Pretend you are a teacher preparing a quiz for the text I will provide. 
            Each quiz question should follow the format below. 
            Ensure that you carefully recheck the questions and answers for accuracy. 
            The output should be a ready-to-use list of dictionaries for the Python eval function:

            [

                    "question": "WRITE THE QUESTION HERE",
                    "options": ["A) OPTION_1", "B) OPTION_2", "C) OPTION_3", "D) OPTION_4"],
                    "answer": INDEX_OF_CORRECT_ANSWER_IN_OPTIONS_LIST,
                    "explanation": "EXPLAIN WHY THE ANSWER IS CORRECT"

            ]

            Text:
             tumors. 
Common primary sources: 
38 
 
• G I cancer: colorectal cancer (CRC) is the most common one, pancreatic, 
gastric cancer 
• Lung cancer, Breast and ovarian cancer, melanoma 
Grossly: Multiple well-demarcated nodules often in both lobes, central necrosis 
(“umbilicated” appearance) may be seen in larger metastasis 
Microscopically, Tumor resembles the primary cancer  
Clinical picture: asymptomatic, abdominal pain, jaundice, hepatomegaly, weight loss, 
anorexia. 
Serum tumor marker: of metastatic tumor; CEA for CRC, CA19-9 for pancreatic 
cancer... 
Imaging (CT-MRI, PET s) 
Biopsy: confirmatory and determine the origin of primary tumor. 
Lymphatic, vascular and perineural spread are both common ways to reach the liver. 
The prognosis depends on primary cancer and extend of liver involvement. 
 
Takeaway points 
▪ Benign Tumors: Hepatic hemangioma (most common), FNH (no malignant 
potential), hepatocellular adenoma (risk of hemorrhage/malignancy). 
 
▪ Malignant Tumors: HCC: Most common primary liver cancer, cirrhosis-
associated, elevated AFP. 
Cholangiocarcinoma: Second most common primary liver cancer, biliary 
obstruction, elevated CA19-9. 
Metastatic liver tumors: More common than primary, mostly from GI, lung, 
breast, pancreas. 
 
▪ The prognosis of liver cancer is poor, but early detection improves survival 
 
39 
 
 
Lecture 5: Choleastatic diseases 
Intended Learning Outcomes (ILOs) 
By the end of this lecture, you will be able to: 
• Recall the hepatobiliary structure and functions and describe the normal bilirubin 
metabolism. 
• Describe the pathogenesis, morphologic changes of cholestasis, and how the 
hepatic tissue alteration contributes to hepatic dysfunction and clinical 
manifestation. 
• Define jaundice, icterus, and hyperbilirubinemia, and discuss the pathophysiology 
of jaundice, and the clinical classification  
• Define biliary cirrhosis and the autoimmune cholangiopathy forms, and discuss 
their pathogenesis, morphologic changes, and clinical manifestation 
 
Outlines 
▪ Introduction 
▪ Cholestasis  
▪ Hyperbilirubinemias 
▪ Primary biliary cholangitis  
▪ Primary Sclerosing cholangitis  
 
 
 
 
 
 
40 
 
 
Introduction to Biliary Tree Structure and Functions 
The biliary tree is a network of ducts responsible for the production, storage, and 
transport of bile, a crucial digestive fluid. It plays a vital role in lipid digestion, waste 
excretion, and maintaining gut homeostasis. The biliary system consists of intrahepatic 
and extrahepatic bile ducts, the gallbladder, and the sphincter of Oddi. 
Structure of the Biliary Tree: 
1. Intrahepatic Bile Ducts: 
• Small bile canaliculi within hepatocytes drain into interlobular bile ducts. 
• These ducts merge into larger segmental ducts, eventually forming the right and left 
hepatic ducts. 
2. Extrahepatic Bile Ducts: 
• The right and left hepatic ducts unite to form the common hepatic duct. 
• The cystic duct connects the gallbladder to the common hepatic duct, form

            Quiz: