      • Malignant tumours include:
        • Hepatocellular carcinoma (HCC)
        • Intrahepatic cholangiocarcinoma
        • Haemangiosarcoma (rare)
    • Secondary liver tumours, or liver metastases, are the most common type of liver tumour in Europe and North America.
      • Sources of metastases include primary tumours in the gastrointestinal tract, lungs, and breasts.
      • Liver metastases can obstruct bile flow, leading to a rise in alkaline phosphatase levels and, in later stages, bilirubin accumulation and jaundice.
    • Immunohistochemistry is used for the histological diagnosis of liver metastases.
      • Markers used for identification:
        • CK20, CDX2 for large intestine
        • TTF1 for lung
        • S100, Melan A, HMB, SOX10 for melanoma

    Hepatocellular Carcinoma (HCC)

    • HCC is relatively uncommon in Europe and North America, but more common in East and Southeast Asia and Africa.
    • Associated with cirrhosis and chronic hepatitis (over 90% of cases).
    • Can occur in non-cirrhotic fibrotic HBV livers.
    • Presentation:
      • In high incidence areas: co-presents with or precedes cirrhosis, in relatively young patients.
      • In low incidence areas: decompensation of cirrhosis, with around 3% HCC/year, vague and changing symptoms.
    • Diagnosis:
      • Radiology: US, specific contrast-enhanced CT and MRI protocols
      • Assessment of nodules in cirrhosis: nodules larger than 1cm or those that are enlarging
      • Alpha-fetoprotein (AFP): used as a tumour marker
      • Biopsy: rarely necessary
    • Screening:
      • High-risk patients (compensated cirrhosis): every 6-12 months, including US and AFP blood tests.
      • AFP blood test alone: not specific or sensitive enough for accurate diagnosis.
    • Prevention:
      • Treatment of underlying chronic liver disease.
      • Prevention of chronic liver disease (HBV vaccination).
    • Treatment:
      • Resection: if detected early
      • Orthotopic liver transplantation (OLT)
      • Local ablative treatments: radiofrequency ablation, arterial chemo-embolization
    • Prognosis: depends on stage, degree of liver function impairment, and co-morbidity.
      • Typically poor, but in selected cases, 5-year survival can reach 50%.
    • Aetiology:
      • Cirrhosis (HBV, HCV, HFE more prevalent than other causes of cirrhosis).
      • Chronic HBV: directly oncogenic
      • Aflatoxins: fungal contaminants of food stores

    Cholangiocarcinoma

    • Adenocarcinoma arising from bile duct epithelium.
    • Classified as intrahepatic or extrahepatic.
    • **Commonest site: **hilum of the liver.
      • Klatskin tumour: obstructing bifurcation of the common hepatic duct (CHD).
    • Intrahepatic cholangiocarcinoma: constitutes a minority of primary liver malignancies (10%).
    • Associations:
      • Primary sclerosing cholangitis (PSC)
      • Rare: chronic fluke infestation, congenital biliary abnormalities.
    • Diagnosis: difficult and often late; outcome is poor.
    • Treatment: surgical resection in selected cases; typically palliative obstruction with stent placement.

    Pancreas

    • Retroperitoneal location.
    • Two distinct embryological components:
      • Exocrine (98%): produces digestive enzymes.
      • Endocrine (2%): islets of Langerhans, secreting hormones.
    • Exocrine part: composed of glandular acini grouped into lobules.
    • Exocrine secretions: drained via ducts, joining to form the pancreatic duct.

    Pancreatic Tumours

    • Exocrine pancreas:
      • Malignant: pancreatic (ductal) adenocarcinoma.
      • Other less common tumours: sometimes cystic, can be benign or have intermediate behaviour.
      • Precursors to pancreatic cancer: some recognized as precursors.
    • Endocrine:
      • Pancreatic neuroendocrine tumours: rare.
      • Behaviour: difficult to predict.
      • Classification: by hormone type produced.
      • Hormone: may cause clinical symptoms.
      • Association with MEN type 1 syndrome: associated with parathyroid hyperplasia and pituitary adenomas.

