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+--- Thread: A 58-year-old man with chronic liver disease prese - doublecheeseburger (/showthread.php?tid=223652)
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A 58-year-old man with chronic liver disease prese - doublecheeseburger - ArchivalUser - 09-25-2007
A 58-year-old man with chronic liver disease presents with recent onset of ascites and rapid weight loss. Examination reveals a palpable tender liver mass. Paracentesis reveals hemorrhagic ascitic fluid. CT scan of the liver shows a large intrahepatic multifocal tumor. Percutaneous fine needle aspiration is positive for hepatocellular carcinoma. The patient deteriorates rapidly and dies 3 months following presentation. Which of the following is the most important predisposing condition to this cancer in the U.S.?
A. Aflatoxin exposure
B. Anabolic steroids
C. Cirrhosis
D. Hemochromatosis
E. Oral contraceptives
F. Tyrosinemia
0 - ArchivalUser - 09-25-2007
a??
0 - ArchivalUser - 09-25-2007
nop, you have to remove spaces ...first
0 - ArchivalUser - 09-25-2007
try again..
0 - ArchivalUser - 09-25-2007
no idea..guessing b/d
0 - ArchivalUser - 09-25-2007
Cirrhosis?
0 - ArchivalUser - 09-25-2007
sorry i forget to remove spacesssssss....
0 - ArchivalUser - 09-25-2007
i also thought the answer is A, but answer is given different:
The correct answer is C.
Most cases of hepatocellular carcinoma in the U.S. are associated with cirrhosis, regardless of the underlying cause. Alcohol-related cirrhosis, as well as cirrhosis developing in the context of chronic viral hepatitis (either B or C), is the most common predisposing condition. Development of liver cancer is thus often masked by the underlying disease. However, this cancer should be suspected when a patient with cirrhosis exhibits rapid deterioration and hemorrhagic ascites.
Aflatoxin exposure (choice A) is a major cause of hepatocellular carcinoma in some regions of Africa and China. Aflatoxins are produced by fungi (Aspergillus flavus) that may contaminate food. These toxins are metabolized by the liver into mutagenic intermediates that act by direct interaction with the DNA. The p53 tumor suppressor gene is particularly susceptible to such mutagenic action.
Anabolic steroids (choice B) and oral contraceptives (choice E) are associated with an increased risk of developing liver adenoma and peliosis hepatis. The former is a benign hepatocellular neoplasm, whereas the latter is a vascular lesion consisting of dilated vascular channels. Both are usually clinically silent, but liver adenoma may occasionally manifest with catastrophic intraperitoneal hemorrhage. Hemochromatosis (choice D) is associated with a greatly increased risk of hepatocellular carcinoma (up to 20% of affected individuals).
Tyrosinemia (choice F) is a rare genetic metabolic disorder associated with increased risk of neonatal hepatitis and hepatocellular carcinoma. Up to 35% of patients with this inborn error of metabolism will eventually develop hepatocellular carcinoma.
0 - ArchivalUser - 09-25-2007
cirrhosis would have a shrunken liver mohammed..isn`t it??
0 - ArchivalUser - 09-25-2007
Most cases of hepatocellular carcinoma in the U.S. are associated with cirrhosis, regardless of the underlying cause.