BOF: 42 (2.25)
A 55-year-old male who is known to have cirrhosis of the
liver as a consequence of hereditary haemochromatosis presents with a rapid
development of weight loss, anorexia, fever, ache in the right hypochondrium
and ascites. On examination of the abdomen an enlarged, tender liver with an
irregular edge is palpable.
Ultrasound scanning of the liver shows filling defects
but serum alpha-foetoprotein is not raised. In this patient;
a)
Hepatocellular carcinoma is unlikely as the alpha-foetoprotein levels
are not raised
b)
Ultrasound guided liver biopsy should be used to confirm the diagnosis
of hepatocellular carcinoma
c)
Ascitic fluid cytology is likely to confirm the diagnosis of
hepatocellular carcinoma
d)
Alpha-foetoprotein levels may be normal in patients with hepatocellular
carcinoma
e)
Radio-isotope scanning should be used to confirm the diagnosis of
hepatocellular carcinoma
Answer:
d)
The rapid development of weight loss, anorexia, fever and
ache in the right hypochondrium and ascites in a patient with cirrhosis should
make one suspect that the patient has hepatocellular carcinoma.
Serum alpha-foetoprotein may be raised but could be
normal in at least a third of patients.
Ultrasound scans show filling defects in 90% of patients.
Liver biopsy in not used as there is a risk of seeding and imaging techniques
show characteristic appearances.