    Pancreatic Carcinoma

    • Adenocarcinoma arising from pancreatic ducts.
    • Common: 5th/6th most common cause of cancer deaths.
    • Malignant: more common in men (M>F), predominantly in individuals over 60 years old.
    • Location: 60-70% originate from the head of the pancreas, the rest from the body and tail.
    • Spread:
      • Direct local: peritoneum (vessels, nerves), duodenum, CBD = 'locally advanced'.
      • Lymph nodes or liver: approximately 50% have metastases at diagnosis.
    • Risk factors:
      • Smoking, diabetes mellitus, chronic pancreatitis: relatively weak.
      • Family history: 5%, considered a stronger risk factor..
    • Symptoms: typically only become apparent with advanced disease.
      • Anorexia, weight loss.
      • Painless obstructive jaundice: tumours in the head of the pancreas.
      • Vague abdominal pain: may radiate to the back.
      • Rare: palpable mass, thrombotic tendency.
        • Migratory thrombophlebitis: Trousseau’s sign.
    • Diagnosis:
      • CA 19-9: serum marker for pancreatico-biliary cancer.
        • Not useful for diagnosis: primarily used for monitoring response and detecting relapse.
      • Imaging: US, CT, EUS
      • Fine-needle aspiration cytology (FNA): via EUS
      • Avoid unnecessary invasive investigation in the majority of cases.
    • Prognosis:
      • 5-year survival: lower in men and the older age group.
      • Late presentation, vague symptoms contribute to poor prognosis.
      • Clinical problem: gall bladder "polyps" often identified on US.
        • Question: could they be neoplasms of the gall bladder (adenomas or carcinomas)?
        • Small/non-progressive polyps: likely harmless non-neoplastic cholesterol "polyps".

    Causes of Extrahepatic Bile Duct Obstruction

    • Gallstones in the common bile duct.
    • Tumour:
      • Adenocarcinoma of the pancreas.
      • Extra-hepatic bile duct adenocarcinoma.
    • Benign stricture: post-operative or caused by primary sclerosing cholangitis (PSC).
    • Mass outside CBD/CHD compressing duct:
      • Mirizzi syndrome: external compression from a stone in the neck/cystic duct of the gallbladder.
      • Primary tumour or metastases in lymph nodes.

    Extrahepatic Bile Duct Obstruction

    • Courvoisier's law: historical interest only, referring to an enlarged, non-tender gallbladder.
    • Investigation:
      • US: shows dilated ducts proximal to the obstruction.
      • Cause: may require further investigation using MRCP or EUS.
      • ERCP: may be used for diagnosis and treatment.
    • Treatment aims to decompress the bile duct and address the underlying cause:
      • Stones:
        • ERCP with sphincterotomy and stone removal.
        • Common bile duct exploration: laparoscopic or open surgery.
      • Stricture: stent placement.
      • Tumour: stent placement, usually via ERCP.

    Ascending (Acute) Cholangitis

    • Infection in static, obstructed bile.
    • Charcot's triad: high fever, pain, and jaundice.
    • Reynolds' pentad: Charcot's triad plus hypotension and altered mental state.
    • Requires urgent decompression.

    Hepatic Abscess

    • Biliary tract disease with ascending infection: most common cause.
    • Seeding from systemic sepsis: may occur in some cases.
    • Historically: spread via the portal vein from intra-abdominal sepsis.
    • Treatment: drainage and antibiotics.
    • Amoebic abscess: a distinct cause.

    Acute Pancreatitis

    • Acute inflammation of the pancreas.
    • Incidence: 10-20/million, mortality rate of approximately 5% (higher in severe cases), can occur as single or recurrent attacks.
    • Pathogenesis:
      • Premature activation of pancreatic enzymes within the pancreas.
      • Irreversible cascade of auto-digestion once initiated.
      • Systemic inflammatory response syndrome (SIRS) if severe.
    • Causes:
      • Obstructing stone at the lower end of the common bile duct: causing reflux of bile and concentration of pancreatic juices.
      • Alcohol: direct toxic effect.
    • Mechanism: premature activation of pancreatic enzymes leads to auto-digestion.

    Severity of Acute Pancreatitis

    • Mild Acute Pancreatitis (80% of cases):*
      • Self-limiting disease.
      • Interstitial oedematous acute pancreatitis on imaging, non-necrotizing.
    • Severe Acute Pancreatitis (20% of cases):*
      • Necrotizing inflammation of the pancreas and surrounding tissue (peripancreatic fat).

    Effects of Severe Acute Pancreatitis

    • Systemic inflammatory response syndrome (SIRS): hypovolemia, hypotension, acute respiratory distress syndrome (ARDS), acute renal failure, disseminated intravascular coagulation (DIC).
    • Hypocalcemia, hyperglycemia, ileus.
    • Local complications:
      • Extensive necrosis (acute necrotic collection), risk of secondary infection.
      • Later: pseudocyst, fistula formation.
    • Mortality:
      • First week: 50% due to SIRS and complications.
      • Second week: 50% due to necrosis and sepsis.

    ###Causes of Acute Pancreatitis

     - **Gallstones** (50% of cases, both men and women).
 - **Alcohol** (a very common cause).
 - **Post-ERCP** (5%).
 - **Idiopathic** (10%), biliary microlithiasis.
- **Uncommon causes (5%):**
    - **Trauma, ischemia, major surgery.**
    - **Drugs, viral infections.**
    - **Hypercalcemia, hyperlipidemia.**
    - **Hereditary pancreatitis.**

    Diagnosis of Acute Pancreatitis

     - **Symptoms**: epigastric pain that may radiate into the back, "acute abdomen" often seen by surgeons.
 - **Severe cases**: differential diagnosis - myocardial infarction (MI), ruptured abdominal aortic aneurysm (AAA), perforated or ischemic abdominal organ.
 - **Blood tests**:
     - **Amylase**: elevated to more than 3 times normal.
     - **Amylase**: short half-life.
     - **Lipase**: might be used in the future, if amylase inconclusive, consider radiology.
 - **Aim:** identify the cause and avoid immediate laparotomy.

    Chronic Pancreatitis

    • Patchy, irreversible fibrosis with ongoing inflammation.
    • Impaired pancreatic function: exocrine function more severely affected than endocrine.
    • Distortion of ductal system: strictures, dilation, cysts behind strictures, pancreatic ductal stones.
    • Causes:
      • Alcohol: a major cause.
      • Idiopathic: unknown origin.
      • Childhood causes: including cystic fibrosis.
      • Cystic fibrosis: more typically associated with pancreatic insufficiency due to damage but without clinical “chronic pancreatitis.”

    Chronic Pancreatitis

    • Symptoms:
      • Dull pain: epigastric, radiating to the back.
      • Weight loss.
      • Steatorrhoea and malabsorption.
      • Secondary diabetes mellitus.
    • Treatment: analgesia (opioids), enzyme supplements.
    • Diagnosis:
      • Difficult: often a diagnosis of exclusion.
      • Amylase: not useful.
      • Tests of pancreatic function: not routine.
      • Imaging: used in advanced disease.

    Pancreatic Pseudocyst

    - **Collection of pancreatic fluid** in disrupted tissue within or adjacent to the pancreas.
- **Defined wall** but not a true cyst (lacks epithelial lining).
- **Causes:** acute or chronic pancreatitis, pancreatic surgery, or trauma.
- **Complications:** pain/pressure, infection, erosion with fistula or blood vessel damage.
- **Treatment:** aspiration or drainage by endoscopy or surgery.

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    This quiz explores the classification and types of liver tumours, including benign and malignant variations. Understand the characteristics of primary liver tumours, as well as the implications of secondary liver tumours and their origins. Test your knowledge on non-neoplastic lesions that may mimic tumours and their clinical significance.

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